Tuesday, October 20, 2009

Pill enforced abstinence

'Condom rivals pill's popularity' says the BBC today. This research comes from the Office For National Statistics, so I guess we can trust them. A quarter of the 1,093 women surveyed said they use condoms over other methods for contraception. The same number were taking the birth control pill. Half on the women using condoms cited worries about STIs as their main motive. The report also mentioned that only 40% of women were aware of the emergency intrauterine device.

I have to say, I wasn't sure what they meant by this and had to look it up. I know what an IUD is, but hadn't realised that the copper kind is effective in preventing pregnancy if inserted up to five days after unprotected sex.

A representative from the Family Planning Association usefully stated, "There are fifteen methods of contraception available. Women should be able to access all of them in equal measure." Fifteen? I'll come back to that in a minute.

I also read the report on this study on the Jezebel website and the posted comments were interesting. A fair few women talked about how they used both condoms and the pill, because of their distrust of the pill's effectiveness or because of STIs. The board discussion ended up on the topic of what they called 'pill enforced abstinence' - how the pill is a very successful method for them as it stops them even think about wanting to have sex.

The number of people contracting STIs like chlamydia and gonorrhea has risen dramatically in recent years, significantly so in the US under the Bush administration. Abstinence-only sex education also increased the numbers of unwanted pregnancies. The Guardian reported a couple of months back that the number of young men with HIV doubled during Bush's time as president.

When you're in a long term relationship, or married, you get mired in thinking about all relationships a certain way. Early on in a relationship, or in a casual relationship, you'd think everyone would want to use condoms, so the numbers in this study seem a little low considering the ratio of people in long term versus casual relationships. It's worth noting women are far more likely to contract infections than men. Somewhere around $15 billion dollars is spent annually, apparently, by the US health care system on taking care of people with STIs. Those pharmaceutical companies manufacturing the pill really must have a good lot of power to keep pushing so hard. I wonder how many women do use both the pill and condoms. I had always thought I was extraordinarily anxious.

I was discussing condoms with a friend the other day, trying to figure out the aversion to them - I'd recently received a couple of messages reiterating this hatred of condoms I've talked about before. We wondered if the dislike lay in part in the fact that using a condom necessitates stopping the lead up to sex and in that moment of stopping you have a minute when you might start thinking about stuff you don't want to be thinking about. Like the potential baby making consequences of what you're about to do. But maybe also whether you really want to do what you're about to do with the person you're about to do it with, how you feel about them, and they you and what you are doing together. As my friend said, it kind of makes you consider the partnership element of even the most casual situation.

I have been considering experimenting on myself with contraceptive alternatives to the pill. I thought I might try out a diaphragm and report back on how difficult it was to acquire, what it was like to get fitted by a doctor and using it and so on. I've been looking into how much an examination might cost: between $50 and $200 here in the US and the diaphragm itself: $15 to $75. Not sure I have deprogrammed myself enough at this point out of thinking anything other than the pill is unreliable.

Today, I came across two types of diaphragm that have been in the making for a long while, and looking for approval from the FDA this year. One is called Duet which is one-size-fits-all and disposable. The other is called the SILCs diaphragm which also wouldn't require a fitting and has a more easily usable shape. The Duet will contain a new kind of spermicide called BufferGel which doesn't contain detergents and so is less likely to cause the infections women can get with normal spermicides. It also will protect women from a number of STDs, possibly even HIV.

Both these diaphragms have been developed by non-profit organisations relying on donations or grants. I was intrigued to see that the pharmaceutical company Schering was involved in the development of the SILCs version initially, but pulled out two years ago after their merge with Bayer. SILCs creation appears to be more focused on the requirements of women in developing countries with little access to doctors, whereas Duet's makers appear to be concentrating on its ability to protect against pregnancy and STIs.

Here are the sites. I was interested just to see what they look like. It's not often you actually get to see a diaphragm, you have to go looking.



Fifteen methods of contraception are out there and despite all my research I could only figure out eight of them. I had a look on the Planned Parenthood site. They include abstinence, withdrawal and what they call 'outercourse' in their list of methods. You can even read about the benefits and disadvantages of outercourse. Aside from all the hormone-based kinds (the pill, the implant, the injection, the ring) there are three non-hormone based kinds other than the diaphragm and IUD that don't require subverting your humanity - the sponge, the cervical cap and the female condom.

None of these are ineffective or even that difficult to use, so it's interesting that my immediate reaction is to think of them like 'comedy' contraceptives. I instantly equate these methods, which are perfectly safe, with the myths of crisps, Coca Cola and chicken skin I wrote about in my last post. On first response they seem silly and archaic to me and I am able to justify their marginalisation. I can think that way even though I don't believe the pill to be modern, sensible or innovative. When confronted with other options, I'm still elevating the pill in my mind, even though I no longer take it because I know it should not be elevated. Hmmm. That Femodette packet is still waiting for me to give in and jump back on the wagon.

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