Sociology of Contraception

Modern contraception has caused a social revolution in the history of humankind. This article discusses sociology and the sociology of contraception. It focuses on the expressed global need for contraception and its social, health, and economic benefits. Also covered are issues surrounding a culture of contraception, including sexism in the medical profession, contraception for minors, morality, male contraception, iatrogenic medicine, and long-term contraception such as sterilization.

Keywords Contraception; Feminist; Iatrogenic Medicine; Long-term Contraceptives; Sexism; Sexual Revolution; Sexually Transmitted Disease; Social Institutions; Sociology; Sterilization

The Sociology of Contraception

Overview

Sociology is the study of human behavior in society, including its social institutions and how they develop and change over time. The sociology of contraception then, is the study of how people behave in their sexual and reproductive lives and how contraception has altered that behavior. Sociologists are interested in emerging trends in population growth and the impact of the advent of contraception. Sociologists also study how contraception changes the lives of individuals and the structure of the family. They research the differences in attitudes between men and women regarding contraception.

Global Population

Historically, large families were desirable: the more children in a family, the more chances for the family line to continue. With much higher death rates at an earlier age, people tried to have as many children as possible. A large family meant more helping hands on family homesteads and farms. But things began changing in the twentieth century with the world population exceeding six billion, and with an estimated 8.2 billion expected by 2025 (United Nations Population Fund, 2013). Sociologists worldwide are studying the effects of the global population explosion (Macionis, 2007).

US Population Trends

When the United States was an agrarian society, children had economic value, and birth rates American cities trended lower. In the nineteenth century, birth rates began to go down throughout the country due largely to urbanization. With farmlands diminishing, there was not a need for the extra help on the homestead that having many children provided. By 1930, because of the Great Depression, the US birth rate had fallen to about a third of that recorded in 1800. At the time, the most widely used methods of contraception, limited as they were in success, were coitus interruptus, douching, and the use of condoms.

Following World War II, a baby boom exploded, almost in reaction to the low birth rates of the Depression era. Some researchers argue that with good wages, a strong home construction market, and fathers home from the war fronts, Americans felt they could afford to have children like never before. But others point to inadequate contraception and a high failure rate of 18 to 23 percent for condoms and other devices, notably the diaphragm.

Reliable contraception did not become available until 1960 with the birth control pill. With that powerful method, the US birth rate dropped in the 1960s and 1970s, even if economically people felt that their lifestyles were comfortable. It is unlikely, according to researchers, another baby boom will occur in the United States. Modern contraceptive devices offer success rates in preventing pregnancies up to 99.8 percent (Centers for Disease Control and Prevention, 2014).

The Sexual Revolution

Modern contraception has caused a social revolution. The search for methods to control fertility while still enjoying sexual contact has perhaps been ongoing, but a necessary and workable solution was not found until the twentieth century. To solve the problem of overpopulation, family planning has become necessary worldwide. A side effect of family planning to stem the tide of overpopulation has been the ability for people to have sex without worrying about pregnancy (Benagiano, Bastianelli & Farris, 2007).

Global Need for Better Contraception

Because the worldwide average number of children born to each woman, known as the fertility rate, has declined steadily over the decades, some believe that the overpopulation problem has been resolved. But the global population is still increasing by about eighty million people each year. And many countries have very young populations. So, while highly effective contraception is widely available to women in the United States and other high-income countries, women and men in many developing countries still lack adequate access to contraceptives, which can create severe social and health problems (Potts, 2000).

In some parts of the world, almost all of it in developing countries, rapid population growth is expected to continue for many years. These are the same countries where family-planning services are wanted but highly controversial at the same time. Many countries lack safe food and water supplies as well as medical, financial, and educational institutions, which affect the quality of life of their people.

Contraceptive use has slowly begun to take effect, but often, contraceptives are too expensive or not available to those who need them. The World Health Organization (2014) estimates that each day there are 800 deaths related to pregnancy complications and childbirth could be avoided if all women worldwide had access to contraceptive services, as well as adequate pre- and postnatal care. Maternal mortality rates are particularly high for poor women, who have the least access to contraceptives. Unintended pregnancies increase the risk of suboptimal prenatal care and leave new mothers feeling overwhelmed and underprepared. In some countries, women are forbidden to have access to the contraceptive pill. Even in Ireland, condoms could not be legally obtained until the 1990s.

Poor countries either cannot afford the cost of manufacturing, distributing, and promoting contraceptives, or their governments do not see family planning as a priority. Sometimes, the only way that the people who live in these countries can receive help with family planning is by receiving donations from foreign countries (Potts, 2000).

Positive Social, Health, & Economic Effects of Contraception

Population Control

If large families were necessary to ensure lineage, then contraception was not desirable and the prohibition was emphasized by social institutions. Members of certain religious groups were historically discouraged from using contraception or even from having sexual contact without the desire for conception.

Infanticide, or the killing of newborn children, occurs at higher rates in countries with extremely high rates of poverty and overpopulation. Female infants are more likely to be victims of infanticide, due to certain cultural values that make male children more desirable and less of an economic burden. With overpopulation as a concern, humanistic groups and even religious institutions themselves are beginning to change attitudes about contraception. Because people are now living longer thanks to modern technology, the world's population has exploded and population control has become important.

Health

There are other positive benefits for using contraception than controlling population growth. Some people want to plan having families around educational goals and financial concerns. Some women are not physically healthy enough to bear children and contraception helps protect their safety as well as the safety of an unborn child. Older women, as well as very young pregnant girls, risk complications such as birth defects and even death of the infant or the mother (Macionis, 2007). Contraception, therefore, has had positive health benefits by also reducing the need for abortions. And some forms of contraception, such as the condom, have contributed to the reduction of sexually transmitted diseases (Benagiano, Bastianelli & Farris, 2007).

Economics

Contraception has had several positive effects on the economic lives of women. Effective and affordable contraception has given women the opportunity to choose whether and when to conceive and bear children. This, in turn, has allowed women to attain better educations and employment training.

Applications

While contraception methods have responded well to concerns about overpopulation as well as to the social, health, and economic well-being of people, there are several issues surrounding the culture of contraception. Conflict over the issue of contraception has existed at least since 1916, when Margaret Sanger, the founder of Planned Parenthood, was jailed for offering advice and contraceptives to married women in Brooklyn. Modern controversies include issues such as sexism in the medical field, teenagers’ access to contraceptives, and contraception access in prisons.

Sexism

Women often experience the health care system as paternalistic, in which their own experiences and knowledge are ignored or downgraded. Historically this has been true especially in the areas of pregnancy, childbirth, and contraception.

Because motherhood is considered a natural role for women, abortion of unwanted pregnancy is often seen as unnatural and even terrible. Contraceptive use is relatively widespread in most Western societies, but in developing societies, such as Central and Eastern Europe and sub-Saharan and West Africa, access to contraception is limited. Abortion rates are the highest in the world in these societies and, in the early 1990s, the number of abortions equaled or was higher than the number of live births in some countries. During the 1990s, as contraceptive methods became more easily available, the number of abortions decreased. In fact, the global abortion rate has been gradually decreasing since the late twentieth century. The abortion rate is typically lower in regions with liberal abortion laws; restrictive abortion and contraception laws are not associated with lower abortion rates (Sedgh, et al., 2012).

Teen Sex & Contraception

In an attempt to reduce teenage pregnancies, many governments promote and distribute contraceptive pills to students, even without the parents’ permission. This situation brings up two issues: morality and health safety. Some critics argue that it is the parents' place to monitor and regulate their children's sexual activity. Others argue that a strong hormonal drug being given to young girls could have long-term negative effects on her health and development. Even contraceptive devices such as intrauterine devices (IUDs) can have complications or side effects, and there is no contraceptive, except the condom, that will protect young people from sexually transmitted diseases.

If governments, including the US government, are not handing out contraceptives, they are at least attempting to educate children about contraception and safe sex. For example, in India, parents and teachers are angered about sex education in schools that includes information about contraceptives and about sexually transmitted diseases, claiming that it goes against Indian cultural values and is an attempt to impose Western cultural values on Indian society. But in India alone, 88.7 percent of the HIV/AIDS cases occur among young people aged fifteen to twenty-nine years old (National AIDS Control Organisation, 2015).

Religious Moral Teaching

Some parents, whether for religious or personal reasons, are not talking with their children about sex, family planning, and birth control. According to Mark Regnerus (2005), African American families belonging to Protestant denominations talk more openly with their children about sex and birth control than do families from other Christian denominations and Jewish families, although these families will talk about the morality of sex with their children. Moreover, all parents talk about sex and birth control more with their female children than with male children.

While religious institutions once took an active role in church members' sexual lives by prohibiting contraception and encouraging sexual relations for the purpose of procreation, many contemporary religious parents are not discussing sex and birth control with their children productively (Regnerus, 2005). Often another social institution, the school, has taken on the role of sex educator, but with resistance from parents who believe it is their duty to provide such counseling.

Male Contraception or Fatherless Children?

Researchers at the University of Massachusetts Medical School and Spermatech, a Norwegian biotechnology company, are working on developing a male contraceptive pill. But social scientists argue that there must be a change in the attitudes and identities of men and women in many societies for the male contraceptive pill to be widely accepted. For the most part, avoiding an unwanted pregnancy is considered to be the duty of the woman. Women, in turn, are not sure they are willing to turn the responsibility for contraception over to their male partners. If there is a mistake, the women would bear the brunt of the responsibility for an unwanted pregnancy (Roots, 2007).

Iatrogenic Medicine

Some medical intervention is iatrogenic; it causes more harm than good with the effects of the treatment worse than the original illness. There have been certain types of contraceptives that have caused iatrogenic injury, such as the contraceptive pill sold under than brand name Yaz, which significantly increased women’s risk for developing blood clots. However, the rate of iatrogenic injury from the use of contraceptive pills is extremely low (less than 0.02 percent), with women over the age of thirty-five years facing the highest level of risk. Women who smoke and take an oral contraceptive are at even greater risk for cardiovascular complications. According to a 2012 study published in the New England Journal of Medicine, some formulations of oral contraceptives have been found to increase women’s risk of having a heart attack or stroke, but in absolute terms the risk remains extremely low because women under the age of fifty years (of reproductive age) rarely have heart attacks or strokes (Lidegaard, et al., 2012). A number of health benefits of oral contraceptives have been identified, including reductions in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and ovarian and endometrial cancer. Some women may experience side effects while taking an oral contraceptive, such as bloating, lowered libido, and nausea. While women deal with the side effects of and responsibility for contraceptive devices, there has been little attempt to develop and market oral contraceptives for men. Therefore, a woman, rather than rely on her partner or risk pregnancy, will choose contraceptive methods that are available.

Women must also rely on doctors for information about what is available. However, Abbot, Wallace, and Tyler (2005) indicated that doctors resent it if patients question their advice or seem to know more than the doctors themselves. Women are also restricted by their partner’s preferences. Many men do not like to use condoms, believing it spoils the pleasure of the sexual act, while the contraceptive pill is less intrusive, at least for men. While contraception allows women to make choices about pregnancy, some critics argue that contraception has also maintained medical and social control over women by placing the onus of responsibility largely on women (Abbot, Wallace & Tyler, 2005).

Several medications and devices are available to provide long-term contraception for women. These options offer from one month to five years of contraceptive protection. Some women are voluntarily opting for long-term contraception rather than the more permanent solution to pregnancy prevention of sterilization.

Contraception as Punishment

Three weeks after one of the first long-term contraceptive implants was approved by the US Food and Drug Administration, it was used as part of the sentence imposed on a woman convicted of child abuse. This creates a form of punishment, changing the purpose of the device from something to give women more reproductive freedom to something that will control them with governmental power. Laws have since been enacted to prohibit contraceptive sentencing, and the contraceptive in question, Norplant, was discontinued in the United States in 2000. However, the practice of contraception as punishment could become a reality elsewhere and recalls the forced sterilizations of patients with mental illness that occurred in the early twentieth century. Both the American Medical Association and the American Bar Association oppose all forms of contraceptive punishment on the grounds of a person’s fundamental right to refuse medical treatment, the US Constitution’s protections against cruel and unusual punishment, and the fact that coerced or forced contraception does not prevent a woman from committing child abuse, therefore making such punishment arbitrary. The developer of Norplant, Dr. Sheldon Segal, condemned the medication’s use as punishment, arguing that Norplant “was developed to improve reproductive freedom, not to restrict it” (American Civil Liberties Union, 1994).

Voluntary Sterilization

The most effective and permanent method of birth control, sterilization has been historically used as an involuntary procedure performed on individuals with disabilities and criminal histories in a grave violation of human rights that occurred in the United States and worldwide in the early twentieth century as part of the eugenics movement. But for hundreds of thousands of men and women, sterilization is a voluntary procedure with a number of benefits.

Sterilization for a man or a woman involves blocking the path of the woman's egg or the man's sperm, from reaching the crucial place where conception can occur. No organs are removed, and sexual intercourse is still possible after sterilization. For women, the fallopian tubes are tied off so that no egg can enter the uterus from an ovary in a procedure known as tubal ligation. For men, a piece of the tube known as the vas deferens is cut and tied off in a procedure known as a vasectomy. If a person decides later on to have children, these procedures can be reversed with a 40 to 85 percent success rate, depending on the patient’s age, the length of time between the initial procedure and its reversal, and the skill of the surgeons performing the initial procedure and its reversal. These procedures are extremely beneficial for individuals who do not want to have children and need a permanent form of birth control, older women for whom pregnancy would be a significant health risk, and for individuals with a genetic disorder or a partner with a genetic disorder who have decided they do not want to risk passing the genetic risk to a child.

Conclusion

In the United States, more than 99 percent of women aged fifteen to forty-four years who have ever had sexual intercourse have used a least one form of contraception. In 2013, more than 60 percent of American women of reproductive age were using a contraceptive method. Approximately two-thirds of women who use contraceptives rely on non-permanent, primarily hormonal methods, such as the pill, patch, or vaginal ring. Among all contraception users in the United States (men and women), 27.5 percent use oral contraceptives, 26.6 percent rely on female sterilization, 16.3 percent use male condoms, 10 percent rely on male sterilization, and 5.6 percent use an intrauterine device, or IUD (Guttmacher Institute, 2013).

The Global Issue of Health & Overpopulation

The proportion of married women who use contraception rose from 55 percent to 63 percent between 1990 and 2011. The proportion of married women with an unmet need for family planning declined from 15 to 12 percent worldwide but remained about 25 percent in forty-two countries, most of them in Africa (Alkema et al., 2013). In an age of rapid population growth, overpopulation, and dwindling natural resources, many people want fewer children and, thus, smaller families. But the size of one's family often depends on available contraceptive options. This is the challenge for an estimated 143 million couples in developing countries who want family planning but had no reliable access to methods of obtaining it (United Nations, 2013). The solution, however, is not only ensuring that those who want contraceptives have the education and the income to pay for it.

Contraception, then, needs to be freely available and less costly. Men and women must be educated and informed so that they do not believe untruths such as that the contraceptive pill causes cancer. The world's population is young and therefore, the global population will continue to increase, even with contraceptive use and family planning. But the health and safety of women can be protected by keeping them and their infant children safe from an unnecessary death (Potts & Campbell, 1994). Further, sociologists Nicholas J. Hill, Mxolisi Siwatu, and Maury Granger (2012) have identified widespread societal benefits of increased rates of contraceptive use, namely a significant reduction in the rate of violent crime since the 1970s, when the use of oral contraceptives was widely adopted; they posit that increased access to contraception has significantly reduced the number of unwanted children born to unprepared or apathetic parents, thereby reducing the number of individuals with high potentials for engaging in criminal activity and contributing to the dramatic reductions in the crime rate witnessed in the 1990s.

Terms & Concepts

Contraception: A device or drug for the prevention of conception, or pregnancy.

Feminist: One who believes in the social, political, and economic equality of both sexes.

Iatrogenic Medicine: Drugs or procedures with side effects that cause more harm than the condition for which they are used to cure or treat.

Long-Term Contraceptives: Methods of birth control that can be effective for up to five years at a time.

Sexism: Prejudice or discrimination based on a person's sex.

Sexual Revolution: A period during the 1960s and 1970s during which sexual attitudes and behavior changed dramatically in Western cultures, particularly relating to premarital sex and the use of contraceptives.

Sexually Transmitted Disease: An infection that is spread through sexual contact.

Social Institutions: Interrelated social groups or arrangements that teach and uphold a society's cultural values and beliefs; education is a social institution, for example.

Sociology: The study of human social behavior, particularly in groups, or categorizations.

Sterilization: A surgical procedure on a man or a woman that prevents conception; voluntary sterilization is intended to be permanent.

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Suggested Reading

Guttmacher, A. (1995). Hopes and realities: Closing the gap between women's aspirations and their reproductive experiences. New York, NY: Alan Guttmacher Institute.

Harvey, P. (1999). Let every child be wanted: How social marketing is revolutionizing contraceptive use around the world. Westport, CT: Greenwood.

Schoen, J. (2005). Choice and coercion: Birth control, sterilization, and abortion in public health and welfare (Gender and American Culture). Chapel Hill, NC: University of North Carolina Press.

Tone, A. (2012). Medicalizing reproduction: The pill and home pregnancy tests. Journal of Sex Research, 49, 319–327. Retrieved January 9, 2015, from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=77190761&site=ehost-live&scope=site

Waltermaurer, E., et al. (2013). Emergency contraception considerations and use among college women. Journal of Women’s Health, 22, 141–146. Retrieved October 28, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=85401152