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Something more than a method
The words “contraception” or “family planning” are quite distant from
defining the relationship between the use of the method and the woman.
Talking about contraceptive methods is talking about women since they are
the ones who consult, use most of the methods, and practically take the
responsibility for this topic.
Contraceptive methods allow us to enjoy the pleasure produced by coitus, as
well as it helps us preserve ourselves from an unwanted pregnancy which
would probably end up being interrupted. In other words, it is the means by
which women can freely decide when, how and who to get pregnant with, if
that desire arises one day.
But contraception is also what allows us to separate reproduction from
sexual pleasure. Our body in its physical, emotional and mental dimension is
what brings us that pleasure.
The woman is subject of pleasure and not a physical object. Many times, in
order to achieve that pleasure, we need to change our point of view and
start feeling that the concepts regarding non-sexual - cultural education,
myths and taboos we received from our childhood are changing inside us.
Through medicine we have also been wrongly informed, because the body is
seen as a synonym of disruption, suffering, illness, and not as a source of
pleasure, communication and normality which leads us to dynamism.
A little bit of
history
Women have always been healers having a great knowledge about the use and
properties of medicinal herbs. They were the midwives who used to go from
house to house and whose secrets about health were transmitted from word of
mouth.
From the XIV to the XVII century they were labeled as witches and persecuted,
mainly being accused of giving contraceptive advice and carrying out
abortions.
As medicine was established as a university profession, women were excluded
from that practice, since they didn’t have access to university by those
times.
As a result, women from high social levels are assisted by male doctors and
the ones belonging to low social levels by healing women.
In the mid XIX century and all along the XX century, the difference between
social levels was clearly cut:
• Rich women were considered perpetually ill, weak, and delicate in every
aspect
• Working women were considered healthy, strong and robust
This is how the idea about women’s disability is created: “the woman who is
menstruating is indisposed”, “pregnancy is an illness which requires medical
intervention”, “menopause is an incurable illness, it is woman’s death
inside the woman”. The illness is considered the key of femininity and
masturbation a particular pernicious defect which provokes mental disorders.
With the arrival of Freud in the same century, hysteria is placed as a
mental illness not coming from the uterus, organ this illness is named after.
The scalpel with which feminine nature was dissected finally passed from the
gynecologist to the field of psychiatry.
Coming back to present, our bodies want to be controlled through a
population control policy, with different programs applied to first or third
world women adducing that the problem of the future of the planet is the
“overpopulation” which has to be controlled through women.
Once again, women have also a major responsibility for the future. This
responsibility mainly lies on third world women of “low social level”,
because in the first world birth rates are asked to increase.
Contraception has been developed since primitive times throughout different
cultures, religions and societies. The first writings about this matter are
Chinese and date back to three thousand years before Christ. They are about
substances such as Arabic gum (taken from acacias’ roots), which liberate
lactic acid with spermicidal properties when fermenting. The Hindus used
rock’s salt intra-vaginally for the same purpose.
Jewish tradition is reflected in the Talmud allowing contraceptive
regulations in three cases: pubescent girls, pregnant women and women
breastfeeding their babies. Contraception was carried out by introducing a
piece of wool in the vagina which worked as a cap.
In Ancient Greece and the Romaine culture, the methods were similar but only
known by a cultural and social elite.
In the Middle Age, the Islam didn’t convict birth rate control, not even
abortion as long as it was practiced in the first trimester of gestation.
Contraception was a discipline carried out not only by doctors but also by
midwives who played an essential role in medieval society regarding women’s
health care.
In that same period, and in spite of knowing all the contraceptive methods
in existence, the Catholic Church only allowed their use in very exceptional
cases.
Saint Thomas of Aquinas’s reflections in the XIII century in which he
convicted contraceptive methods have had a fundamental influence over
occidental moral, unfortunately until these days.
After the industrial revolution the idea of regulating birth rates from a
collective point of view arises, instead of the individual way used in the
Ancient times. The strategy of covering the glans penis aimed, at first, at
stopping the spread of syphilis which was threatening Europe. However, we
can consider this technique to be the beginning of modern times’
contraceptive methods.
By the end of the XIX century in Germany, the first diaphragms were
described. By those times, in England, the first spermicidal substances,
which were improved in the 20s, appeared. The first intrauterine disposals
also arose in those years, not being accepted, however, by the Medicine and
the population in general until the 60s.
In 1959, the inhibition of ovulation through the administration of a
combination of synthetic feminine sexual hormones: estrogens and
progesterone was discovered. This is how “the pill” was born, carrying with
it a social and scientific revolution, especially for women who consider it
an important achievement in their fight for freedom. However, the use
medicine has generally given to this method along these years is more
related to birth control at any cost than to women’s sexual freedom.
In the Spanish Estate, contraception was legalized in 1978 due to a
modification in the penal code. Until then, contraception had been compared
with abortive practices.
Current panorama
As we all know, there currently exist different contraceptive methods which
can be classified as follows: permanent methods are the ones which act on
the body independently from the sexual moment, that is to say that the woman
is always in contraceptive disposition (intrauterine disposals,
contraceptive pill and other hormonal methods). These permanent methods
require an important and periodical control by the doctor since they are the
ones generating most side effects on the body. With these methods,
professionals feel safer since they can control the method… and therefore
the feminine body.
The non-permanent methods are applied in relation to the sexual act and
require information and learning about their use. These methods are more
independent from the doctor, and it is the woman, and in eventually the
couple, the one in charge of them. They have a few or none side effects and
they allow a more intimate approach between the woman and her body from the
very beginning. Most of these methods are known as “barrier” ones because of
how they work: masculine and feminine condoms, cervical cap and diaphragm.
“Natural” methods such as coitus interruptus, basal temperature, etc. are
also part of this group.
Another possible classification is dividing them into reversible methods,
which when retired from the body and after some time stop producing
contraceptive effects (the pills or IUD), and irreversible methods, which as
its name indicates last forever (tubal ligation).
Women receiving
hormones for life
According to allopathic or official medicine, the hormonal methods are the
best ones in any of their forms: pill (daily), vaginal ring (monthly),
transdermic patches (weekly) or intradermic hormonal transplants (every 3
years); or either the IUD (intrauterine devices), given that, according to
statistics, they are the most effective.
But this statement is not totally true, the experience in our consultations
shows that non-permanent methods are generally effective and safe and that
women learn from their bodies without any difficulty.
Medical-scientific developments, however, have only and exclusively been
concerned with hormonal issues. As time goes by, we get “better”
combinations to administer hormones aiming at the interruption and
disarticulation of the beautiful biological structure of the feminine body.
In advanced societies, the project is: once active sexuality is initiated
during adolescence and youth, provide women with hormones to inhibit
ovulation.
The further this daily act is from women’s consciousness, the better. It is
not a question of remembering taking the pill every night because by
introducing the vaginal device the woman can “avoid thinking” about it for
the whole month. Either that method or the intrademic hormonal transplant
which will make the woman forget abut this topic for no less than three
years, would be less toxic for not being oral and therefore, for skipping
the hepatic barrier. Their toxicity will have to be verified along the time.
Hormonal contraception abusively administered for many years, with very few
or none resting periods, originates many disorders once it is abandoned,
when the feminine cycle is restored. Many times, natural ovulation is not
achieved any more.
Fertility disorders appear which added to the advanced age for maternity,
gets the woman in contact with ART (Assisted Reproductive Techniques) and
their consequent absolute overflow in the administration of hormones to
stimulate the ovaries and obtain a number of ovules exceeding the natural
amount.
It is known nowadays that for any of the assisted reproductive techniques,
even when the disorder is not associated with the woman but with the man’s
spermatic reproduction, the stimulus falls anyway, on the healthy woman’s
ovaries either for an artificial insemination or an in vitro fecundation.
Some years later, the SHT (Substitutive Hormone Therapy) appears making the
woman consume hormones again, this time in the menopausal period, to appease
the symptomatology of the climacteric period until further notice.
As far as we see, from adolescence to post-menopause, we can affirm that
women’s body doesn’t rest. If we don’t become aware of this, hormonal
stimulation will continue being part of the whole feminine fertile life.
The best method
In my opinion, the fewer side effects the method produces, the more adequate
it is, although in certain circumstances, using a hormonal method can be
appropriate for a specific woman in a determined moment of her life. In
other words, it can also be a big mistake indicating a barrier or natural
method in an inadequate moment.
Given the time of having to choose a contraceptive method there are some
parameters which should be considered and each woman will choose according
to her priorities. These parameters are:
1. Effectiveness: it depends on the one hand on the intrinsic
effectiveness of the method and on the other hand on its use which, at the
same time, has to do with the knowledge the person has about their bodies as
well as the method itself.
2. Safety: apart from the intrinsic safety of the method, safety is
also what the woman acquires when she starts feeling more confident and
“comfortable” with the method.
3. Comfort: to some women, comfort means “having nothing in mind at
the time of the coitus”, to other women it means “becoming aware of their
own wish and being able to manage contraception freely at that time”. This
is the reason why I consider it very important to take individuality into
account when giving advice about this topic.
4. Harmlessness: there is a primary harmlessness found in some
contraceptive methods such as the natural ones (barrier methods, etc.).
There is also a secondary harmlessness which has to do with how the woman
feels and manages the method according to the circumstances. For example, if
a woman who is very afraid of getting pregnant and was brought up repressing
her sexuality was directly indicated a method which requires much observing
and touching her own body, her anguish and insecurity could be increased.
The consultation
about contraception: giving and taking information
Finally, the contraception
consultation must be a space where a global view of the woman’s health
should be developed. I conceive this space not as a precise moment but as
something which is developed throughout the time, which will be different
for each woman depending on their history and experiences. Women will look
for that little formula which will lead them to the capacity of enjoying
themselves…and being able to share the joy with the other.
Natural methods are not aggressive and can be very effective, but require an
attentive and permanent contact with our bodies, which not always can be
achieved.
It is the woman in first and last place who has to choose what is more
appropriate for her in this moment of her life, counting with all the
information I provide her with.
I consider that “THE” contraceptive method doesn’t exist, the best one, the
one indistinctly applicable to every woman…and this is how I transmit it to
my patients. We will be able to find the most adequate method according to
the current moment, the time of her life and her sexuality depending on the
relationship she has with her body, if she has children or not, a stable
couple or not. I say “we” will be able to find the method because I consider
it to be a team work between the gynecologist and the patient.
The key is to listen and provide the patient with good and complete
information in order to let the woman choose as freely as possible her own
method.
Bibliography
• Cabero Roura, L. “Tratado de ginecología, obstetricia y medicina de la
reproducción”. Published by Panamericana. Barcelona, 2003.
• Ehrenreich, B. y English, D. “Brujas, comadronas y enfermeras. Historia de
las sanadoras. Published by La Sal. Barcelona, 1984.
• López de Castro, F. y Lombardía Prieto, J. “Novedades en anticoncepción
hormonal”. En: Revista Información Terapéutica. Vol. 29 Nº3 year 2005.
• Strobl, I. Fruto extraño : sobre política demográfica y control de
población. Published by Virus. Barcelona, 1994.
Article published in
Magazine Mujer y Salud Nª 20, Barcelona, winter 2006
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