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December 26, 2012 | Posted By Lisa Campo-Engelstein, PhD

As I have written about before in this blog, although I fully support the requirement that insurance companies cover contraceptives without a co-pay, this new law will not solve many of the social and gender inequalities in the reproductive realm. In a previous blog, I discussed how this law conflates reproduction with women and ignores men. Here I want point out how there remains a social perception that women cannot be trusted with contraception and enumerate five factors that contribute to this perception. 

First is the high rate of unintended pregnancies—almost half of all pregnancies in the U.S. are unintended. According to some calculations, a woman can expect to have 1.42 unintended pregnancies by the time she reaches 45. Despite our recognition that no form of contraception is 100% effective, the existence of so many unintended pregnancies leads us to question women’s competence with contraception. 

Second, and further eroding trust, is the knowledge that many women are unhappy with their contraceptive options, sometimes leading them to inconsistently and incorrectly use contraception. In fact, half of all unintended pregnancies occur when people are using contraception. Women’s dissatisfaction with available contraceptive methods is reflected in the fact that most types of contraception have discontinuation rates approaching fifty percent after one year of use. Women who are dissatisfied with their contraceptive method are at high risk for experiencing a gap in contraceptive coverage and, at any given time, between 9-16% of sexually active women are not using any type of contraception. 

Third, the cultural belief that women who use contraception are always prepared for sex and therefore must be sexually promiscuous leads some women to risk unintended pregnancy rather than use contraception. The salience of the virgin/whore dichotomy and the no-win dilemma is creates for women—if they contracept then they are viewed as sluts, but if they do not contracept, then they increase the probability of pregnancy—and may diminish their trustworthiness to use contraception. 

Fourth, there is a cultural fear that women become pregnant deliberately to "trap" men. In other words, some men worry that women lie about their contraceptive use because they believe becoming pregnant will force men to commit to a relationship with them. The belief that women are deceptive about their contraceptive use diminishes their contraceptive trustworthiness even more. 

Fifth, until the introduction of the female contraceptive pill in the 1960s, men were generally seen as the ones responsible for contraception because contraceptive use was tied to the act of sex itself, sexual knowledge was synonymous with sexual experience, and dominant gender roles aligned masculinity with contraceptive responsibility. Although both women and men today tend to relegate contraceptive responsibility to women, the long historical association between contraceptive responsibility and men may still play a role in the social perception that women are not trustworthy with contraception.     

The perception that women are untrustworthy with contraception contributes to the resistance to the new law requiring insurance companies to cover contraception without a copay: if women cannot be trusted with contraception, then why should we make it readily available and free of charge to them? However, while the list I have provided of factors that contribute to this perception is by no mean exhaustive, it is worth acknowledging that many of these factors are social reasons and thus are factors that can change. As traditional gender norms, such as women who are sexually active are whores and women try to trick men into marriage through pregnancy, dissipate, it seems likely that there will be greater trust for women using contraception and greater support for this new law.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Reproductive Medicine, Women's Reproductive Rights

Comments

Thiago

Thiago wrote on 02/11/13 1:28 AM

Adrienne,I've read that even though Bush saingficintly increased federal funding for abstinence only programs, funding for contraception & safe sex type programs still far outstripped this amount. One article</a> I read stated that in 2002, funding for safe-sex programs outpaced abstinence-only programs by a 12:1 ratio. Another article stated that in 2006, funding was still in favor of safe-sex programs. Your take?Also, I rarely read any articles that deal with the constitutionality of federally sponsored sex ed programs, whether abstinence-based or safe sex/contraception based. It would seem to me, based on a cursory reading of the Constitution, that this is a matter for individuals, families, churches, nonprofit groups, private clinics, and at most, state governments to address. I fail to see federal jurisdiction in this arena, as stipulated in the Constitution. What do you think?

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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