While most birth control methods put the onus on women, comprehensive education about contraception would open up a healthier dialogue for all genders.
The pill is perhaps the best-known hormonal contraceptive, but it is not the only birth control method available to women. Monik Markus/Flickr (CC BY 2.0)
Modern birth control can be credited largely to the work of the Malthusian League and other contraception advocates in the late 1800s and early 1900s. Through their advocacy, they promoted education and broke down the taboos surrounding sex and birth control. Early clinics in the British Empire aimed to “emancipate women from their slavery to the reproductive function”. In addition to empowering women with knowledge about birth control and normalising the idea of contraception, these groups also promoted and distributed condoms and diaphragms, which were readily available and inexpensive during this period.
Since this pioneering work championing women’s right to control their own fertility, many additional contraception options have become accessible. Today a variety of both hormonal and non-hormonal fertility control options are available to women. While the condom and vasectomy are currently the only contraception options for men, a novel non-hormonal gel injection, Vasalgel, is now being developed. This is a long-lasting and reversible method, which works by inducing sperm to undergo the acrosome reaction, dissolving the head of the sperm within the testes. This process usually occurs at the egg membrane, allowing the contents of the sperm to fertilise the egg. Inducing this reaction in the testes by Vasagel renders the sperm ineffective. This novel method of male contraception will hopefully soon be a viable male contraception option worldwide.
Non-hormonal contraception options for women include copper intrauterine devices (IUDs), female condoms, caps and diaphragms. While female condoms, caps and diaphragms act as physical barriers to prevent sperm from entering the womb, the copper IUD changes the uterine lining, preventing fertilised eggs from implanting into the womb.
Natural family planning is another option that uses a woman’s understanding of her own menstrual cycle. A range of methods can be used to indicate when a woman is most fertile, including monitoring the stickiness of discharge produced by the cervix, monitoring cyclic temperature changes and estimating when ovulation is occurring. Apps such as Natural Cycles and Lady-Comp as well as thermometers are available to help women gauge when they are non-fertile, therefore enabling them to have unprotected sex. Natural family planning methods increase in effectiveness over time as a woman becomes more in tune with her cycle and indications of fertility. Depending on how often a woman is having sex, how old she is and how well she is monitoring her cyclic changes will determine the effectiveness of natural family planning, which can be up to 99% effective.
When the pill became widely available, it gave women unprecedented reproductive autonomy. Raychel Mendez/Flickr (CC BY-NC-ND 2.0)
Hormonal contraceptives are either a combination of synthetic estrogen and progesterone, or progesterone alone, that can be taken orally (the pill), injected or directly absorbed into the bloodstream via a slow-release implant in the arm. Additionally, a hormone-releasing IUD is available, which slowly releases synthetic progestogen once implanted into the womb. These contraceptive options work by preventing ovulation, the release of eggs from the ovary. They also thicken the mucus of the cervix, making it harder for sperm to enter the womb. Some hormonal contraception options also change the uterine environment so that a fertilised egg cannot implant in the uterine wall.
The implant, injection and hormonal IUD contraception options have 99% efficacy, while the pill is 92% effective. As with any medication, hormonal contraceptives can have side effects. Sore breasts and irregularities in bleeding patterns are common, while some women experience headaches, mood changes, vaginal dryness, weight gain, loss of interest in sex, and acne. Some hormonal contraceptives also increase the risk of cardiovascular disease for women who are over 35 years old, are overweight or smoke. Both the implant and IUD have risks of infection upon administration, and occasionally IUDs can cause pelvic inflammatory infection. Most women begin taking contraception in their late teenage or early adult years, when the side effects of hormonal contraceptive options have the potential to affect puberty and other important developmental changes. These effects can be managed by changing contraception to a more suitable alternative.
Cost is an important consideration when deciding between contraception options. Family Planning Victoria quotes the out-of-pocket cost (after Medicare rebate) of the copper and hormonal IUD insertion cost to be $205 and $95 (plus $40 dispensing cost), respectively, while the hormonal implant is a cheaper option at $25 (plus $40 dispensing cost). The pill costs $10 to $30 per month. While the cost of contraception is widely considered affordable in Australia and in many other countries, including more-affordable New Zealand, this is a very subjective matter. Greater subsidisation for women who require it could make contraception, and thus the right to fertility control, more accessible for everyone.
The balance of freedom, responsibility and burden of birth control is hard to strike. Women in Australia today are incredibly lucky to have access to a variety of safe and effective birth control options. This is a liberty we often take for granted. Our sisters from previous generations did not have these options, and neither do those currently living in countries where contraception is difficult to access. Having the autonomy to make informed contraception decisions and the resources to implement them has given women sexual freedom separate from reproduction.
In consultation with their physicians, women are now able to find the birth control option that best suits them. ILO in Asia and the Pacific/Flickr (CC BY-NC-ND 2.0)
However, the burden on women still remains, given the many side effects of contraception and the responsibility of maintaining continuous contraception (booking and attending medical appointments, filling prescriptions, taking the pill daily, taking temperature and analysing fertility patterns in natural family planning, having the injection at regular intervals). Additionally, the cost of contraception often falls on women given the lack of male contraceptive options and there remains a small risk of pregnancy with all contraceptive options. Unfortunately, the compromises women make in order to obtain fertility control are not fully appreciated by both men and women, and the topic remains taboo for many.
To lessen the weight of the numerous responsibilities contraception imposes on women, the dialogue surrounding fertility control needs to be increased. Currently, the Australian Curriculum, Assessment and Reporting Authority (ACARA) covers ‘practices that support reproductive and sexual health’, which includes contraception. However, decisions about teaching this content are made by the relevant educational jurisdiction (government, Catholic and independent sectors), schools and individual teachers. Comprehensive education about contraception should be delivered to both young boys and girls across all schools and states, so that everyone can make informed decisions. This would enable a more open conversation, in which women are supported in choosing the contraceptive option that best suits their needs, improving their wellbeing in the process.
