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From Condoms to the Pill: Trust, Control and Violence

Putting more contraceptive options on the table, also for men, is a social good. But as I mentally review the testimonies of the hundreds of women I have spoken to about their lack of autonomy in contraceptive use, I find women's right to birth control neither inevitable nor sad.
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As media reports celebrate advances toward new male contraceptive methods, the fact that women currently take the larger responsibility for birth control is held up as somewhat inevitable and sad. In effect, contraceptive use is now so firmly established as a woman's responsibility that data on birth control often are collected from women only. Moreover, pundits regularly question how to get a man to wear a condom -- the main existing form of male contraception, barring vasectomy -- and why men are so uninterested in something that surely pertains to them, too.

Historically, however, the responsibility for birth control has fluctuated.

The use of modern contraceptive methods started at least in part as a male project. George Bernard Shaw called rubber condoms the "greatest invention of the 19th century," and by the early 20th century the U.S. birth rate had fallen significantly, in part because of effective contraceptive use, condoms in particular.

This male control over contraception was seen by some suffrage leaders as immoral, because it made it easier for married men to cheat on their wives. Later feminists saw access to woman-controlled birth control as essential to advancing women as equals, in particular women from the working classes. And in time, a woman's right to decide, alone, about the timing and spacing of her pregnancies has become a key tenet of the women's rights movement, evidenced by the massive improvements in women's status since the approval of the birth control pill over 50 years ago.

Male contraception remains very much in the mix, though, and contraception decisions still are very much a matter of trust and control.

For starters, as some of the suffragettes noted, the use of contraception allows for sexual encounters with a substantially lower risk of both pregnancy and, depending on the method, sexually transmitted infections.

As a result, if a person wants to use contraception, that is sometimes seen as a sign of their desire to "cheat," or even as proof that they already have. In societies where male infidelity is seen as more "normal" than female straying, this can cause problems. In 2004 I spoke with dozens of women in the Dominican Republic who had been beaten by their male partners for daring to ask them to use condoms. Human Rights Watch research from Uganda, the Philippines, Zambia and elsewhere confirms that expectations about female fidelity and submission is a central problem in the fight against the spread of HIV/AIDS: women can't control their husbands' sexual encounters, and they fear abuse if they ask their husbands to use condoms.

Trust, control and violence are interlinked with use of contraception in other ways, too. In a news report from 2010, 20 percent of women who sought family planning care in northern California reported that their partner had sought to pressure them into having a child, including by sabotaging their contraceptive use. In my own reporting from Argentina, experts told me that a significant number of abusive men deliberately sabotage their wife's or partner's access to contraceptives as part of the control and abuse. One woman I spoke with, who had had 10 pregnancies during her 14-year abusive marriage -- including two miscarriages caused by the abuse -- told me her husband said: "I am going to fill you with children so that you can't leave my side." As a result of this relatively prevalent dynamic, many women in Argentina choose invisible contraceptive methods, such as voluntary sterilization or hormonal injections.

Also for those who have not personally experienced a physically abusive relationship, trust is often central to contraceptive choice. Even the most superficial web search reveals that many men and women are loathe to trust their partners about birth control. The truth of the matter is that unless you can see it or use it yourself, you can never be 100 percent certain that a pill has been taken or a condom is intact.

Of course, putting more contraceptive options on the table, also for men, is a social good. But as I mentally review the testimonies of the hundreds of women I have spoken to about their lack of autonomy in contraceptive use, I find women's responsibility for, and right to, birth control neither inevitable nor sad. Most of the women I speak to are still struggling for choice, and their lack of reproductive autonomy has only brought them grief.

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