Wednesday, December 10, 2008

Back to real life... and contraceptive choices

There's very little to beat the great feeling when you press "send" on a piece of work - well, very little you can do with your clothes on, anyway. Today I got my high from submitting my latest manuscript - Weekend Lover, you may remember - and winging it off to the publishers. I'm still amazed at how many different activities one can do in the course of an erotic weekend - and all of them legal!

In the meantime, in among the final mansucript checks of a sex book I've been keeping an eye on the 'real life' elements of sex and following today's "pill scare". No, not a horror story of hormonal side-effects, but a panic in some quarters that now women will be able to get the contraceptive pill from their local pharmacist, the country is going to go to rack and ruin.

Stepping aside from that particular argument as being intractable - the sex education lobby and the abstinence lobby come from such totally different moral viewpoints that it often feels like reversing through porridge to even try to reconcile - I'd like to comment instead on whether having easier access to the pill will help the pregnancy rates.

I can't fault the arguments that easier (and just as safe) access to the pill is going to help women take greater charge of their contraception. Of course if something is more widely available it will be more widely used. And all the practicalities affecting contraceptive choice are clear - women use it more if it's easier, less intrusive, more effective, safe, spontaneous, reversible.

But I don't think those are the only elements in play here. What I'm seeing in my postbag are much more subtle influences that affect choice - particularly female choice. In short, I think we underestimate the role of values in creating this problem.

Because it's not just whether a woman can get to the GP surgery that dictates whether she uses contraception or not. It's far more complicated than that. Under the practicalities are a whole slew of emotionally laden reasons why women choose to protect - or not - against conception.

Is contraception feminine ? (if she believes that a woman's main role in life is baby-making, the answer may be no).

Does it negatively influence the way she looks (if the pill makes her put on weight, the answer could be yes)

Does it reflect her friends' choices? (if all her friends are getting pregnant, she'll want to as well)

Does it please her partner? (if he wants condom free, or hates her taking the pill, what is she to do) ?

Does it allow for passion? (the pill and the coil do, the condom and the cap don't)

Does it make her feel good about herself - and make other people feel good about her? (if she believes that having a baby will make her worthwhile, where's her motivation to use contraception?)

All these are amorphous elements... but I believe they are crucial in forming women's choices. Bottom line, the vast majority of sex education today presupposes that women who say they don't want to have children will therefore want to use contraception - and the only issue is making that contraception available.

I disagree - I think many women out there are incongruent about the whole issue. They don't use contraception because it cuts across their core values.

And until we truly take that into account in sex education, in sexual health programmes and in contraceptive consultations, then all the open pharmacies in the world won't dent those pregnancy figures...

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