What are contraceptives? How do they work?
A ‘contraceptive’ is a method used to prevent pregnancy. A ‘pregnancy’ can occur when one person with testes and another with ovaries engage in sexual activity that allows for contact between the semen and the vulva or vagina. There are a few different ways in which contraceptive methods work. Physical methods like the internal and external condoms prevent semen from coming in direct contact with the vagina by creating a barrier. Hormonal methods like the oral contraceptive pill, hormonal IUD and injectable help to prevent ovulation, and non-hormonal methods like the non-hormonal IUD help prevent fertilization/implantation by making the uterus inhospitable for sperm. Most contraceptive methods allow people with uteruses to prevent an unwanted or unintended pregnancy, but only two methods (external condoms and surgical sterilization) exist for people with penises.
The contraception gender divide
Due to what is perhaps a patriarchal bias that has creeped into scientific research, most options for contraceptive methods are catered towards people with uteruses. People with uteruses (such as cis women, trans men, nonbinary people) often tend to hold gender identities that are marginalized by society. The same power dynamics that exist out in the world are often replicated in the bedroom in explicit and implicit ways. People with uteruses not only bear the biological burden of bearing a fetus in the event pregnancy occurs, but also the economic and social responsibility of having an abortion or giving birth.
Why can’t (cis) men use condoms or get sterilized?
The unequal agency of cis men compared to people of other genders manifests in several ways, including the choice to use condoms for vaginal intercourse. When young couples have sex, cis men often expect cis women (or any people with uteruses) to take hormonal contraception. The stress of contraception and accidental pregnancy can be significant and this can reduce the pleasure experienced by people with uteruses. However, our patriarchal society tends to centre the pleasure of cis men and their sexuality, making it difficult for women to speak up or enforce their preferences in the bedroom.
The gender imbalance is also seen for more permanent types of contraceptive methods like sterilization. National Health Surveys in India have shown that among people aged 15-49 , 30% of couples opted for the person with the uterus to get sterilized while only 0.3% opted for the person with the penis to get sterilized.
What if sharing the responsibility of contraception does not feel like an option?
Content warning: mentions of abuse
If you are a person with a uterus in a relationship and your partner (if they are a cis man or a person with a penis) does not want to share the responsibility of contraception with you, I want you to know it’s okay to feel what you are feeling. Years of conditioning have taught us that women are not supposed to have any sexual agency and are often shamed and disparaged for wanting to be sexually active. It’s also okay to want to enjoy shame-free sex without the intention of falling pregnant. Unlearning ideas around gender and sexuality can take a long time, but even now, you have a right to your own reproductive choices.
If your partner is unwilling to respect your bodily autonomy, it is possible you may be in an unhealthy relationship which may even be toxic and/or abusive. Additionally, studies have shown that people who experience intimate partner violence may also experience reproductive coercion. Leaving an unhealthy relationship is often not an overnight process, and you may choose to continue having sex with your partner for various reasons (which may even include your own safety or pleasure).
If you would like to prevent a pregnancy and you agree with your partner not to use a condom, you may want to consider using a hormonal method like a daily oral contraceptive pill. If you only need a contraceptive occasionally, you can use the emergency contraceptive pill within 72 hours of unprotected sex. Some people feel worried about their pills being found, and in this case you can consider an ‘invisible’ option like a birth control injection, however, this would require a visit to a doctor every 1-3 months (depending on the type). An even more ‘invisible’ option can be a hormonal or non-hormonal IUD which is inserted inside the uterus by a doctor and can last anywhere from 3-12 years (depending on the type). Nobody would know you have an IUD as it’s placed inside your uterus. In some cases, people have claimed to feel the strings against their penis, but you can ask your doctor if they can trim them for you. Please note, however, that a condom is the only method that provides protection from STDs and STIs.
What if I’m under 18 and my partner refuses to use a condom?
Content warning: mentions of abuse
Young people are in sexually active relationships around the world even before they reach adulthood. As you make informed choices, remember any sexual activity under the age of 18 in India is considered sexual assault. Additionally, you may want to loop in a trusted adult in your life as you go about decision-making in your relationships. In the event that you’ve had intercourse without any contraception and do not wish to fall pregnant, you can reach out to an Adolescent Friendly Health Clinic (AFHCs) near you as soon as possible. It is also advisable to get tested for STDs/STIs.
Lastly, if you’re in a relationship where your partner forces you to do things you are uncomfortable with or you are unable to speak with adults around you about experiencing abuse, you can consider reaching out to the India national helpline for Child Sexual Abuse (ChildLine) by calling 1098.
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About the author: Karishma Swarup is a sexuality educator, Instagrammer (@talkyounevergot) and works at a global consulting firm. She is passionate about destigmatising pleasure and normalizing sexual health with an intersectional feminist lens.