BETWEEN SEXUAL
FREEDOM AND
RESTRAINT
A sociological study on the adverse effects of
modern contraceptives
Graduate School of Social Sciences
Msc Gender, Sexuality And Society
Elif Gül 11096004
Supervisor: Sherria Ayuandini
Second Supervisor: Dr. Marie- Louise Jannsen
15.08.2017
Acknowledgments
This topic has been on my mind for quite some time. I feel very lucky that I have been able to conduct this research at the University of Amsterdam. For years I had these questions in my mind and it feels very satisfying to get answers and also see how one’s own perspective can be inaccurate sometimes.
First, I want to thank both of my supervisors. Sherria Ayuandini, for keeping me and the whole group on track, for giving me lots of feedback and making me work independently. And Marie-Lousie Jannsen for all her amazing lectures, that made me realize that the field of Gender and Sexuality is my passion. I want to thank all my friends in Amsterdam who made this whole year an amazing experience, especially Tom, Eddy, Azadeh, Cheyane and Baris and also Chrissi and Antonio who supported me from Vienna. My family is the driving force behind me and I am so grateful for their never-ending love and support.
And I could not have done this research without the precious time of my respondents, which meant a lot to me.
SIX
Bibliography 67
a. Academic acources
b. Online scources
TWO
Theoretical Framework 13
FOUR
Results and Analysis 25
4.1
Counseling on birth control
4.2
Adverse effects and pain
managment
4.3
The moral panic of unwanted
pregnancies
4.4
Male contraceptives
FIVE
Conclusion 65
ONE
Premise and Context 5
1.1
Counseling on birth control
1.2
Adverse effects and pain
managment
1.3
The moral panic of unwanted
pregnancies
1.4
Male contraceptives
THREE
Methods and Data 17
3.1
Accessing the field
3.2
Informants
3.3
Qualitative research
3.4
Quantitative research
Summary
My research focuses on ideas and perceptions about gender and sexuality regarding modern contraceptives and their adverse effects. I focus on hormonal contraceptives and IUD’s as modern contraceptives since those are the ones that majorly changed the options about family planning and carry risks. However, there seems to be a gender bias in the production of contraceptives, since methods are mainly only available for women. Contraceptives were marketed as empowering women and facilitate sexual freedom which is the case for a lot of women worldwide. However, I will also try to look at the other side of the coin and locate the ways contraceptives can be limiting to modern day women. For this, I talked to gynecologists and women of a certain age group to locate the ways contraceptives influence them. The main theories I am using here are biopower, shame, moral panic and also work that has been done in science technology studies. During my research, I located the ideas and mechanisms that lead to the current situation where birth control is mainly a woman’s responsibility, simply because there are not enough methods for men. Although birth control opened a lot of new doors for women, if the method of contraception induces adverse effects this can lead to a more limiting mechanism for the same woman. This is why I interviewed doctors and patients about adverse effects, male contraceptives, their experiences on how contraceptives influence their lives. To better support my arguments I also started an online survey.
In my first chapter, I explain the foundation for my research as well as the context of Austria. Next, I elaborate the theories that I will use to continue with the research design. Later I present my Data and discuss counseling and choice, adverse effects, unwanted pregnancies and male contraceptives.
ONE Premise and Context
Modern birth control methods were introduced in the 1950’s, an event that many call a major social revolution which changed the course of human development and evolution (Benagiano et al. 2007). The main form of contraceptives that are seen as revolutionary are hormonal contraceptives and intrauterine devices. Apart from these contraceptives, we know of other methods that have been in use since the time of Ancient Egypt (Bullough et al.2001). Recently, we have been able to distinguish between modern and traditional or alternative contraceptive methods as well as between reversible and irreversible methods (UN Wallchart 2013). According to the UN Population Division, 58.8% of couples in Europe use modern methods of contraceptives, which include injectables, IUDs, the pill, condoms, sterilization, implants, and vaginal barrier methods (UN Wallchart 2013). Modern contraceptives have become a part of women’s gender identity and a world without them is hardly imaginable today.
From early on, hormonal contraceptive pills have been heavily debated between women, gynecologists, and the World Health Organization. Firstly, because the trials were done on ethnic minorities in Puerto Rico (Women and Health Research 1999) then the adverse effects of the contraceptives caught a lot of public attention in the 1960’s and hitherto, the pill became to be the most sued drug in the history of pharmaceutical companies (Ourdshoorn 2003). This is one of the reasons why pharmaceutical companies are reluctant to test new methods; hormonal contraceptives are considered to have high risk of potential failure (Oudshoorn 2003).
Furthermore, despite 60 years of advancement of medical technology and the development of modern contraceptives, we still do not have any modern contraceptive methods for men that are comparable to those for women. Condoms, sterilization, abstinence, and withdrawal are currently the only options available to men (Behre et al. 2016). And not only are there few methods for men, but also women’s modern birth control methods use the technology that is already more than 50 years old (Siegel Watkins 2012). Reproductive health is mainly a women’s topic; contraception and its responsibility is performed by women and on women’s bodies. This signifies an "institutionalized process of othering" of women’s bodies, according to Oudshoorn (2003:5).
It is important to note that while almost all medication has side effects, the distinction that can be made for contraceptives is that they are used by healthy women. They are not used to cure a disease
or illness but rather to stop conception. Generally the advantages outweigh the disadvantages with normal medication. I will further discuss the adverse effects in the following chapters.
While a lot of women face some sort of problem with modern methods of contraception, medical studies and trials emphasize how important it is to get more women to use modern methods and to increase acceptability (Sabatini et al.2011:150). Kara Granzow (2007) explains in her research that not using contraceptives is not really a choice because the option of not using anything could be sanctioned by society. In light of the overwhelming data on how hormonal contraceptives influence women’s bodies and their adverse effects, it is somehow puzzling that every day young women are still prescribed drugs that can cause major health issues in the future. This is again is in stark contrast to the treatment of men in relation to contraceptive use. Pharmaceutical companies as well as researchers and the World Health Organization are much more careful with new inventions and recommendations regarding male contraceptives (Oudshoorn 2003).
Although today various types of safe methods exist to minimize the number of unintended pregnancies in the western world, there are still 4.4 Million abortions per year in Europe according to the Guttmacher Institute (Guttmacher Institute, Induced abortion World Wide, 2016). Contraceptives are an effective and important part of reducing unwanted pregnancies; however, they carry risks and come with adverse effects, which I will argue are reasons why they can fail.
This research aims to explore how people in positions of power, particularly gynecologists, give information and prescribe contraceptives to women despite knowing the adverse effects and legitimizing them with their practice. As there has been a lot of activism against hormonal contraceptives (Djerassi 1989), this research aimed to elaborate on how knowledge flows between parties and how doctors position themselves in this dynamic. I talked to seven gynecologists of which two had abortion clinics, ten women between the ages of 20 and 30 and one psychotherapist who provides sex education and accompanies women during their abortions. I asked them about their views on the importance of contraceptives, as well as their views on contraceptives given their side effects. It was very important to talk to gynecologists, they represent those in power and prescribe the contraceptives. Their ideas and counseling is very important for women’s decision making. Abortion clinics are very interesting because contraception plays a big role in every counseling session. The procedure of abortion always includes counseling on contraceptives. Women often leave an abortion clinic with a (new) method of contraception. This is clearly visible
just by looking at websites of abortion clinics, for example, prowoman.at, abtreibungen-wien.at, and gynmed.at. There is a lot of research on contraception and, for example, how choice is constructed by Kara Granzow (2007). Also, anthropological research often looked at contraception in developing countries (Teixeira et al 2012, Hulkin 2012, Sheoran 2014, Decat et al. 2011, Westoff 1978), where the focus is on the importance of sex education and contraceptives for women, as well as the unmet need for them. Research that focuses on the interaction between the macro and micro-level are rare or only focus on doctor-patient relationships. Some research focuses on doctors’ recommendations (Fiebig et al. 2015) and there has been work done on post-partum contraception and contraception after abortion (WHO 2015). However, studies are yet to be done in which health professionals are interviewed about their role in being mindful of the side effects of contraceptives, on the one hand, and helping to plan patients’ reproductive lives, on the other.
Vienna is an interesting city for this research because it was chosen as the most livable city several times by Mercer. Austria, with 72% of contraceptive use is very close to the average of 70% in Europe. The lowest contraception use is documented in Bosnia and Herzegovina (45.8%) and the highest in Norway (88.4%) (UN Wallchart 2013, Verhütungsreport 2015). Austria has a very good health care system and ranks 9th in the WHO ranking (World Health Report 2000) Furthermore Vienna is interesting because it has the only contraception museum in the World. In the next section, I will elaborate further on the specifications of the Austrian health care system, since it is crucial to understanding the nature of my research. In contrast to other research that has been done in developing countries which explain the need for contraceptives (as I mentioned above) Austria represents a rich, industrialized, western country where the life expectancy is at 81.5 years (WHO, Life Expectancy 2015). There are two paradox situations regarding Austria and contraception. First apporoximately 35 000 abortions are still carried out each year, although women have access to most contraceptives; this is viewed as a problematic number (MUVS, 2017). And second the adverse effects of contraceptives are taken on as a burden although Austria is a very health- counscious country nevertheless there is no research done for providing women with better options in Austria.
My initial plan was to do an analysis on the medical discourse around contraception. I wanted to gain knowledge about the macro level dynamics in gynecology and contraceptive research to better
understand the ones who prescribe the drugs. My main idea was to do in depth interviews with health professionals to better understand their views and experiences, as well as their thoughts on the problems that women face. During my research phase I found out that only interviewing health professionals would be limiting and would not give me the rich analysis of the topic that I wanted. Therefore, I included interviews with women to first understand the problems and then ask the gynecologists. I also conducted a surveys to find more information and to further support my arguments.
During my research, I conducted interviews with health professionals on the topic of contraception and explored the paradox situations mentioned above and research how they think and feel about modern contraceptives including their perceptions of problems that women face. I will also investigate their ideas of the gender dynamic and the possible asymmetry that exists between men and women in relation to contraceptive decision making.
My research has a focus on side effects of contraceptives and how they are being handled by women and their gynecologists, as well as present attitudes towards male contraceptives. My aim so to say is to show the discrepancy between the doctor’s attitudes and expectations towards birth control and the patients views. My second aim is to reveal how modern birth control methods can be liberating and limiting at the same time, hence my title "Between sexual freedom and restraint". I will elaborate on how contraceptives also might have changed views about abortion and try to explain the big emphasis on unwanted pregnancies although this rate keeps falling.
Therefore, my research question is:
What are the expectations and experiences about adverse effects of modern birth control methods of gynecologists and women in Austria and what are the underlying ideas of gender and sexuality in regards to contraceptives?
1.1 Austria and its Health Care System
Austria is a small country in central Europe and has a population of 8,739,806 million and an area of 83.879 km2. The average number of births per woman is 1.53 and the life expectancy in 2016 was 79.1 years for men and 84 years for women (Statistics Austria- Population 2016). The main spoken language is German.
Austria has a long history with the rise and fall of the Habsburger Empire and its dark history of Nazism and the Holocaust. In 1995 Austria joined the EU (Bischof et al. 2011).
According to Eurostat Austrians are above the European average in terms of their overall life satisfaction, which ranks at 7.8 out of 10. The European average is 7.1 (Eurostat,Lebensqualität: Fakten und Wahrnehmungen in der EU, 2015).
There are more physicians available per 1000 inhabitants than in other European countries. Social insurance is mandatory in Austria and is mainly funded by insurance contributions. It is not possible to choose your social security institution. The place you are insured by depends on your employment, or your parents’ employment, because children are insured in their parents’ name. The same is true for young adults who are studying and do not have their own income (Bundesministerium für Gesundheit, 2013). To give an example: self-employed people are insured at a different institution (SVA) than people who work for the government. This distinction does not change the treatment, but doctors can choose which insurance companies to work with. So, it is possible that as a self-employed person you will not be able to go to a certain gynecologist if they chose not to work with your insurance company. In my further chapters of results it will be clear what effect this has on doctors and patients. Residents can also use a private insurance that additionally covers treatments, like ultrasound, that the mandatory insurance does not cover. The principle of solidarity ensures that everyone gets the treatment needed (in most cases) regardless of income. Higher earners pay more to the insurance company. In Austria, every patient can choose their own doctors (outside of hospitals) and there is no need to consult a general practitioner before going to a specialist, like a gynecologists or an orthopedic specialist. This means that there is no "gate-keeping function". However, as mentioned above, you can only see a doctor who works with your insurance company. If patients want to see other doctors, they have to pay themselves (Bundesministerium für Gesundheit, 2013). Unfortunately, some treatments that are essential for women, such as an ultrasound or gynecological contraceptive counselling, is not covered by some of the insurance companies. Contraceptives and abortions are also not free or
aided, which means that women carry all the costs. Abortions range from 300 to 800 Euros, depending on the chosen clinic. Women with a very low income have the possibility of having one abortion in their lifetime paid by the state. (Wien GV Sozialinfo, 2017)
In 2015, the Austrian Parliament published data on the numbers of so-called "Wahlärzte" - which are all the doctors who do not work with insurance companies and all those who do. This only concerns out-patient doctors who are self employed and have their own practices. Self-employed doctors can choose whether they want to work with insurance companies or not, which means that patients pay for their treatment themselves if they choose to go to that doctor. According to this report, there were 801 gynecologists who did not work with insurance companies in Austria and 416 who did. Generally, gynecologists who do not work with insurance companies can charge per consultation or treatment, which means that they have more time for the patient, but also that there is always a part that the patient must pay herself. This leads to higher earners to be more likely to see “Wahlärzte”. As it will be clear in my results, “Wahlärzte” usually take more time to consult and this can have an impact on contraceptive choice or satisfaction.
1.2 Definition and History of Birth Control
Contraception is mostly synonymous with birth control. Today there are various types of contraceptives that can decrease the possibility of pregnancy up to 99.9%. Chemical methods such as spermicides (uncommon today), hormonal contraceptives as well as pills, injections, or implants and sterilization.
Options of birth control methods can be categorized in different ways. I will categorize them according to their mechanism and later explain and define the birth control methods that I talk about in my research.
Birth control methods include barrier methods also called “mechanical methods” like the condom, female condom, and diaphragm. These ensure contraception by providing a barrier between the sperm and egg. Next, there are hormonal contraceptives, which all work in a similar manner and can be used in the form of pills, vaginal rings, patches, injections, or implants. All of these methods use the same mechanism to ensure contraception. Estrogen and gestagen are the main hormones that are used to prevent conception (Woodhams et al. 2012). They are delivered in different ways
depending on the woman’s preference. The hormonal IUD, the injection, and the “mikropill” only work with gestagen and do not have any estrogen in them, which means the main mechanism is the prevention of ovulation. Second, the cervical mucus prevents sperm from getting through and in the event that the egg and sperm do meet, the uterine wall is thinned so that a fertilized egg cannot settle into it (Woodhams et al. 2012).
LARC (Long Acting Reversible Contraceptives) methods include IUDs and the implant.
Non-hormonal modern contraceptives all work with copper. They are all inserted into the uterus as an IUD. However, there are different forms of this IUD. Gynfix, for example, is attached to the uterine wall by a gynecologist. A copper IUD is inserted and its form prevents it from falling out. For a few years, there has also been an IUB, which works the same way but is advertised to be more applicable to young women.
Other than these options, there are chemical contraceptives that are spermicidal, sterilization of women (tubal ligation) or men (vasectomy), coitus interruptus (withdrawal), and emergency contraceptives such as the morning after pill and the copper IUD.
At first sight, it seems like there are a lot of options in contraceptives. However, when looking at the technology behind it, it becomes clear that the mechanisms are all the same, delivered in different ways to the female body (Siegel Watkins 2012). As it will be clear in my results section, these contraceptive variations are useful when it comes to advertising, but do not show a significant variance in users experiences and adverse effects.
There is no contraceptive method that is 100% certain other than removing the reproductive organs or abstinence. Contraceptive methods were used throughout history to prevent unwanted pregnancy but they were not as efficient as they are today. Some contraceptive methods are more efficient than others and the efficiency is measured using the Pearl Index. The Pearl Index refers to the number of unintended pregnancies per 100 women during one year after using the same contraceptive method (Bullough et al.2001). If no contraceptives are used, 85 out of a 100 women would get pregnant within one year (Woodhams et al. 2012).
The use of contraceptive methods are documented as far back as ancient Egypt, where women would use different kinds of herbs to reduce the risk of unintended pregnancies. Also, some barrier methods would be used, honey and some sort of gum would be used to block sperm from entering the cervix. This means that there was a lot of knowledge about contraception and pregnancy. Also "coitus interruptus", where the penis is withdrawn out of the vagina for ejaculation was and is one form of contraception. (Bullough et al.2001)
Crocodile and elephant feces were also used to prevent pregnancy in ancient Egypt and Rome. The Chinese would use coitus interruptus, which was a method to uphold the males "yang", which means that it was propagated to be something beneficial rather than preventing pregnancy. Also, cutting off the flow of sperm by pressing between scrotum and anus leads to not ejaculating and simultaneously not losing the pleasure of orgasm. This knowledge was prevalent for the Chinese (Bullough et al.2001).
For my research, I visited the contraceptive museum, which is one of a kind in the world and located in Vienna, Austria. The contraceptive museum also gives a lot of different examples of failed attempts to reduce the risk of pregnancy, for example, special vaginal showers and blocking the entrance to the cervix. Unsafe, illegal abortion and infanticide were methods of ending an unwanted pregnancy or “ending motherhood”. Both of these practices have been made illegal in Europe. The topic of infanticide has been adapted into a lot of novels and poems like Friedrich Schiller’s “Die Kindsmörderin”/”The Infanticide”.
The contraceptive museum emphasizes the triumph that COC’s brought to women and continuously describes the terrible faith women had to face only 70 years ago, when contraceptives were not available and abortion was illegal. So, modern day contraceptives are portrayed as a savior. What it does is more than giving information about practices. It tells a story about a dark past and a bright future. This victorious story is very prevalent in doctor’s ideas and attitudes towards modern birth control methods as it will be clear in my results section.
In my research, I do not consider condoms a modern contraceptive, since it has been around for a long period of time, according to Aine Collier, who dedicated a whole book on the history of condoms. They can be traced back to ancient Egypt (Collier 2007).
So, what do I mean by modern contraceptives? According to the world contraceptive patterns, modern methods are hormonal contraceptives, IUDs, and barrier methods. However, I will not define barrier methods as modern methods, since this idea has been around for much longer and was in use before the pill was invented. I will work on hormonal contraceptives and IUDs. These are the methods that are described as revolutionary, created a high level of safety, and are used by most sexually active women. 59% of Austrian women used one of these methods in 2015, according to Gynmed, 27% did not use any birth control and 14% used other methods (Verhütungsreport 2015).
TWO Theoretical Framework
This section of my thesis contains the theory, that will be applied to my findings. The main theories I use are bio-power, shame
Michel Foucault’s theory about bio-power is applicable to women’s bodies being regulated in regards to reproduction, health, fertility rate, and population control. Bio-power is the power that is created through knowledge and its distribution to the actors themselves, so it works in finer channels than other power mechanisms. Foucault explains this by showing that the power to kill someone was replaced by the power to let someone live (Foucault 1983:134). So today the power is about life and not death, which for Foucault is controlled by two important aspects. First, ²the anatomy politics of the human body², the body is a machine that needs to be optimized for usefulness in economics. And second, ²regulatory controls: a biopolitics of the body², which regulates birth, mortality, the level of health, and life expectancy. (Foucault 1983) Through those two mechanisms, power over life is ensured. Contraception falls into both of these categories by being useful for economics because women can work „uninterrupted” and mostly more cheaply than men. And the regulation of birth and population control is clearly linked to the use of contraceptives, at least in Europe. Foucault talks about a time in which all regulatory mechanism, schools, universities, other education facilities, and the military came in to existence in the dimension we have today. (Foucault 1983)
Bio-power and its micro channels of power that get into or onto each of our bodies through actions are applicable to women who take the pill every day and regulate their bodies and perform some power over their own fertility. This means that the state does not have to force sterilization on someone to regulate fertility. Power here is exerted by taking medication every day or putting an intrauterine device into your body.
Taking this into account, I worked on these micro channels of power and tried to locate the micro-power and knowledge that flows to women who use contraceptives and searched for the medical discourse that makes this possible as well as locate these micro channels in women.
One of these micro channels that caught my attention during my research and was very prevalent in my results: the emotion of shame. Thomas Scheff calls shame the master emotion, because it signals moral transgression (2003). Living up to standards of society and in case of failure
experiencing shame is described as an essential part of societal life. Scheff tries to give a description of the term shame and wants to include Goffman’s work (1963) he describes it as “seeing self negatively, if even only slightly negatively, through the eyes of others” (Scheff 2003:254) Shame signals a threat to the social bond and includes many cognates like humiliation, embarrassment, guilt. (Scheff 2003). Charles Horton Cooley explains that shame and pride are not “mechanical reflections of ourselves, but an inputed sentiment, the imagined effect of this refelction upon another’s mind” (Cooley 2009(1969) :184). Norbert Elias explained how the awareness of shame is decreasing but the feeling itself is increasing in modern societies (1939). Scheff argues that this creates a taboo around shame itself and that many other “emotions” are used or mentioned when the main feeling was shame. My research does not test Elia’s hypothesis that shame is rising, but it does contribute to the study of shame and how women experience contraceptive “failure” as a shameful event but still do not say the word “shame” or did not describe themselves as ashamed but rather as “stupid, afraid, self conscious, embarrassed in front of partners” and so on.
Bryan Turner who’s work is strongly linked to Foucault and also Weber calls the human body “unfinished” and in need to be “trained, manipulated, cajoled, coaxed, organized and in general disciplined” (Turner 1992:15). His work is located in medical sociology, however, as many others the sociology of health and illness is mainly about the creation of healthy bodies and meanings of sick bodies, but as we know modern contraceptive methods are neither of these options. As Oudshoorn (2002) says contraceptives are drugs for healthy people. And they are not used to make the body healthier, like for example vitamins or dietary supplements, which means that they represent another division in the sociology of medicine. What is very applicable to my research in Turner’s research about the rationalization of diet is how he applies Foucault’s theory to it. And I will try to contribute to his research by arguing that a rationalization of sex also exists which is due to controlling reproductive our reproductive organs. According to Turner all the mechanisms of rationalization, like the rationalization of labor are achieved by discipline, diet, training and regulation and are serving the capitalist development (Turner 1992). For sure contraceptives are also located somewhere in the capitalist world, since women were not able to participate in the industrialized and capitalist labor market as much before reliable methods of birth control existed. What Turner means by the rationalization of diet is that today some forms of consumption are viewed as irrational and thus unhealthy and dangerous. Obesity, he argues became a form of deviance. I will try to show that also heterosexual sexuality- if not “performed right” as well as reproduction is viewed as a form of deviance, which is very visible in women’s feelings about
reproduction and also doctor’s views. It is viewed as deviant when women get pregnant without planning to, have an “irrational” amount of children or are “too young” to become a mother. All of this is linked to modern methods of contraceptives, because they are the solution for this problem as well as the creators of the problem.
It might seem like I am only talking about the rationalization of reproduction, since my research is about birth control, however, not every sex is to reproduce this means that there also must be a rationalization of sex. Furthermore there always must be a way to control populations reproduction to ensure that they do not grow too fast, and traditionally this was done by controlling women’s sexuality and delaying marriage (Turner 1984). Now in western Europe or specifically Austria it is done by choosing the right contraceptive method for every woman.
Kara Granzow is another sociologist who is “deconstructing choice” in contraceptive use. Choice is always dependent on age, class, gender and is restricted by access and availability (Granzow 2007).
Chikako Takeshita who focused on the Biopolitics of the IUD in her work calls the IUD political versatile technology that can be argued for in a feminist and also in a non-feminist way (Takeshita 2012). I will argue that this does not only apply to the IUD but also other modern contraceptive methods. This versatile foundation that contraceptives have arises from different societal problematics. This characteristic is of immense importance in my research since my findings also show this feminist and also non-feminist effect that contraceptives can have on women. With feminist effects, I link sexual freedom that contraceptives can offer and with non- feminist effects I link adverse effects and pain with insertion that women have to take on for fertility control.
“Ironic Freedoms” is a book and theory by Judith A. Baer, who is a professor in political science and specializes in Public Law and Feminist Jurisprudence. Her book is about all epiphenomena that accompany reforms in politics and society such as abortions, the nonrestrictive access to contraceptives and even euthanasia. Although women’s rights activists fought a long battle in legalizing abortion and access to contraceptives for all women this also brought some “ironic freedoms” with itself argues Baer. One example from her book would be that women nowadays are able to participate in the labor market, however they will get the lower paying jobs and mostly do all the housework and child rearing as well, which means that they often work more than their partners. This right to work was long fought for by feminist activists, however in reality it created
some “ironic freedoms” for women (Baer 2013). She also points out, that birth control can be forced because it is legal now, which does not mean that it should not be legal, but that this has societal consequences and is used for population control purposes. Another point is that abortion is legalized and by this legalization some women might be forced to have abortions. With Judith Baer’s words: “a policy change designed to increase individual freedom may also decrease the freedom of the people who ostensibly benefit from the change and increase the power that other people, institutions, and conditions have over them.” (2013: 4)
Contraceptives do not only enable women to live their sexual freedom and only voluntarily become mothers but it also enables men to avoid fatherhood, which in the past was linked to intercourse. Another aspect is the threat of compulsory contraceptive use for example after giving birth or after abortions (Baer 2013). The absence of reliable information is another problem for women’s rights, since modern contraceptives have a big impact on economics, by letting women enter the labour market almost unrestricted and also the profit that pharmaceutical industries make through contraceptives. Some women welcomed this because they did not experience big side effects or were okay with them (Baer 2013).
THREE Methodology and Data Collection
This part of my thesis outlines the methods I chose to collect the data used to answer my research question. My data was collected from April 2017 until 11th May 2017 in Vienna, Austria and includes qualitative as well as quantitative data.
My research question and focus changed during my research. My initial plan was to focus on health professionals and their views and ideas about gender and sexuality in relation to contraception. I mainly interviewed gynecologists and saw that the relationship between patient and doctor was very important for the discourse in medicine as well as women’s ideas on how fertility needs to be taken care of and what burdens to take on for this. However, women also received a lot of their information online in support groups and similar websites, which was a main factor in my “observation” of online forums. The knowledge that I gained after only a few interviews lead me to change my focus and look at both sides of the story to have a better understanding of the realities women face and doctors create.
Therefore, my research was conducted in three steps. First, I interviewed gynecologists and according to the information I received from them I went on and created an interview outline and also interviewed women who use or used modern birth control methods. As the last step, I created an online questionnaire for women to gain more data and clarify whether the information collected from the gynecologists is similar in the eyes of the women. As Hennink says in The Design Cycle, “mixing methods can be an advantage and quantitative research that follows qualitative research functions in different ways for instance quantifying the findings of the qualitative research", "generalising the findings of qualitative research among a small group to the general population", and "diversifying the findings of qualitative research to different groups in society"(Hennink 2011:57).
All those steps were accompanied by online research on Facebook support groups, media articles on contraceptives, and forums on contraceptives, as well as me taking part as a patient in counseling for contraceptives and the installation of IUDs myself, which adds participatory qualities to my research. I used a mixed methods approach to better understand mechanisms and to avoid biased research that only provides one perspective on a topic that is connected on multiple levels.
Furthermore, I visited the contraceptive museum in Austria, which is the only contraceptive museum in the world, to gain more insights on how the history of contraceptives influences Austrian doctor’s and women’s daily interaction with them and thoughts about them.
In the following part of my methods chapter, I will explain all the steps taken to complete my research and analysis as well as go into detail about the problems and difficulties I faced during my research, including any shortcomings of my research and the ethical problems.
3.1 Informants
I interviewed 10 women, seven gynecologists and one psychotherapist, who worked in an abortion clinic. \in addition, I have 406 online surveys from women who live in Austria.
The women I interviewed were all sexually active, of reproductive age, engaging in sexual activities with men, and born in Austria. The youngest was 18 years old and the oldest 30 years old, which means that all my respondents grew up with the possibility of very effective birth control methods. In my analysis, it will be clear why this is important. The collective memory of times where safe contraceptives were not available is not present in the generation of women that I interviewed. All of them used the pill at some point in their lives and some are currently using it. Three of my respondents used natural family planning at some point and one use the copper IUD. One of my respondents was pregnant at the time of interview and plans to get a copper IUD after giving birth.
The gynecologists mostly practice in their own practice or their own abortion clinics. They include four female doctors and three male doctors as well as one female psychotherapist. Three of the gynecologists are “Wahlärzte”, two of them run abortion clinics and two are working with different insurance companies.
The interviews range from 30 minutes to two hours. It might seem odd that there is only one psychotherapist that I interviewed. However, when I asked to interview someone from the abortion clinic, she was the only one available to represent the whole clinic and I did not want to miss out on the opportunity. This gave me very interesting insights into sex education as well.
3.2 Accessing the Field
The principal research for this thesis was conducted in Vienna, Austria. I started searching for gynecologists and abortion clinics in March so that I could start my interviews in April. At that point, I still thought about sitting in on counseling sessions. I later changed my mind because of ethical considerations of the gynecologists. They deemed it unhelpful to have a second person in the room because it is such a sensitive topic.
Prior to my visit to Vienna, I had contacted over 60 doctors per email. Abortion clinics and in particular doctors who are committed to the field of contraceptives and who are active in organizations to promote sex education accepted to be interviewed.
One major problem for my research was the limited time given and the difficulties in making an appointment with the doctors. I knew that it was not going to be easy to make appointments but I needed to contact them multiple times before we finally managed to have a fixed date. One other problem was that it was Easter during my period of fieldwork, so a lot of doctors were on vacation or had some days off, which lead me to drag my research on until mid-May. I gained more experience in contacting doctors after a short while and stopped e-mailing them and rather called their offices to ask for interviews. This worked much faster and if they were willing to meet me, we arranged a meeting immediately or they mostly called back the same day if they were interested.
Accessing online forums and Facebook groups where women wrote about their experiences and gave each other ideas and advice on contraceptives was easier, but I needed to get accepted into the groups. Every time I asked questions I would say that I am researching this topic and that this is where my interest comes from. These online groups (which exist for each and every type of contraceptive) gave me so much information about women's experiences because they themselves decide to post online and ask questions about their Intra Uterine Ball, IUD, Implanon and so on. Although most of the gynecologists thought that online groups like this mainly existed because of women who had some sort of problem with their contraceptive, which would have affected the direction of my research. This is not the case at all. Women mainly enter those groups before they start using a new contraceptive to ask about experiences and stay in the group long after they started using it. This means that for the next "newcomers" they are able to explain the method and how they feel about it. The only shortcoming that could be argued to this method is that only women of
a certain age group use the internet this frequently. However, my focus in research is also only on women of reproductive age, which means that this does not limit my research field.
The access to all women I interviewed was less complicated and through Facebook and my own network, I could easily find women who were willing to talk to me about birth control. At that point, I did not decide to focus on adverse effects yet. Through talking to women and hearing their experiences with adverse effects, I decided to put a stronger focus on this. This means that I did not choose women depending on whether they had ever experienced adverse effects or not. It was rather the other way around. All women that I talked to had some sort of problem with adverse effects at some point in their lives. I interviewed 10 women who all used some sort of contraceptive and were in sexual relationships.
Furthermore, I did a quantitative online questionnaire that helped clarify women’s attitudes towards their contraceptive method and their gynecologist, to which over 500 people have responded but only 406 are used since some respondents were male or stated that they lived outside of Austria.
3.3 Qualitative Research
The qualitative part of my research consisted of in-depth interviews with doctors and structured interviews with women. Although it would have been interesting to talk about the role of contraceptives in a woman's sexual history, I decided to focus on their relationship to their contraceptives and doctors to confirm what doctors had told me.
My qualitative research started on the 7th April. I had an interview with a gynecologist and was very excited and nervous, since I had never interviewed a professional before. I did not know what to expect. Although an hour of interview was planned it ended after 35 minutes which was due to my nervousness. I chose to use a semi-structured interview outline with questions that I asked all of the professionals but the gynecologists still went into detail on different topics.
Almost all of the interviewees who were health professionals were under some sort of time pressure and kept looking at their watch, which made me very uncomfortable to continue asking questions. However, after the first three interviews, this problem no longer existed because of my attitude and the experience that I gained. I would start by asking how much time I had for the interview and
then managed to stay calm and not stress myself during the interview although they were still looking at their watches. With my relaxed attitude, the interviews transformed into discussions and conversations rather than structured interviews. This transformation can be easily retraced by looking at the length of the interviews I had with health professionals. The first interviews were barely an hour long and the last two interviews ranged from one and a half hours to two hours. The interviews with women were no longer than an hour but still more relaxed and under less time pressure. I started off with asking to record the interviews and askes for their verbal consent and explained what I was doing and that it was anonymous with all my interviewees and started with my first question. My questionnaire can be found in the appendix.
3.4 Quantitative Research
The quantitative part of my research was done only with women and to support my qualitative research. During the qualitative research, I noticed that some questions were not as comfortable for the women to answer as I assumed, for example, a question about feelings towards abortion or libido loss and vaginal lubrication. I noticed that to support my arguments, it would be easy to create a short online questionnaire to ask women what kind of contraceptives they used in the past and currently, as well as what kind of adverse effects they experienced and how their gynecologists dealt with this situation.
The main questions were:
1. What method of contraceptives did you use in the past? (mandatory) 2. What method of contraceptive are you using right now? (mandatory)
3. What is your main source of information when it comes to birth control? (mandatory) 4. Did you use contraceptives before you were sexually active? (mandatory)
5. How long was the consultation with your doctor to choose a birth control method? (mandatory)
6. Did your doctor actively ask you about your experiences with adverse effects after prescribing a contraceptive or fitting an IUD? (mandatory)
7. Did you ever talk to your gynecologist about your sexuality or sexual problems? (mandatory)
8. If there were contraceptive methods for men, besides sterilization and condoms, would you let your partner use birth control instead of using it yourself? (mandatory)
9. Did you ever experience any of the following side effects? (mandatory)
10. Did you chose your birth control method for any other reason than birth control? (mandatory)
11. Did you tell your doctor about having these side effects? (mandatory)
12. If you talked to your doctor about the side effects, how happy were you with the proposed solution? (not mandatory)
13. Were you warned about side effects of your chosen contraceptive method? (not mandatory) 14. Do you trust your gynecologists with the decision of your birth control method? (not
mandatory)
15. From 1 to 5, how applicable is this statement: I only use birth control methods when I am in a relationship. (not mandatory)
16. From 1 to 5, how applicable is this statement: I would rather not use or use a better form of birth control. (not mandatory)
17. Are you scared of an unwanted pregnancy? (not mandatory)
18. From 1 to 10, how big would the impact on you be if you had an abortion? (not mandatory)
The complete list of questions can be found in the appendix. As I got feedback from friends I decided not to have only mandatory questions. I received some negative feedback about the last two questions which were perceived as too personal or hard to determine. This is why I changed them during the research to “not mandatory”.
I do have three hypothetical questions and think that they say a lot about gender and sexuality. One is about male contraceptives, the other one about the possibility of no or better contraceptives, and the last one about abortion. I did not want to ask specifically ask if the women had abortions already because this would open up a whole new topic. I just wanted to know how “scared” women are of unwanted pregnancy and see if this maybe says something about their contraceptive use. The mandatory questions where those that were crucial to my research. All the other questions were not mandatory.
Google Forums gave me a short and general analysis of the data. However, I continued to analyze it on excel and used pivot tables for the analysis. This was enough for my analysis since my data is not too complicated and is only used to support my qualitative analysis.
This quantitative research only represents the online community since I only advertised it online and within my own social network. The initial number of answers was way over 500. However, I removed all men and everyone outside of Austria from the statistics as well as women who never used contraceptives or only used condoms, since their answers are not relevant for my research. There is a simple way of achieving this and when answering a certain question, the questionnaire could be invalid automatically. However, I do know that sometimes people want to do the survey and will give incorrect information to be able to see all the questions. This is why I tried to get all the information to then filter all the women who used modern birth control methods. I did specify
in the description that this research is only for heterosexual and sexually active women who live in Austria. Despite this, I got more than 10 men that answered the survey and more than 50 people from outside of Austria.
Everyone who answered the survey was able to leave a comment. I got a few comments from lesbian women, who felt that it was not the right kind of survey for them and they could not find themselves in the questions. I also received some positive feedback from respondents who did not want to specify their gender and from women with an intersex condition for giving more options than “male” and “female”.
3.5 Problems and Shortcomings
One of the problems is that I selected group of women through my research on online groups and also the promotion of my questionnaire, which mainly happened online. The quantitative data is not representative of the Austrian population, I do have more women who are higher educated and also the majority of women who answered my survey were up to 30 years old. But as I said it only represents the online community.
My respondents all had at least the “Matura” which is the examination at the end of the secondary school that enables young adults to study at universities. So I did not interview any women who only had vocational training or less than 12 years of school education.
The main ethical considerations were that the doctors I interviewed might detect each other’s quotes or profiles, since I was asked multiple times if I had spoken to certain doctors for my research or was asked generally who I had already interviewed. Which brought me into an uncomfortable situation. Although some of the doctors were okay with using their real identity, I decided to have pseudonyms for all of them. The reason for this is that sometimes conversations became particularly interesting when doctors said something like “okay I should not say this, but…”. this is why I decided to keep everyones identity to myself.
Positioning myself in my research was more important than I thought. I was part of this system and the discourse from the very beginning. I was part of some of the problems that doctor’s explained to me and I got offended by some of the comments they made, for example one of the doctors called a journalist “stupid” for her article on the pill, which I read as a very liberating feminist
piece, it had its flaws and was very very subjective however the feelings she explained were the feelings I had when I used the pill.I realized this way that I was in the middle of this discourse. I will go into further detail about these incidents in “adverse effects and pain management” and in “male contraceptives”.
I was also asked a variety of questions about who I was and why I was interested in this field. As a woman, I was asked a lot about my own contraceptive method and my opinion on the topic. As a sex educator, I was asked different questions about contraceptives for women. As an Austro-Turkish woman, I was asked lots of questions about the situation in Turkey. As a woman who had “unbearable side effects” from the pill, I was already placed within the whole discourse between hormone-free contraceptives and hormonal contraceptives. To avoid being treated as an anti-hormone activist , I did not expose this in the beginning of my research with gynecologists. However, if I felt comfortable in the conversation and was asked I did tell.
FOUR Results and Analysis
In this section of my thesis, there are different chapters for each of my results, which are all interconnected. The context in which my theories and findings are embedded is described in the analysis. In each chapter, I begin by explaining women's perspectives and experiences and then go on to the doctor’s opinions to continue the analysis. The discussion will be longer after each section, since I will connect the previous section to the next one. The following theories are embedded in the analysis and results chapters: counseling on birth control, adverse effects of contraceptives, the moral panic around unwanted pregnancy, and male contraceptives.
4.1 Counseling on Birth Control
"I am 16 years old and seeing a gynecologist for the first time, I am scared and very excited. I put on a nice dress and high heels, I wanna feel grown up today. After waiting half an hour I am asked to come inside. The doctor asks me why I am here and I explain that I need birth control so she asks me what I want and I answer: "the pill". She writes something on her computer and tells me that this is a pill that only consists of gestagen. I have no idea what this means but I nod. She asks me when the first day of my last period was and I tell her that I am still menstruating, she tells me that she will do the vaginal examination next time then, and I feel a bit relieved. "Do you know how to use this?", she asks. I nod again and say "yes". "You can start using it today but need to also use condoms until your next period starts, you are not protected this month yet." "Okay", I answer. And I am sent out. Was that it? All the questions I wanna ask all of a sudden pop up in my mind. I can't go back. "Okay, I will just read the package leaflet very precisely," I tell myself and spent the next three hours googling words I don't understand." -Elif Gül
Counseling on birth control is a crucial part of decision making and information about risks and benefits that contraceptives have. As one major part of the knowledge- flow, gynecological counseling on birth control is important in deciding which method to use and which not to use. This power that these counseling appointments have over the patient and how it is performed is dependent on many outside factors, as I will explain in the following. It also shows how risks are
assessed and what topics are relevant and which are not for patients and doctors. This quote that I placed here is me when I was 16, I think it summarizes the story that I am trying to tell in this chapter additionally I will also look at the other side and try to show what gynecologists experiences are.
I want to start with introducing my interviewees: Christa, Marlene, Helen, Konstanze, Stephanie, Jara, Serena, Olivia, Emma and Franziska. They are all between 20 and 30 years old and besides Franziska all of them are in some sort of sexual relationship. Other than Christa, whose husband has a low sperm count and Marlene, who is pregnant, all of my respondents are using some sort of contraceptive method. Most of them are using the pill, and all of them have used the pill at some point in their lives. Most of them used condoms with their first sexual encounter, besides Stephanie, she already started the pill before she had sex. The others started the pill with their first sexual relationships. Their first sexual relationships started between the ages of 13 and 18. This was also approximately the time when they first started to see a gynecologist, as it is customary in Austria to see a gynecologist for regular check ups. All of them like their current gynecologists but most of them have seen different ones. Since it is customary in Austria for every woman to choose a gynecologist herself the relationship with doctors in general is specific. People will ask each other to what specialist to go and recommend doctors to each other.
Furthermore, women are recommended seeing a gynecologist each year after their 18th birthday or first sexual activity for cancer screenings and the pap-smear. However, this regulation changes from country to country. For instance the American Cancer Society recommends it every three years from a woman’s 21st birthday (American Cancer Society 2012). The European Guidelines for Quality Assurance in Cervical Cancer Screenings recommends a three to five-year interval between each pap-smear. However, it is customary in Austria to do it every year from a woman’s 18th birthday according to Aerztezeitung (2011). This reduces the risk of expected cervical cancer by 93% (International Agency for Research on Cancer, 2008). Austria is one of the few countries that recommends screanings this frequently. So, the meaning of the gynecologist is more specific in Austria.
One of the number-one reasons for women seeing their gynecologist, however, is birth control. The women using modern birth control methods, tend to go more often than those who do not or those who do not use methods that need to be prescribed.
Dr. Kehl explains the most important reasons to see gynecologists.
„On the one hand, cancer screenings and, on the other, contraceptives. We have established cancer screening programs for women.” Dr. Kehl
Dr. Eva Brauner told me about her experiences about the significance of gynecological visits. “Gynecologists in Austria sometimes also take the role of a general practitioners for women, I have patients that are way past their reproductive years, but still come in. Just to feel like they are taking care of themselves.”
With all doctors and women that I talked to birth control was one of the number one reasons to see a gynecologist. Christa is 27 years old and working at a law firm as an assistant and studies law. She first saw a gynecologist at the age of 12 due to very strong menstrual cramps, where she was told to take the pill to reduce the cramps. However, her mother did not approve. She started using the pill when she was 23. Before that she used condoms. Christa had four different gynecologists before she found one that she liked, who was recommended to her by her sister. Now her whole family and friends are seeing the same doctor.
"My first gynecologist was the one my mother went to. She was too strict. The second one was very harsh while doing the examination and the third one was not interested in me at all and the counseling was very short. Now, I have an extremely nice gynecologist and he is by far the best. However, I noticed that sometimes he also can be laid back when it comes to some topics." Christa,
26
There are two things to unpack here, in Christa’s case. Firstly, it is very important for women to have a gynecologist that they feel safe with and who gives them the answers that they need, most of them search for recommendations on the internet and ask relatives and friends for recommendations. There are various websites that rate Austrian doctors, for example,
www.docfinder.at. This was prevalent through all conversations with women, they would always praise their doctors or tell me that they want to change.
Secondly, we can also see in Christa’s case that her mother did not want her to take hormonal contraceptives. At the age of 12 girls can not decide to take hormonal contraceptives without parental guidance. After the age of 14 girls will be able to go to a gynecologists themselves and ask for birth control without parental guidance. So what if Christa did want to take the pill at the age of 12? What if her menstrual cramps were so bad, that she would rather face possible adverse effects, than suffering from these cramps? We do not know the outcome, but her mother had the power in this situation and denied the doctor’s recommendation. This is not negative or positive,
neither way, as long as it is the mother’s decision and not the girls nobody can decide if it was right or not. And who can tell if at 12 years someone is mature enough for these decisions? If the mother maybe was in favor of the pill, Christa would have started taking it. As teenagers, women are very much dependent on their parent's ideas and views on birth control and sex, as well as their peer's ideas. Who is making the decision? Who are women influenced by and what do they base their decision on? Do they know about the adverse effects? And how balanced can their decision be? Jara’s story is similar to Christa’s and shows the exact same power mechanisms. Jara is 24 years old and was working in a library recently until she quit to move to Amsterdam. She had sex for the first time when she was 13 and started taking the pill the same year. What is interesting about her story is that she never went to the gynecologist before the age of 20. I was confused and asked her how she could be taking the pill since it is only available on prescription in Austria. She explained:
Jara: So when I was 13 and had my first boyfriend my mom gave me the pill. When she noticed that I was starting to have sex she said "okay, so you need to take the pill" and I also wanted to take the pill, because I thought that it won't hurt. And this could be interesting too, I have never been to gynecologists before I was like 20 or something, because my mother kept on telling me that I don't need to go.
Elif: So how did you get the pill then?
Jara: From my mom, because she is working at a general practitioner and was able to prescribe the pill.
(...)
Elif: Did your mother educate you on how the pill functions?
Jara: Yes, she just told me that I need to take the pill every day at the same hour and actually nothing else. So, she didn't tell me that it has so strong hormones and stuff like that. I learned all of that later when I was older. But I know that my mother was taking it and some of my friends too. (...) But if your mother tells you that you don't need to go to the gynecologist for this then you believe it.
I think that Jara tried to defend her mother in front of me, because I was shocked that something like this happens. And we know that mothers mostly have very good intentions for their children, but what is good?
Jara was influenced by her peers as well, she did not think much about negative effects of the hormones because people in her environment used it. However, her mother was the one making the decision. Jara did have adverse effects with some of the pills that she used, and I will talk about
this in a later chapter, however, she did not know that adverse effects of the pill exist until she experienced them.
We can see how important parents are when handling contraceptive choices. Jara's case about her younger years is very special and this situation is not applicable to all others, still even without the counseling or supervision of a gynecologist Jara was told to take the pill and Christa was told not to. This issue is not only problematic for girls and mothers bur also some doctors had comments on this issue. Dr. Eva Brauner has recurring experiences with some of the mother-daughter pairs that visit her practise. She is a psychotherapist and gynecologist and is not working with insurance companies. She stated that:
"Sometimes mothers come in with their 14-year old daughters and ask for birth control. And then
I have to intervene and start asking questions to the girl. There might be no need of birth control yet, but the mother is too scared of pregnancies so she wants to be sure. I send them back and ask them to come back when the time comes."
In Dr. Brauner’s case it seems beneficial for girls to have medical supervision and not to rush, and be dependent only on a parental guidance. In gynecology and also contraceptive research, the risks of unwanted pregnancy are weight against the risks of adverse effects of contraceptives (Oudshoorn, Kammen 2002). Since there is no risk of unwanted pregnancy with the girls Dr. Brauner is talking about she sends them back and asks for them to come when they have sex. This shows another mode of performing power, this time by the gynecologist who does not prescribe contraceptives although the mother of the girl asked for it.
Stephanie (30) is a secondary school teacher and also saw a gynecologist for the first time with the company of her mother. She then started using the pill. At that time she had not had sex yet but received the pill because of her acne and because she thought that she might have sex soon with her then-boyfriend. As we can see in all three cases, parents and especially mothers ideas and judgements are also a factor for the decision to use birth control. Throughout my thesis it will be a recurring topic, what role mothers have. As I already mentioned in the Introduction, it is not uncommon that girls will be prescribed the pill to “regulate” their cycles, reduce acne or menstrual cramps. These are all factors that need to be taken into account when making a decision. In all of my respondents, the role of the mother was special, I do sometimes refer to “parents”, however I did not talk to any woman who stated that her father was the main influence or attendant when making contraceptive choices or going to a gynecologist.
A recent study that examines parental attitudes towards contraceptive use of their teenage daughters in the United States found out that parents are more accepting of the pill (59%) and condoms (51%) than IUDs and implants. The study furthermore states that parents’ influences are often overlooked and can play a big role in decision making. (Hartman et al. 2011) Unfortunately, there is no specific study about Austria, but another German study showed that parents recommend their female daughters the pill (46%) then condoms (33%) and some recommended them to use both methods (Bundeszentrale for gesundheitliche Aufklärung, 2010).
Christa, Jara and Stephanie were all under parental guidance when making a decision. Both parents and gynecologists perform power in these situations, which does not mean that the young woman can not make an own decision, however, she must be at least influenced by these recommendations. Christas mother exspecially did not want her daughter to take the pill because she thought that she was too young for hormones and was certain that it would harm her daughter, sex was not a interesting at that age for Christa. However, parents can also want to protect their daughters from the risk of unwanted pregnancy and thus rather have them face adverse effects, than a possible pregnancy. In another chapter “moral panic of unwanted pregnancies” I will go deeper into this dynamic. So, Jara and Stephanie both wanted to take the pill as well as their mothers. If Stephanie was Dr. Brauner’s patient, maybe she would have been sent home without birth control.
But not only parents are important in making decision and weighing pro’s and con’s.
Another big factor in choosing birth control methods is the influence of friends. All of my interviewees who started using birth control in their teenage years started with the pill. I asked them why they chose the pill and the answers were very similar.
All of my interviewees knew that they wanted to have the pill before they received any information by their gynecologists. Helen is a student at the university of Vienna and works part time. She is not in a commited monogamous relationship, but still in a sexual relationship with one of her male friends. Her decision to chose the pill was connected to her friends ideas.
Elif: Why did you choose the pill?
Helen: Because it gives me safety. I always have it under control and because it is hormonal it gives me the feeling that nothing can go wrong as long as I take it regularly. So I really have the responsibility.
Helen: For me, it was always clear that I will use the pill, also because of my friends circle and what they told me, so it was the most common way of birth control. When I talked to my gynecologist we basically only talked about the pill. I did not even look at other options. I don't even know if I know all birth control methods that exist.
Helen went straight to the gynecologist and knew what she wanted. She started taking the pill after she was 18 and did not see a gynecologist with her mother. She did not think much about adverse effects of her birth control method. Marlene is very similar to Helen, however she faced serious adverse effects later.
"I wanted the pill because I saw everyone in my circle using it, so I wanted to try it" Marlene, 22
Emma, Franziska and Olivia did decide for the pill as their first contraceptive choice as well and were influenced by their peers as well. When I asked all the women about the reason they chose the pill Ireceived very similar answers like this one: “So, most of my friends were using it already
and they started much earlier than I did. And yes, I think I started even before I had sex for the first time.” – Serena 24
Serena went to the gynecologist herself when she was 14 years old and did tell her mother after she received the prescription. In her case the relevance of her friends is much more visible. Her doctor also did not talk to her about other options of birth control methods, they just talked about the pill. She did know about other contraceptives but felt like she is too young for anything else.
“I think that is the logical way of thinking, when you are a young girl you don’t want to get the IUD inserted. ” – Serena
The main source of information for birth control methods is clear, the Internet.
42,4% of women's first source of information about their current birth control method is the Internet according to my quantitative research. Other answers were gynecologist (34,2%), family and friends (14.8%), sex education (4.2%), and 8.6% chonse other options . My question was: "Where did most of the information that you have about your method come from?
However, lots of misinformation and outdated information is presented on the internet.
One good example of misinformation on the internet is ellaOne - which is a morning after pill that works up to 5 days after unprotected sex. The website and even the package leaflet states:
