Perceptions of contraception
Early findings through interviews
At this point in my thesis, I am reflecting on the relations between agency, race, gender and cultural perceptions toward contraception and how is their contribution weighed in the decision-making process. Through this study, I analyse and list several reasons for decision-making as encountered in the interviews, classified as Impulsive, Planned and Compulsive decisions. These are further discussed with each participant’s response as a case study to either support or contest another participant’s perceptions. I refer to these reasons as ‘rationalizing behaviours’, as the participants discussed these as logic and rationale as to why one would reject physical contraception.
On individually analysing each rationalizing behaviour, I discovered several variables like insobriety, spontaneity, lack of agency, relationship duration, comfortability, affordability and relationship expectations that may act individually or in conjunction with other existing socio-economic factors. Due to the limited sample size, the data is inconclusive about the measure of the contribution of each factor.
Channels of Sex Education
As part of my thesis research, I have been surveying University of Cincinnati students on how and when they acquired their understanding of contraception. It is an ongoing study, but so far I have identified an exponential shift in the source of information to be more personal and online. This means more teens are learning about sexual health online and 2 out of 3 teens failed to recollect what they learnt as formal sex ed in school when discussed in retrospect(research in progress). This also means there are higher possibilities of data inaccuracy resulting in false agency and misconceptions.
Many teens share their experience of formal sex education at school professing Abstinence only until marriage(AOUM). Although AOUM is theoretically fully effective, in actual practice abstinence often fails to protect against pregnancy and STIs. Few Americans remain abstinent until marriage; many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviours as adolescents. In fact, by age 20, 77% of respondents reported vaginal intercourse and nearly all had sex before marriage. By age 44, 99% of respondents had sex; 95% had premarital sex, and 85% had married. (Finer LB, 2013)
In the following section, I elaborate on my criteria for recruiting an accessible and diverse set of participants to be able to analyze their responses across the broader social dimensions discussed in this section.
In order to establish a baseline perception of contraception, I conducted in-depth interviews with 3 women in the age group of 25–29. While all of them either American or 1.5 generation Americans, two women were Caucasian and one African-American. None of the participants had limited access to contraception and all of them lived around the Clifton area in Cincinnati. In terms of channels of sex education, they all had completely different sources based on the location of upbringing and religiosity. Respondent 2(R2) practised Nation of Islam as her religion, while the other two(R1 & R3) were part of Catholic institutions yet had substantially varied experiences.
On investigating the channels of sexual health information I learnt that they all acquired information about contraception from different sources like friends, internet, self-exploration and sex education at school. According to two of them, sex education at school was discussed as a ‘scare tactic’ with stress on abstinence. At home, 2 out of 3 had ‘a very surface level’ birds and bees conversation with their parents(R3) and one had a lengthy discussion re-enforcing abstinence(R1). While all 3 had been sexually active from the age of 13–15, 2 out of 3 had to hide it from their parents until they were 18. It is important to note that 2 of these women were on birth control since the age of 13 and 16, and had explored many different methods to find out what suits them best. They had both learnt about sex ed as abstinence-only. The third participant who grew up with the teachings of the Nation of Islam was not on birth control and showed the most vacillating decision-making process. All 3 women identified as heterosexual.
However, for the purpose of this exercise I used an excerpt from the complete interview to compare the perceptions about a particular scenario, “In your experience, is there an instance when it is okay to not use contraception?’’. This question was singled out in order to analyse behavioural deviances and how women rationalize it on an individual level. To condense the transcribed data from the interviews, I participated in a group coding session where we shuffled and coded each other’s transcripts amongst a group of designers and sociologists. The group of coders defaulted to mostly In Vivo coding and a few instances of Eclectic Codes. Most of the codes were ‘taken directly from what the participant himself says and (is) placed in quotation marks’ (Saldaña, 2013). Using this interpretive method, I was able to step in to analyzing the similarities and differences in each participant’s perception.
In the following section, I list the various reasons that the participants stated to rationalize avoiding contraception in their experience. This led me to study their words of action like ‘exclusivity’ and ‘trust’ that lead to this shift in agency. I further triangulate that rationale based on the information I have about their channels of sex education, and other identity markers (gender, culture, race/ethnicity, place, inequality, and structure), social factors (relationship and partner roles), and individual beliefs. I also begin to develop an inexhaustive argument for the role women take in this conversation as well as the roles they assume or assign for their partner(s).
Even though for the purpose of the exercise my sample set was limited to three participants, I was able to discover six distinct but interdependent justifications stated by these women. I have coded these ‘Rationalizing Behaviours’ according to types of decision-making adopted by the participants, as Impulsive, Compulsive and Planned. Each participant adopted combined reasons to make their argument and I list them below without a particular sequence and without analysing whether or not they are considered medically safe.
1. Impulsive Decisions
Decisions taken in the heat of the moment, without much contemplation are referred to as Impulsive Decisions here. Since these are impromptu, they are most likely to be based on individual’s extant beliefs and perceptions and can often prove regretful.
This refers to impaired judgement due to alcohol and/or drug use causing higher vulnerability to unprotected sexual activities and advances. In cases of sexual assault it is understood that “..in a high-conflict social situation, alcohol would make it more difficult to recognize sexual assault risk, lowering intentions to resist sexual advances.” ( Testa, Tamsen, Livingston, Buddie, 2006) However, this study focuses on consensual yet unprotected sexual intercourse.
According to Alcohol Myopic Effect (Steele, Josephs, 1990) ‘alcohol intoxication decreases the amount of information that individuals can process.’
One of the study participants describing a hook-up particularly constructs the role of the inebriated woman(herself) as the receiver of the man’s actions, hence victimizing herself and shifting blame.
“But as a female, when you’re in the heat of the moment, that’s how they get you. You go, fine f*ck it just put it in, you’re hot and ready,……. because as a man, its like a mindgame, they get you, …….. you aint thinking at this point, … That’s how you end up having sex without a condom”
She justifies this lack of agency as a gendered difficulty in decision-making.
“And as females, and I even hate to say this, our judgement is very blurred at that moment, because we’re in heat, and we’re ready to go, we’re not thinking.”
According to a Psychology study at the University of Washington revealed that “….alcohol’s focusing effect acts in conjunction with pre-existing individual perceptions to influence cue salience directly and sexual risk intentions indirectly.” (Davis KC, Hendershot CS, George WH, Norris J, Heiman JR, 2007) This suggests that inebriated judgement is not simply impaired, but skewed distinctly towards the participant’s individual perceptions.
All of the participants shared ‘Slip-up’ as the most common reason for potential inconsistency in using condoms due to spontaneity. Often couples experience uncertainty of their plans, hence higher possibilities of being unprepared at the time. While two of the participants were on birth control, one of them was using no method of contraception at all in a spontaneous casual date.
1.3. Gendered responsibility
Most participants shared the responsibility of contraception, with the woman taking preventative measures of birth control and the man would use condoms for double protection. These relationships were discussed with the language of “we” and highlighted open-communication about the topic.
“Cause we both agreed that it was kind of important that that issue doesn’t come up.”
One of the participants explicitly stated her perceived male responsibility to bring condoms. She expressed the most inconsistency in the use of contraception and said that it was a decision relying on whether or not her partner prompted it right before penetration.
“Now, depending on the type of guy, he’ll stop, grab one from his pocket and grab one from his wallet or wherever its at and it’ll…that’s how you know he’s on his stuff, like ok, he uses safe sex.”
Even though she answers in an urgent tone, “Oh I respect him so much.” in response to how she feels if a man does stop to take a condom, it is not her first instinct to do so herself.
On the other side, it emerged that the consequences of nonuse of contraception are unanimously perceived to be borne by women alone.
“like specially for women, you bear most of the risk. That’s just true across the board. And should pregnancy come from it, society says you’re most responsible for it. They’re not. So guys can walk away you can’t.”
2. Planned Decisions
These decisions refer to actions that are thought-out and deliberated amongst the partners, often reflecting an open-communication and collective decision-making. Planned decisions could also be individual, if anticipated well in advance by one of the participants.
2.1. Relationship Dynamics
The seeming discrepancy presented in the previous insight is addressed and justified by all the participants through the dynamics of their relationship. I have identified a framework of relationship dynamics and their role in contraceptive decision-making. In the case of the study participants, their current relationships and retrospective instances of teenage dating were discussed. The types of relationships discussed can be classified as follows:
2.1.1. Exclusive Relationships:
Partners in relationships they perceive as exclusive and long-term (subjective durations of time based on personal experience) are more likely to deviate from using condoms, owing to mutual trust. “Relationship duration was negatively associated with consistent condom use, but the effect of duration was explained by feelings of relationship importance.” (Manning, Flanigan, Giordano, Longmore, 2009).
One of the participants directly related exclusivity and trust to being okay with not using contraception.
“We could be 6–8 months in and we happen to switch it and not use one, I don’t have a problem with that. Now if I’ve only known you for a month and some change and you wanna raw dog it we got a problem.”
She also stated followed this with a clear opposition to unprotected casual relationships.
On the other end of the spectrum, the two other respondents were practising double-protection, even in exclusive relationships. ‘Double-protection’ is used here to refer to being on birth control and still using condoms. Another commonality in these two participants was that they received formal sex education at schools that followed an abstinence-only curriculum(Texas and Indiana). One of them felt confident to state that “We’re both clean.” in regards to STDs and claimed to be using condoms primarily to ‘protect herself from pregnancy’. Even though both of them were not abstaining from sexual activity until marriage, their perceptions seemed to be affected by what they had learnt at school. Abstinence-only curriculum promotes the idea that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects, as stated under Section 510 of Title V of the Social Security Act. School-based sexuality education similarly focuses on the harms versus the pleasures of sex (Connell, 2009; Goldman, 2008), especially for girls and young women (Fine, 1988). As a result, they displayed signs of extreme paranoia around pregnancy and one of them referred to it as ‘the hard way’ to learn whether or not her methods of contraception are efficient. This also indicated her non-reliability on birth control as well as condoms, when used without the other.
The other participant who received information from formal sex education and a brief conversation with her parents referred to sex education as a ‘Scare-tactic’. She further illustrates her fear and shares why she uses double-protection too.
“So I fought with my mom and got on birth control when I was 16 and I still use condoms as an extra precaution because I was so terrified of becoming pregnant at a young age. We were taught that it’s the worst thing that can happen to you in school, I think it’s why I still don’t think I will ever want children.”
Contrary to the results of the study by Manning et al in 2009, my small sample suggests monogamy in relationships may or may not contribute to the nonuse of contraception. Individual perceptions are more likely to be the determinant, supported by the perceived quality of the relationship.
2.1.2. Casual Dating
In the stories shared by the participants, casual relationships referred to either short-term dating, one-night stands and open relationships where there was the possibility of multiple partners. In these cases, participants showed more agency in decision-making.
“In the process of stopping him going down my pants, I got out of bed and grabbed one. I didn’t even give him the chance to think about whether he had one or not, just because I don’t know you like that, I’ve only been talking to you for maybe 3 weeks and this just decided to happen. So it all depends, for me, it depends on my relationship with you.”
This scenario has been researched previously by scholars, establishing an inverse relationship between contraceptives and trust in relationships. Greater contraceptive use in casual sexual relationships may be associated with less trust and commitment to their sexual partners, resulting in more need to protect themselves from the potential risk of a sexually transmitted infection. (Manning et al. 2009)
2.2. Pleasure and sensation
Another reason for not using condoms was “Pleasure deficit” (Higgins, Hirsch, 2007) that either partner may experience. In my research, it was brought up as a comfortability issue by the participant, who then explored alternative methods along with her partner. This was a mutual decision in her exclusive long-term relationship.
2.3. Expectations from life and relationship
One of the participants said the only acceptable instance to avoid contraception is when a couple is seeking future prospects of a family and are ready to take responsibility together.
“..for me personally I think it’s important because of certain life goals like especially for women, you bear most of the risk.”
This concept is reinforced by the other participant who insists on double-protection as she is ‘terrified of becoming pregnant at a young age’ which can be interpreted as at a time when her expectations do not match the potential consequences.
3. Compulsive Decisions
Compulsive is defined as uncontrollable or urgent, that means these decisions do not present many viable options. The user has to resort to the only option they have, even if they may or may not benefit from it.
3.1. Cost of contraception
Even though all participants had similar access to resources (no one stated a lack of resources), some of them had clearly been investing way more in contraceptives than the others. Two of them had explored more than 3 methods of contraception, like IUD, Vaginal Ring, birth control pills, condoms and Arm Implant. While the other participant had been on birth control for a short while in her teens and had discontinued it due to physical rejection.
One of the participants shared,
“To get an IUD implemented, it’s about a $1000 but it lasts for 5 years. Which I can tell you is cheaper than my Nuva Ring. Long-term and short-term. That was about $100/month.”
Even though she shared her relative satisfaction with her latest contraceptive, such costs of female contraceptives could be unaffordable to various populations, who would be compelled to avoid contraception and use other clinical irresolute methods such as Withdrawal(also known as pull-out) and Fertility Awareness(also known as Rhythm).