Ideas, influences, and facts about contraception

Contraception takes on considerable importance in a woman's life as soon as she begins to have regular sexual intercourse. Improper use of contraception may obviously have serious repercussions for her. There is evidence of considerable irrationality in the way women (and men) choose and utilize contraceptives.

Unsafe contraceptive methods are frequently chosen or there may be a neglect to employ contraception at all, despite overtly not wanting to become pregnant. Some of this irrationality stems from religious indoctrination (for example, Catholic opposition to formal contraception), some derives from being poorly educated and lacking access to proper information, and some probably represents passive, "taking a chance" behavior.

Of course, it's possible that you can find a compromise for contraceptive methods that still allow for the possibility of sexual pleasure.

Rainwater (1965) has shown that contraception is least effectively practiced in those lower class families in which the husband and wife have poor communication and are characterized by a "segregated" relationship in which they "go their separate ways."

Scattered and inconclusive attempts have been made to relate contraceptive behavior to other variables such as relative dominance of husband and wife, neuroticism, degree of personality similarity between husband and wife, and personality of the wife.

When deciding on which contraceptive method you will use, various birth control considerations come into play. The effectiveness of contraception may or may not be an important consideration (as, for example, when religious dictates take precedence).

However, the reliability of any way of preventing a woman becoming pregnant - sex positions when a woman is expecting a baby - depends on whether it's used consistently, effectively and correctly - which also depends on the partners' ability to communicate.

That being said, the failure rates of some methods are significantly higher than others. the decision as to what is adequate is entirely personal. Incidentally, it's a myth that certain sex positions lead to easier conception or prevent fertilization.

It is particularly pertinent to one of the prime objectives of this book to ask whether contraception plays a role in a woman's sexual responsiveness. There are frequent assertions in the literature that fear of pregnancy inhibits women and prevents them from experiencing sexual stimulation positively.

Women who had one child and who feared becoming pregnant again suffered sexual inhibition as a result of this anxiety.

Ferber, Tretze, and Lewit reported an improvement in sexual responsiveness in a sample in which the fear of pregnancy was banished because the husband had had a vasectomy.

These studies seem to be unanimous in their implication that inadequate contraception may arouse anxieties that will interfere with a woman's sexual responsiveness.

However, it must also be reported that an unusually well-designed study by Rodgers and Ziegler ( 1968), which evaluated changes in sexual behavior of one sample of couples after the husband had received a vasectomy and in another sample after the wife began using ovulation-suppressing medication for contraceptive purposes, detected no changes in sexual responsiveness as a result of the greater safety from pregnancy that had been thus provided.

In both samples interview and questionnaire data were obtained just before the new contraceptive procedures were instituted and follow-up data were then secured for four years.

There were no indications that the women in the two samples showed a significant increase in sexual responsiveness or frequency of intercourse as a consequence of their increased immunity from unwanted pregnancy.

One source of irrationality in contraceptive behavior derives from the fact that some contraceptives require a woman to touch and manipulate her own body, which may in turn arouse anxiety and disturbance.

Metzner and Golden discovered this fact in a study involving 100 women who were systematically interviewed concerning their contraceptive practices, sexual attitudes, and so forth.

The interview also probed specifically concerning the woman's attitude toward the use of intrauterine devices (IUD). It should be added that a sentence completion test (containing incomplete sentences such as, "Birth control is probably - ") was administered to each subject.

The analysis of the findings pertaining to which women did and which did not favor the use of IUD's revealed a general difference between them in terms of reluctance to use any contraceptive device requiring vaginal manipulation.

To a significant degree, the pro-IUD group exceeded the anti-IUD group in their past use of such vaginal techniques as diaphragm, foam, and suppository.

The former group also expressed significantly more positive attitudes than the latter with regard to insertion of other objects (for example, tampons) into the vagina.

Apropos of this point, Ellis describes a patient who owned a diaphragm that she rarely used because it required touching her genitals that were repulsive to her.

Relatedly, Rainwater noted in his interviews with working-class people that they had rather distorted concepts about the consequences of using an intravaginal device such as a diaphragm.

For example, they feared that it might get "lost" within the woman's body or that it might produce internal injury.

Rodgers, Ziegler, Prentiss, and Martin had 50 married couples rate various contraceptive dimensions (for example, masculine versus feminine, embarrassing versus non-embarrassing) and discerned, among other things, that some were perceived as masculine and others as feminine.

Thus, the condom is seen as masculine and the diaphragm as feminine.

One of the chief determinants of whether a device is classified as masculine or feminine is whether the man or woman has control of, and responsibility for it.

Both Rainwater  and Pohlman point out the irrationality in contraceptive behavior that may arise as the result of the obligations and demands made upon either a wife or husband as a function of the masculine or feminine quality of the contraceptive they employ.

A wife who uses the diaphragm may resent the burden of deciding whether to insert the diaphragm each night because it implies a decision as to whether sexual intercourse will take place.

If she delays inserting the diaphragm until its need is apparent her husband may become angry at the delay and inconvenience occasioned by the interruption.

Clearly, there is the potential for considerable misunderstanding and role conflict. If a "masculine" form of contraception is used (condom), a woman may feel particularly insecure (and therefore unresponsive) because she has no direct control over what is done and has to trust that her partner is adequately protecting her.

Her partner may sense her distrust and this may in turn influence the efficiency with which he applies the contraceptive device.

Some of the factors that might possibly determine whether a contraceptive will be acceptable to a particular husband-wife pair is illustrated by the observations of Rodgers and Ziegler.

They studied 39 couples (by means of interview and psychological tests) prior to their use of an oral contraceptive; and subsequently followed up their behavior for four years after contraceptive use had begun.

Fifteen of the couples continued to use the oral contraceptive during the four-year period; but nine discontinued without any obvious logical rationale for doing so.

Rodgers and Ziegler were interested in possible differences between such "continuous" and "discontinuous" couples. They found, particularly on the basis of psychological tests that the "continuous women are generally more socially competent, self satisfied, and independent than are the discontinuous women"; and they obtained lower femininity scores than the discontinuous.

Further, the same tests indicated that the husbands of the continuous women were less concerned about avoiding criticism than are their continuous counterparts; and also less "conscientious about fulfilling their own social role obligations."

When the attributes of husband and wife were compared, it was found that the use of the oral contraceptive was most likely to be continued in a marriage in which the wife had relatively more ascendant traits.

One could interpret such a finding in the context of the fact that the oral contraceptive requires the woman to take prime responsibility. She must monitor herself and make sure that she takes the pill at specific points in time.

Perhaps a woman who is low in assertiveness and who avoids assuming obligations becomes uncomfortable with the burdens placed upon her by the responsible role linked with the use of an oral contraceptive.

During their study, Rodgers and Ziegler became impressed with the complex interplay of motives between a husband and wife as they seek out a form of contraception that will be acceptable to both.

Although they remarked that it is usually the one who is "most conscientious" and who tends to assume "ambiguous role responsibilities" who is also most likely to take the responsibility for contraception, they pointed out other potential complications that may develop.

For example, a wife may reject the use of the oral contraceptive, not because she is a person who usually tries to evade responsibility, but rather because it results in more frequent sexual intercourse than she prefers.

She may want a form of contraception that will make her less continuously sexually available or make it possible for her to use the excuse of fear of sexual activity during pregnancy as a reason for limiting intercourse frequency. The need for intimacy can make a woman want sexual connection more at this time.

This motive may cause her to exaggerate the side effects of an oral contraceptive and to declare them intolerable. It should be added, by way of a note of caution, that although there were individual cases in which degree of interest in sexuality seemed to play such a part in contraceptive behavior, it was not possible to demonstrate in the sample studied an overall significant relationship between continuing the use of the pill and intensity of sexual interest.

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