Contraception is a public health issue with worldwide
prevalence, complicated by difficulties with access, proper use, stigma, cost,
and more. Unfortunately, many
misconceptions exist that limit use of birth control, whether through public
policy or individual choice. Public
policy that restricts birth control access is very difficult to fight, being
that it is grounded in social norms and cultural beliefs of the majority or of
the governing party. For example, I have
been researching women’s health care access in Italy, where emergency
contraception is still prescription-only; this barrier is even more problematic
when you consider the time-sensitive nature of emergency contraception. One study found that some Italian doctors
will refuse to write prescriptions because they misunderstand the medical
mechanism, considering it to be like an abortion rather than a true prevention
of fertilization; this forces women to try clinic after clinic until they can
finally get a script for what should be an easily accessed method of pregnancy
prevention (Bo, Casagranda, Charrier, & Michela Gianino,
2012).
In addition to public policy challenges, personally- or
societally-held misconceptions can limit birth control use in practice, even if
it is not limited by policy. A recent
article from Science Daily (“Fear of
gaining weight may influence contraception choices,” n.d.) discussed the very real fear
that many women have of gaining weight due to oral contraceptives, and how this
deters them from using this method. The
study they referred to (Bhuva, Kraschnewski, Lehman, & Chuang, 2016) found that women who were
overweight or obese were more likely to use either highly effective forms of
birth control (IUD or implant), or minimally
effective forms (condom, withdrawal) to none at all, but had lower rates of
pill use. Pill usage has been linked in
the public discourse to weight gain, but literature review has shown no true
correlation (Gallo, Lopez, Grimes, Schulz, & Helmerhorst,
2006). I have many friends who have stopped or never
started oral contraceptives because a fear of weight gain, but in reality any
initial weight gain is usually due to a shift in water weight and normalizes
after a few cycles of the pill. The fact
that this study showed that overweight or obese women tended to avoid the pill
is concerning, because some of them ended up using less effective to no method
of contraception. Just last week I was
reading about factors that influence pregnancy outcome: pregnancy intention
leads to better outcomes for mother and baby, but more than half of all
pregnancies in the U.S. are unintended (Frayne et al., 2016). This means we must fight any and all
misconceptions about birth control that are preventing women from using it, in
addition to access and policy barriers, here and throughout the world. Proper education about contraception, free of
misconception, myth, or stigma, is vital.
References
Bhuva, K., Kraschnewski, J. L., Lehman,
E. B., & Chuang, C. H. (2016). Does body mass index or weight perception
affect contraceptive use? Contraception.
Bo, M.,
Casagranda, I., Charrier, L., & Michela Gianino, M. (2012). Availability of
emergency contraception: A survey of hospital emergency department
gynaecologists and emergency physicians in Piedmont, Italy. The European
Journal of Contraception & Reproductive Health Care, 17(5), 373–382.
Fear of
gaining weight may influence contraception choices. (n.d.). Retrieved December
3, 2016, from https://www.sciencedaily.com/releases/2016/11/161117101728.htm
Frayne, D.
J., Verbiest, S., Chelmow, D., Clarke, H., Dunlop, A., Hosmer, J., … Zephyrin,
L. (2016). Health Care System Measures to Advance Preconception Wellness:
Consensus Recommendations of the Clinical Workgroup of the National
Preconception Health and Health Care Initiative. Obstetrics & Gynecology,
127(5), 863–872.
Gallo, M. F., Lopez, L. M., Grimes, D.
A., Schulz, K. F., & Helmerhorst, F. M. (2006). Combination contraceptives:
effects on weight. The Cochrane Database of Systematic Reviews, (1),
CD003987.
Sydney
ReplyDeleteGreat post!
I totally agree with you that resistance to contraception is a major public health problem. In addition to the political factors and the weight gain misconceptions regarding contraception use, I believe that religious factors are also important. Some may abandon the use of contraception because they consider them as a refusal to the gifts that God brings them.
Additionally, some ways of contraceptions, such as pills, require high levels of adherence which may make their use a frustrating issue. Besides, it can limit their long term use and make them ineffective. Another factor is the beliefs that they are unsuccessful based on others personal experiences.
I believe that all these factors in addition to the ones you already mentioned should be taken into consideration in order to be able to face this public health challenge.
Hi Sydney,
ReplyDeleteThis is a great post. And I agree with you that in order to increase its use we need to address any misconceptions or stigmas surrounding it. However, to answer your question from a consumer behavior standpoint if I can, the embarrassment associated with purchasing and even acquiring about contraceptives is troubling. This level of embarrassment has even be seen in many countries around the world with cultures that are not fully supportive of many birth control methods. In addition, religious beliefs, cultural tradition all come into play here as well. Looking at it from a North American standpoint, it has been found that contraceptives such as condoms in many states in the US lock their condoms where consumers need to ask for them if they wanted to purchase. In this instance, researchers were interested to see what would happen in a treatment set of stores where the condoms were unlocked and on the shelves as normal products. It was found that these pharmacies had a decrease in condom thefts as well as an increase in sales as a result in comparison to the control sample of pharmacies who kept their condoms locked in cases, as well as past months'records (Ashwood et al., 2011). All of this most likely comes into play as a result of the embarrassment associated with it. It really is concerning! Interested to see what is found in future research!