PATRIARCHY, MEDICINE & THE FEMALE BODY: THE FEMALE CONTRACEPTIVE PILL

Content Warning: Discusses mental health related concerns as side effects of taking the contraceptive pill.

Disclaimer: The contraceptive pill and the inequalities of medical research apply to a range of gender identities. However, the majority of medical research into this field exists on the experiences of cis-women. This is another feminist issue that needs to be explored to enable an understanding of how medical inequalities are impacting trans men and non-binary identities however, this article is written from the current existing research in the field.

When I was 16, I was very unaware of anything to do with sex. I didn’t know how exactly a baby was made or how contraception worked, let alone the side effects of contraception or even the process of coming off contraception later in life. I became sexually active, and my main focusses were being able to sleep over at my boyfriend’s house and not getting pregnant. This was when I spoke to my mum, and her advice was to go on the pill and only then was I allowed to stay the night at my boyfriends. Little me was so concentrated on the sleepover aspect of the deal that I went straight to the doctors and started taking the first pill that they recommended to me within 24 hours of the chat with my mum.

Oh how much I regret that decision now…

Looking back I am quick to judge myself for being so naïve but really the problem stems from lack of awareness, lack of education and the minimal discussion of the side effects of hormonal contraception like the pill for reasons to do with stigma, lack of medical understanding of women’s bodies and patriarchal ideologies that put the full load of pressure onto women to prevent pregnancies.

Many other women have felt the same in their contraception journey, so I set myself a research goal to understand why women are having such bad experiences on contraception and how the wider problem of gender inequalities in medical research impacts this.

Inequality, patriarchy and misogyny in the medical sector:

The Gender Health Gap is real and its encouraging a divide between information on male and female bodies in medical research resulting in general medical and contraceptive struggles amongst women. A report conducted by the Women and Equalities Committee in 2022 recovered proof of a great lack of understanding amongst primary healthcare practitioners regarding women’s reproductive health concerns, specifically amongst young girls. Female bodies and hormones are much more complicated than men’s especially in adolescence and stages of puberty which differs greatly depending on the young woman. Even NHS articles address how ‘there's not enough evidence to say whether these are caused by the progestogen-only pill’ when referring to specific side effects of the contraception. However, this should argue as to why more research needs to be done into female anatomy and hormones, but patriarchal values overruled, and male research was seen as the ‘norm’.

This ‘norm’ began in 1977 when women were recommended to be excluded from drug trials in the Food and Drug Administration policy as a result of certain drugs causing limb deformities in pregnancies. However, this meant that there was a lack of data on women which initiated protests as part of the women’s movement to encourage long-term research on how external, social factors impacted women’s health. By 1986 the new National Institute of Health (NIH) policy encouraged inclusion of women in medical research however, there remains a prevalent imbalance in today’s society. 

Systematic research into the gender medical gap was completed by the Journal of Women’s Health Reports in 2022 which revealed that women wait longer for treatment or diagnosis and are more likely to be discharged when experiencing serious medical events than men. We also see misogynistic differences in the types of topics researchers are exploring such as the relation between medical concerns and female attractiveness. A ‘disgusting’ example of this- as quoted by The Guardian- would be the National Library of Medicine study on the Attractiveness of women with rectovaginal endometriosis. This focus on unnecessary and misogynistic aspects of research rather than what really matters is evident from the ‘60% of women in the UK who believe their health issues are not taken seriously.

Trust issues with medical professionals at contraceptive appointments:

It is evident how women are feeling as though their health issues aren’t being taken seriously in terms of the dissatisfaction of women at contraceptive GP appointments. Women are losing trust in medical practitioners more and more as they are turned away or misunderstood by GPs and other medical staff- specifically in relation to contraception.

A Women’s Health survey in 2022 revealed that 84% of the 100,000 female participants admitted to experiencing feeling unheard by medical professionals.

As a result, informal feminised health networks- or in other words- friends, family members and other social circles have become the most common method for women to discuss contraceptive choices. Research about these informal feminised health networks undergone in 2022 revealed that many women felt dissatisfied by contraceptive appointments, they didn’t feel respected for their autonomy and came out of appointments still unsure in their contraceptive decision-making leading them to seek guidance and reassurance from experiences of other women close to them. The worst part is that 50% of women in the UK experience ‘serious trouble’ after starting the pill as their chosen contraceptive method yet we are feeling unheard and unable to receive medical answers.

One of the biggest side effects of the pill is changes in mood with nearly half of pill users- in a research survey of 188 people- 43.6% experiencing this and 48.3% discontinuing the pill due to side effects in general. 83% of participants in a survey said that their healthcare practitioner never mentioned the psychological side effects of contraception during contraception counselling which reveals the extent of the communication issue with professionals. Even for women turning to online research about the pill they will only ever read the phrase ‘mood swings’ on NHS platforms when referring to psychological side effects.

This communication issue has been evident in my contraception journey with my first pill- Desogestrel. After 3 months, I stopped taking it and switched to Noriday after struggling with overwhelming emotions and sadness. It wasn’t until a friend mentioned that it could be the relation between me taking the pill and the sudden change in my emotional state. Like many other women, prior to the pill I wasn’t warned about this side effect resulting in me reaching out to the GP much later than I would have done if I’d known about psychological side effects in the first place.

The patriarchal influence on the burden of family planning and contraception:

Whilst focussing on the negative areas in need of improvement regarding the pill and more medical communication and research- it is important to note how the pill has been revolutionary for the second wave feminist movement. It has paved the way for sexual liberation, choice and power in sexual relationships for women. However, men and women are far from equal when it comes to contraception and women are still carrying a larger burden when it comes to family planning and pregnancy.

Professor Andrea M. Bertotti’s research revealed that women assess the impacts of contraception to their lives a lot more than men do. We have to assess the side effects of the pills we could take varying from headaches, to blood clots and all the way to the possibility of being at higher risk of cancer. We must assess how different pills fit in with our lives: when will I take my 7 day break on the combined pill if I’m going on holiday or have a date with a potential new sexual partner?

One of the most significant factors that reveal the patriarchal system reflected in contraception is that men have access to a non-permanent, easily accessible, non-hormonal contraceptive method- the condom. However, in a systematic review of the barriers to condom use- results found that condom fit and feel including ‘tightness, irritation and sensitivity’ are significant barriers to condom use. In comparison, the folded sheet inside an oral contraceptive box can unfold until it hits the floor with a long list of side effects and health risks of the pill including breakthrough bleeding, nausea, headaches, abdominal cramping, breast tenderness, increased vaginal discharge, decreased libido, risk of strokes, blood clots, heart attacks and cancer.

The remaining notable aspect of this divide is the fact that condoms are 98% effective when used correctly but only 82% effective when broken or not used correctly. In a study of 260 undergraduate male identifying students- 11% broke condoms using sharp instruments to open packages, 19% didn’t realise the fault of storing theirs in their wallet, 83% failed to change their condom when switching to a different form of intercourse and 28% had experienced condoms slipping off or had broken during sex. From this data alone, it is quite clear how untrustworthy and difficult it is to use a condom correctly whereas, a pill taken on time each day is 99% effective making it the more obvious choice for contraception in heterosexual sexual relationships.

With 25% of women ages 15-44 amongst the 68.8% of women taking some form of oral contraception in the UK, we can clearly see how women feel the need to take more responsibility in the contraceptive process than men since they have been given more contraceptive options with higher success rates than male alternatives- until the creation of male contraceptives that we are yet to see. It is important to note how women can see this as empowering as they are in control of pregnancy and family planning in their lives. Other positives include the 77% drop in teen pregnancy as a result of contraceptive use. However, the unfairness of the burden over women’s heads rather than equally on both men and women and the significantly larger impact that contraception has on women over men raises this as a feminist issue yet to be resolved.

With the solution to this being the creation of a male contraceptive pill- there are concerns around whether men will take a pill or whether the burden of family planning will still be on women. There are also prevalent debates and hesitancy around women trusting men to take oral contraceptives but evidence in research by the Journal of Human Reproduction found that 70% of their American participants (both male and female) felt as though men should be more involved in the contraceptive process- yet, we remain without a male pill but rely on nearly 70% of women in the UK to take contraception that has many health and hormonal implications.

Feminist Campaigns to close the medical gender gap and improve contraception:

The unfairness of medical research, the feeling of being unheard by medical professionals, the weight of the burden of contraception and the failure to create a male contraceptive pill alternative is causing outrage amongst feminists.

Last year the Fawcett Society started running an activist campaign- The Gender Health Gap: Our Stories. The campaign aims to give a platform to women’s voices and experiences in the medical sector to encourage better medical treatment for women and to protest sexism and misogyny in the sector.Alongside providing this vocal platform, the campaign is researching methods to improve the medical system for women and ‘encourage the Government to step up to the challenge’ to close the Gender Health Gap.

The British Pregnancy Advisory Service (BPAS) are campaigning to ‘take action for contraceptive innovation’. In order to do this, they are petitioning for the government to fund more contraceptive research into the creation of a male alternative and other contraceptive solutions as a result of dissatisfaction in women due to the pill and its many side effects.

It is clear that the influence of the patriarchal system and misogyny are prevalent in the medical sector and- in terms of the contraceptive pill specifically- women are unaware of its effects and feel unheard by medical practitioners. Men, as usual, have had a head start in their own medical research leaving women set back and with many questions. We need to continue the fight for understanding, being heard and understood by our GPs and if the burden of contraception is to be so strongly encouraged as predominantly a women’s issue, then women need help in the decision-making process, and we need to have a full understanding of what we are committing to. Continue sharing your voice and experiences to the Fawcett society and donate to the BPAS to encourage the campaign for contraceptive medical equality.

Our medical concerns and contraceptive decisions need to be taken seriously.

#contraceptivepill #medicalequality

CHARLOTTE BEATTIE

MEDIA COMMUNICATIONS UNDERGRADUATE STUDENT

Charlotte is a BA Media Communications student from Bath Spa University with a passion for feminist activism, sex & body positivity and journalism. In her spare time, she loves baking, listening to music and going on long walks around the Somerset area.