The secrecy of . . . contraception

Ireland has a complicated and unsettling relationship with sex and family planning, so the recent launch of a free contraception scheme for women aged 17–25 was a welcome step forward for the right to choose birth control during reproductive years.

The scheme includes access to a doctor to discuss contraception options and avail of repeat prescriptions free of charge at participating pharmacies; fittings and removals of implants, IUDs or IUSs; check-ups and follow-up care; and emergency contraception.

And yet, while it is most certainly a positive move, it cannot address all of the barriers faced by women in accessing contraception. Traditional beliefs and attitudes remain embedded in society and culture which means the necessity to navigate a stigma around reproductive health still exists.

“Contraceptives are about choice and bodily autonomy for women and people who can get pregnant, and unfortunately these have always been and continue to be profoundly contested terrains,” says Karen Sugrue, psychotherapist and sociology lecturer in TUS Limerick. “To paraphrase the brilliant Mona Eltahawy, they go to the heart of defying, disobeying and disrupting patriarchy because contraceptives empower people to choose the kinds of life they want to lead and how they wish to express their sexuality.”

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The stereotyping of expectations and the social significance of responsibility continue to emphasise the behaviour of “good women” supposing that the use of contraception suggests promiscuity and irresponsibility. This stigma can hinder a person’s sexual and reproductive health with women appearing to face an increased stigma, fear of judgment and anxiety in this instance.

“There are still a lot of old sexist tropes and narratives about women who are sexually empowered and that includes carrying condoms,” says Sugrue. “Phrases like the ‘walk of shame’ are still used to describe women – but not men – walking home the morning after a sexual encounter and there is still a strong social expectation that women would have fewer sexual partners than men.

“These ideas are based on very old, ingrained ideas about what women’s sexual behaviour should look like and these ideas are not very different from what they were a generation ago, which is very disheartening.”

The health and social impacts of contraception and choice are among the world’s greatest public health achievements and yet mired by a complicated shame and labelling of those who use contraception to experience their sexuality. What is important is finding a contraceptive option that works for an individual and not having to justify their actions or choices.

[ The secrecy of periods: communication about menstruation is culturally constricted ]

“With the fall of Roe v Wade in the US, we are reminded that access to contraceptives can be a life or death issue for people who can get pregnant and how contraceptives and abortion services are all part of normal healthcare,” says Sugrue. “A huge part of what we voted for in 2018 was access to free contraceptives and a robust programme of education to be brought into the primary and secondary curricula.

“Five years on, we are still waiting for the new RSE [Relationship and Sexuality Education] programme to be fully implemented, resourced and rolled out with appropriate training for teachers, and we cannot hope to address stigma until we normalise discussions about choice and consent from junior infants to Leaving Cert.”

Programmes such as Debunking the Myths, a sexual health education programme for teenagers, a collaboration between the Royal College of Surgeons in Ireland and the Rotunda Hospital, aim to dismantle the myths surrounding sexual health. Understanding and being informed about sexual and reproductive health will continue to support the dismantling of sexual stigma.

The gender inequality in cost and burden can only be resolved by State funding to remove the cost barrier of access to and choice of contraceptives

—  Dr Ahmeda Ali

“With holistic and inclusive sex education scheduled to be introduced into Irish schools from 2023 onward, and the widespread availability of consent classes, this stigma will hopefully become a thing of the past,” says Dr Ahmeda Ali, GP with webdoctor.ie. “Shame and stigma stem from silence and lack of knowledge around sex and as we empower people with knowledge, they can understand the spectrum more on a personal level. Locations that teach abstinence only or refuse to provide sex education often have high rates of unwanted pregnancy, specifically teenage unwanted pregnancies.”

A review of international sex education curriculums by Unesco published in 2018 showed that, internationally, comprehensive sex education results in delayed initiation of sexual intercourse, decreased frequency of sexual intercourse, decreased number of sexual partners, reduced risk-taking, increased use of condoms and increased use of contraception.

Dr Ali recognises that the barriers to contraceptive access and long-lasting reversible contraception (Larc) uptake can include lack of awareness of contraceptive options, regional disparities in the quality and availability of services, stigma and lack of confidentiality, and lack of provider training in Larc insertion methods.

“The cost burden of contraception falls on women significantly more than on men,” says Dr Ali, “and the impact of an unintended pregnancy, whether it is continued or not, is also significantly harder on women. The gender inequality in cost and burden can only be resolved by State funding to remove the cost barrier of access to and choice of contraceptives.”

“Women do the overwhelming share of work associated with sexual reproductive health because it has always been framed as being entirely their responsibility,” says Sugrue. “It falls into the category of ‘women’s work’, alongside care work, worry work, domestic tasks and emotional labour. Gender and sexuality are the most pervasive and bitterly contested domains of oppression by the powerful. We are seeing this around the world right now as hard-won rights and freedoms are being stripped in the areas of gender and sexuality.

We need to contact our TDs and impress upon them the urgent need to fund, support and implement a mandatory and robust RSE programme

—  Karen Sugrue

“Freedom to love and present ourselves to the world in any way we choose should not in 2023 be revolutionary, and yet it is. An enormous focus of hate and hostility on the trans and non-binary community lies in their challenge to the operation of the systems of oppression. It is an act of enormous revolutionary power and bravery to live a life that doesn’t easily fit into the social categories that have been laid out for us.”

Sugrue recognises that deconstructing and freeing ourselves from the old gender norms and expectations will benefit everyone, particularly in the realm of sexual health and sexual freedoms.

“But we will have to fight for every inch of ground and we must start with education,” she says. “We need to contact our TDs and impress upon them the urgent need to fund, support and implement a mandatory and robust RSE programme.”

The secrecy of . . .

1. Periods
2. PND
3. Contraception