In Our Control (51 page)

A lack of cultural sensitivities on the part of those offering family planning services plays a role in many places. For example, methods that require insertion or application by an often male provider are objectionable to women in certain cultures. Differing perceptions of who should be responsible for contraception are also influential in how well a given method will be adopted.

Just because a woman begins using a method doesn’t mean she will
continue: as in the United States, international studies in developing nations have found that contraceptive discontinuation is high for all methods,
³⁹
with a third of patients deserting their method within a year and half and giving it up within two. The most common reason for discontinuing modern methods, including the Pill and IUD, is concern about side effects and safety. For natural methods, accidental pregnancy is the main cause of stopping method use. Importantly,
lacking
access to a contraceptive method is not as frequent a reason for discontinuation as researchers had anticipated.
⁴⁰

Forty-three percent of people in the world today live in countries that have finished the “demographic transition”—that is, they live in places where the average number of births is at or below replacement levels.
⁴¹
This means that the population has stabilized and isn’t growing significantly or at all. Another 43 percent live in countries where population growth has slowed significantly but is still ultimately expanding, and 16 percent live in countries where growth is still high.

It is important to note that the risks of carrying a baby to term are markedly different in various parts of the world. Some estimates suggest that the risk of dying during pregnancy and childbirth in many parts of the developing world is “several hundred times higher”
⁴²
than in North America. The majority of deaths from unplanned pregnancy around the world results from unsafe abortion practices.

While certainly the risk/benefit analysis of contraceptive use changes dramatically for women living with inadequate access to health care and safe living conditions, the right to be an informed patient should be international. Greater risk of maternal or infant mortality is not an excuse for not providing patients with complete information about the safety profiles of their contraceptive methods.

Today, when it comes to anxiety about the global population, the old is new again. As food and energy get more expensive, previous fears about outstripping the planet’s resources find new currency. Food riots in over a dozen countries in 2008
⁴³
seemed like proof of impending disaster to those predicting Malthusian chaos.

While populations have declined in most parts of the world and fertility in the developing world has fallen by half in the last fifty years,
⁴⁴
overall, the global population continues to grow. In the developing world,
the size of the average family has fallen from around six children to three, but this number is still above replacement fertility (two children), and that means that the globe continues to swell by 75 million people each year.
⁴⁵
People are now living longer, which can compound the pressure being placed on the earth’s resources. This has led some to argue that family planning initiatives are more relevant than ever.

Increasing contraceptive access globally is a valuable goal as long as it is part of a broader program of improving health care access. The problem with the return to neopopulationist ideologies is that they seek to fix bigger problems of global inequality and injustice in women’s bodies.

Nearly all of the major population growth that demographers predict in the next forty years will happen in the developing world. Resource shortages don’t happen simply because poor women have babies. In fact, overconsumption in developed nations and unequal distribution of global resources that allocate more to fewer people play a much bigger role. Overpopulation is a symptom of these injustices, not the cause.

As the old saying goes, “Hope for the best and prepare for the worst.” Many people hope that recent gloom and doom scenarios of food and energy crisis will be averted by technological or agricultural innovation. Just as the dire predictions of the 1950s, 1960s, and 1970s proved significantly overstated, perhaps today’s population worries will be prevented. In the meantime, those who are concerned about ballooning human numbers should put their efforts into empowering women. Part of this project entails improving contraceptive access and making sure that women can have the number of children that they want. It also means making sure that women have access to education, jobs, and economic autonomy.

Michelle Goldberg writes, “Emancipated women become a symbol of everything maddening and unmooring about modernity. To tame them seems a first step to taming an unruly world. But the oppression of women doesn’t create order; it creates profound social deformities.”
⁴⁶
As we move toward the problems of the future, let’s hope that we can apply the lessons of the past half century without having to painfully relearn them.

Resource Guide

General Resources for Women’s Health

The Center for Menstrual Cycle and Ovulation Research,
http://www.cemcor.ubc.ca
, founded by Dr. Jerilynn C. Prior.

Feminist Women’s Health Center,
http://www.feministcenter.org

Mayo Clinic,
http://www.mayoclinic.org

Medline Plus,
http://medlineplus.gov

National Women’s Health Network,
http://www.nwhn.org

Our Bodies Ourselves, also known as the Boston Women’s Health Book Collective,
http://www.ourbodiesourselves.org

Parker, William H., with Rachel Parker.
A Gynecologist’s Second Opinion
. New York: Plume, 2003.

Planned Parenthood,
http://www.plannedparenthood.org

RH Reality Check,
http://www.rhrealitycheck.org

Sanson, Gillian,
http://www.gilliansanson.com
, an Australian’s women’s health writer and activist with an excellent website.

Scarlateen,
http://www.scarlateen.com
, a great website with information on contraception and sexual health.

On Contraceptive History

Gordon, Linda.
The Moral Property of Women: A History of Birth Control Politics in America
. Urbana and Chicago: University of Illinois Press, 2007.

Jütte, Robert.
Contraception: A History
. Cambridge, UK, and Malden, MA: Polity Press, 2008.

McCann, Carole R.
Birth Control Politics in the United States, 1916–1945.
Ithaca, NY, and London: Cornell University Press, 1994.

Roberts, Dorothy.
Killing the Black Body: Race, Reproduction and the Meaning of Liberty
. New York: Vintage Books, 1999.

Silliman, Jael, Marlene Gerber Fried, Loretta Ross, and Elena R. Gutierrez.
Undivided Rights: Women of Color Organize for Reproductive Justice
. Cambridge, MA: South End Press, 2004.

Solinger, Rickie.
Pregnancy and Power: A Short History of Reproductive Politics in America
. New York and London: New York University Press, 2005.

Tone, Andrea.
Devices and Desires: A History of Contraceptives in America
. New York: Hill and Wang, 2001.

On the Pill and the History of the Pill

Read

Bennett, Jane, and Alexandra Pope.
The Pill: Are You Sure It’s for You?
Crows Nest, NSW, Australia: Allen & Unwin, 2008.

Dickey, Richard P.
Managing Contraceptive Pill Patients
. 13th ed. Dallas, TX: EMIS Medical Publishers, 2007.

Djerassi, Carl.
The Man’s Pill: Reflections on the 50th Birthday of the Pill
. Oxford and New York: Oxford University Press, 2001.

Grigg-Spall, Holly. Sweetening the Pill.
www.sweeteningthepill.blogspot.com
.

Marks, Lara V.
Sexual Chemistry: A History of the Contraceptive Pill
. New Haven and London: Yale University Press, 2001.

May, Elaine Tyler.
America and the Pill: A History of Promise, Peril, and Liberation
. New York: Basic Books, 2010.

Seaman, Barbara.
The Doctors’ Case Against the Pill
. Alameda, CA: Hunter House, 1995.

Watkins, Elizabeth Siegel.
On the Pill: A Social History of Oral Contraceptives, 1950–1970
. Baltimore and London: Johns Hopkins University Press, 1998.

Watch

The Pill
. Directed by Erna Buffie and Elise Swerhorne. Montreal: National Film Board of Canada, 1999.

The Pill
. Directed by Chana Gazit. Steward/Gazit Productions, Inc., for
American Experience
, 2003. See
http://www.pbs.org/wgbh/amex/pill/
.

On Menstruation

Buckley, Thomas, and Alma Gottlieb, eds.
Blood Magic: The Anthropology of Menstruation
. Berkeley and Los Angeles: University of California Press, 1988.

Delaney, Janice, Mary Jan Lupton, and Emily Toth.
The Curse: A Cultural History of Menstruation
. New York: E. P. Dutton & Co, 1976.

Houppert, Karen.
The Curse: Confronting the Last Unmentionable Taboo, Menstruation
. New York: Farrar, Straus and Giroux, 1999.

Kipnis, Laura.
The Female Thing: Dirt, Envy, Sex and Vulnerability
. New York: Vintage, 2007.

Kissling, Elizabeth Arveda.
Capitalizing on the Curse: The Business of Menstruation
. Boulder and London: Lynne Rienner Publishers, 2006.

Laws, Sophie.
Issues of Blood: The Politics of Menstruation
. London: MacMillan Press, 1990.

Martin, Emily.
The Woman in the Body: A Cultural Analysis of Reproduction
. Boston: Beacon Press, 1987.

Muscio, Inga.
Cunt: A Declaration of Independence
. Berkeley, CA: Seal Press, 2002.

Museum of Menstruation,
http://www.mum.org
.

On Menstrual Supression

Rako, Susan.
The Blessings of the Curse: No More Periods?
Lincoln, NE:
Backinprint.com
, 2006.

On Fertility Awareness Method (FAM)

Singer, Katie.
The Garden of Fertility
. New York: Avery, 2004. See
http://www.gardenoffertility.com
.

Weschler, Toni.
Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body
. New York: HarperCollins, 2006.

______.
Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement
. New York: HarperCollins, 2006.

On the Male Pill:

Oudshoorn, Nelly.
The Male Pill: A Biography of a Technology in the Making
. Durham, NC, and London: Duke University Press, 2003.

On Hormones and the Environment

Davis, Devra.
The Secret History of the War on Cancer
. New York: Basic Books, 2007.

On Global Reproductive Justice

Goldberg, Michelle.
The Means of Reproduction: Sex, Power and the Future of the World
. New York: Penguin Press, 2009.

Kristof, Nicholas D., and Sheryl WuDunn.
Half the Sky: Turning Oppression into Opportunity for Women Worldwide
. New York: Alfred A. Knopf, 2009.