Even though it takes two to make a baby, a study published in April in the Journal of Sex Research points out that the burden of trying to prevent a pregnancy usually unfairly falls on the woman.
Most forms of highly effective birth control are designed for a woman's body, but that doesn't mean men can't also be involved in the physical, mental, and emotional work it takes to avoid getting pregnant, argues Katrina Kimport, the study's author and an associate professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. According to past research cited in the study, a typical woman in the US will spend 30 years of her life doing this work.
To understand what these burdens look like, and how doctors have normalized so-called "fertility work" as "women's work," Kimport received the permission of 342 patients to record their contraceptive counseling sessions with their clinicians. For this study, she analyzed 52 conversations featuring women who reported not wanting to have any future children.
Not only does taking contraception involve physical labor—whether that's taking a daily pill, getting a regular shot, or having an IUD inserted—it also takes a toll mentally and emotionally, the study states. In more than half of the visits, doctors spoke with their patients about how important it is to stay on a regular schedule with contraception, thus highlighting how time, attention, and stress factors into commencing and maintaining contraception.
Kimport also found that clinicians make it seem normal that women bear most of the responsibility for preventing pregnancy. For example, when patients expressed taking measures to prevent having any future children, their doctors responded with surprise and doubt—as if it's out of the norm to want to forego fertility work entirely. In one instance, a young woman who had no children talked about getting sterilized; instead of entertaining the idea, her doctor ultimately discouraged her and set her up on the pill.
Even when a vasectomy seemed like the best option—as, the study states, it is the only prevention method that truly addresses the burden women face—the responsibility, time, stress, and attention typically fell on the woman because contraceptive counseling sessions in the US typically do not include men in the room.
Interestingly, out of the 52 clinicians followed in this study, only one acknowledged the unequal burden of fertility work. "It's not fair," Joyce told her patient. "A lot of responsibility for birth control they put on women's side.
While the study offers a few ways doctors can help reduce the burdens that come with pregnancy prevention—including pushing more LARC, such as IUDs, or offering a one-year supply of birth control so women don't have to carve out time in their busy schedules for yet another doctor's appointment—Kimport says individual women and men can also be proactive in shifting these expectations.
"Talking about the mental and emotional work of choosing and using contraception with your partner is a good first step," she tells Broadly. While no one solution will work for any person and every couple, "partners could shoulder the work of picking up prescription refills; partners could coordinate more of the household tasks when the woman has an appointment for a Depo shot or a clinical visit; partners could attend the contraceptive counseling visit itself; perhaps more radically for many people, partners could be in charge of keeping track of the woman using the method such as taking a daily pill or changing the patch or ring (just as women often supervise vitamin and medication consumption for children and spouses)."
And, of course, Kimport says, there's always the option for a man to get a vasectomy once he and his partner are certain they don't want any or more children.
It's important for people—and not just women—to realize that just because women have historically assumed the bulk of the burden of preventing pregnancy doesn't mean it has to be that way, Kimport continues. "It doesn't mean that changing the status quo will be easy, but the point is that no change can happen if we see think of the status quo as a natural occurrence rather than as something produced."