« 100% desired births: a dream? »

This is the slogan of a poster made for the 20th anniversary of the Belgian law decriminalizing abortion(1). Starting from a good intention, the choice of women should serve the individual development of the whole society, starting with their own, this sentence is very revealing of the issues surrounding the fertile period of women’s lives, from puberty to the end of menstruation. 

We find in it the idea of zero risk, the will to control, the tension between freedom and constraints, the individual and collective responsibility towards birth control… but also towards women’s bodies. And 35 years of flawless mastery is a long time! 

From puberty, the question of risks prevails over the question of intimacy, sexual encounter, pleasure… Thus, as Michel Bozon notes(2)The first visit to a gynecologist is a rite of entry into sexuality. In some cases, this first time precedes the « first time » in the sense of the first sexual relation with penetration, the one that, in our minds, generates the most risks: transmission of STI, especially AIDS, and unwanted pregnancies. This first medical visit, intended to prescribe a hormonal contraceptive method, fortunately does not necessarily include an examination, is also a sort of rite of acceptance by the mother of her daughter’s entry into so-called adult sexuality. For this is often a mother-daughter relationship, a new form of transmission where the mother uses an expert third party and takes a back seat. 

While this is sometimes a modest pretext intended to reassure girls that they are not sexually active, in some cases the use of hormonal contraception is also really diverted from its primary role of preventing unwanted pregnancies. It can be prescribed to teenagers to induce menstruation, if it has not yet started by the age of 17. Its use to regulate hormonal cycles is already a matter of controlling the body’s mechanics, although it is normal for these cycles to take a few years to set up: it is in fact between the ages of 25 and 40 that menstrual cycles find their cruising rhythm, which differs from one woman to another. Some doctors also choose the pill to fight hirsutism or acne… 

Boys’ bodies are not subject to such control, even before talking about fertility. 

Young girls must learn to play with moral and social codes, as for their body, to show it off, without doing too much, to seduce while being respected, to hide their moods in all senses of the word, from menstruation to anger, passing by the cervical mucus of which they generally know neither the name nor the utility And already, they are learning to take charge of their fertility on their own: their freedom to experiment, to discover their sexuality, requires a prescription that they must obtain, sometimes without their parents’ knowledge, and then find the means to pay the bill. 

The liberalization of hormonal contraception has certainly had a positive effect in that it has allowed women to have greater access to contraceptives that take away the fear of unwanted pregnancy: this is no small thing. But the question of the relationship between men and women has shifted: the reproductive responsibility still lies with women and if, according to studies conducted in France(3)While women have gained in terms of sexual fulfillment, some emphasize the male sexual demand, which is all the more pressing since women’s sexual availability has increased! A certain idea of male desire, a sign of virility, transformed into an imperious need, would remain the barometer of heterosexual relations. 

In terms of sexual education, if it has been able to find a small place in schools since the 1970s, society does not offer boys or girls an equal choice when it comes to taking charge of their fertility. While human reproduction is taught in biology, information about how cycles work, learning to observe body changes, understanding the factors involved in these changes and potential fertilization remain unclear, even opaque to many. And, again, boys are less encouraged to take an interest… except by a handful of family planning center facilitators, as part of Sexual and Emotional Life Education in high school classes(4).

Do we see the glass as half empty or half full? Indeed, the pioneers of the fight for access to contraception find young women ungrateful when they criticize hormonal contraception. Let’s say that the achievements allow us to point out more finely the inequalities that persist. For those who question the medical profession, it is not a question of taking a stand against the pill, but rather of questioning the current hierarchy and categorization of alternatives, including non-hormonal alternatives. Many health professionals agree that the best contraception is the one that the woman chooses. But in reality, what are the stakes of this choice? 

To illustrate some of them, we propose to comment on four demands made by a group of young women gathered in the Namur branch of Vie Féminine. Their campaign, « Contraception: a pill that goes wrong » was launched on a day of action on May 5, 2012 with the aim of challenging politicians, health professionals and citizens. 

« Freely choose a contraceptive without having to worry about the price. » 

There are contraceptive methods that cost little or nothing, but are not well known, or even depreciated (so-called natural methods). There are others that are not reimbursed (often the most recent ones) or not available on the market (barrier methods apart from condoms). Between the two, there is the pill, which is relatively well covered by social security thanks to the lobbying of family planning federations, which are fighting against the conception of contraception as a comfort drug. However, without social security coverage, there is no reimbursement. Too bad for the most precarious women. As soon as we pass the barrier of adolescence, that is, the period of compulsory schooling and the beginning of higher education, society’s concern about unwanted pregnancies decreases, so the measures stop, while the risk statistically increases. A woman between 20 and 30 years of age is more likely to experience an unwanted pregnancy, given the greater instability of this period of life, both socioeconomically and emotionally. 

« To benefit from contraception without suffering its harmful effects on our health 

Choosing also means being able to choose a non-hormonal contraception. This one is back in fashion with the mini media scandals around the 4th generation hormonal contraceptives. However, one normative injunction should not be imposed in place of or in opposition to another. But women should also have the choice according to their state of health, their life cycle, their convictions, their rhythm of life, their daily constraints, the reality of their sexual life without prejudging their (in)competences or their good or bad reasons for asking or refusing such or such method. How many professionals feel that they have the responsibility — as society expects them to do — to ensure that a woman who seeks their services is « covered » from the risk of an unplanned pregnancy, sometimes to the detriment of taking into account the side effects. These cannot be minimized. We will not go back over the cardiovascular problems that require a history and a possible health check-up before the prescription. We think more modestly about the decrease of libido, very little heard and heard as an argument to look for a real alternative in view of the scale of value that we have. Sexual health is also about wellness and having power over your choices and your life, not just about managing risks. Isn’t it up to the women to weigh up, with the information provided in the most objective and complete way possible, and with the collaboration of doctors for example, what is most important for them? 

Safety is also declared as one of the conditions of medical definition and prescription of a contraceptive, and it is also the basis of medicine: the first principle of Hippocrates invites to first do no harm. What a lesson in humility! 

« Feeling concerned about contraception as a couple and sharing responsibility for it » 

We mentioned above the continuity of the assignment of women to the management of reproduction, despite the turn that the vision of sexuality took 50 years ago, namely the official, socially accepted separation between procreation and sexuality. The context is not very favorable to men’s involvement: few male contraceptive methods are available, there is little motivation and a lot of resistance in research, little information, little awareness-raising… as a result, men’s initiatives are marginal. As if only women were fertile! 

« Receive concrete and complete information regarding the different possible contraceptive methods, talk about sexual education openly » 

We have already discussed the issue of information above. We note that information is conditioned by the dominant discourses of society, which are relayed by the media, the Internet, the medical profession, friends and family. What speeches? Those forged by our cultural conception of what should be the woman, the couple, the family, the maternity, the health, without forgetting the economic interests of a particularly lucrative market since the public is easily retained as long as the alternatives are not widely diffused. If there is no information widely disseminated and supported by the public authorities on the sympto-thermal method, for example, it is because it does not correspond to the current model which combines performance, efficiency, flexibility, self-control, speed, even acceleration. It is not profitable at any level: observing oneself costs nothing, except time. And empowerment and self-empowerment do not mix well with the market economy. The method had to be the subject of scientific research that proved its effectiveness, a method model that was padlocked to be secure and in the Cartesian image of our globalizing Western world. It was necessary that some citizens start to question so loudly that we hear them, surfing on the essentialist wave that resurfaces in reaction to the dominant way of life, or swimming against the tide towards the most possible autonomy. And now doctors are starting to take a renewed interest in so-called natural methods(5) !

Thus, women’s life cycles are channeled, marked out to meet the norm, or to be as close to it as possible, and to fit into the categories forged by society: puberty, young active woman, young mother, mother of a family, mature woman. Each one has its own contraception, just like on the glossy paper of the pharmaceutical companies’ advertisements. What if it’s not that easy to pigeonhole us? 

Lara Lalman

Animator and project manager at CEFA asbl 

Notes et références
  1. Loi Lallemand-Michielsen du 3 avril 1990.
  2. Michel Bozon, Sociologie de la sexualité, Armand Colin, 2009.
  3. Valérie Haudiquet, Maya Surduts, Nora Tenenbaum, Une conquête inachevée: le droit des femmes à disposer de leur corps, Ed. Syllepse, 2008.
  4. L’éducation à la vie affective et sexuelle dans le sens d’un espace de parole libre, de débat, de sensibilisation et d’information est principalement dispensée par les centres de planning familial au sein de la Fédération Wallonie Bruxelles, en collaboration avec les écoles qui le souhaitent. Cfr chapitre sur les acteurs de transmission in Lara Lalman, Contraceptions: quels choix pour les femmes aujourd’hui?, CEFA, 2010.
  5. Un recyclage pour médecins a été initié pour la première fois sur ce thème par la Fédération Laïque des Centres de Planning Familial le 20 avril 2013.
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