Do women really have reproductive autonomy?

Throughout this article, we explore the concept of reproductive autonomy and reflect on the contraceptive methods available to women today – asking the question: should women have to choose between hormonal change, mental strain and physical pain?

First up, what is reproductive autonomy?

Reproductive autonomy can be defined as ‘the power to decide about and control matters associated with contraceptive use, pregnancy and childbearing’. Examples of reproductive autonomy include having the freedom to choose whether, when and how to: become pregnant, what kind of contraception to use (if any), or whether to continue a pregnancy.

Reproductive autonomy doesn’t exist in a static state. A woman’s reproductive autonomy is continuously influenced by the relationships around her – from her partner to her family, culture and lifestyle. As these factors evolve and change, a woman’s level of reproductive autonomy will fluctuate.

Why does reproductive autonomy matter?

Reproductive autonomy matters because pregnancy is a life-altering process in women’s lives. When unplanned or unwanted, pregnancy can have a detrimental impact on a woman’s physical, mental, financial and emotional health.

So, the autonomy to make decisions around reproduction is vital to a woman having freedom over her own body and life prospects.

What’s the relationship between reproductive autonomy and contraception?

Research has shown that women’s reproductive autonomy is more threatened when trying to avoid pregnancy than when trying to pursue it. This is because of the many challenges of trying to control fertility through contraceptive access and use.

Most heterosexual women spend up to 30 years of their lives navigating contraceptive options. Many will try multiple methods over the course of their reproductive lives in a trial-and-error way. This is known as embodied experimentation.

When it comes to understanding how people make decisions with their contraception, we have to take a step back and look at the options available.

When the first contraceptive pill was developed in 1961, it was revolutionary for women’s empowerment. It offered women the autonomy to control their fertility, make decisions about their future and have the opportunity to explore life outside of the domestic home.

But fast forward 60 years and we now have multiple contraceptive options for women. At first glance, this may seem like evidence of admirable innovation. But when taking a closer look, the contraceptive options available to women today leave a lot to be desired.

The Paradox of Choice: Hormonal Change, Mental Strain or Physical Pain?

The paradox of choice is based on the idea that the contraceptive methods we have available today can fit into 3 categories: hormonal change, physical pain or mental strain.

• Hormonal change: the combined hormonal pill, the progesterone-only pill, the hormonal intrauterine system (IUS), the patch, the injection & the vaginal ring.
• Mental strain: barrier methods & fertility tracking.
• Physical pain: the copper IUD.

Hormonal Change

Hormones play an intrinsic role across multiple functions in the body, so introducing synthetic hormones to the mix can have a big impact. Side effects can be physical – such as weight gain, headaches, sore breasts, or irregular periods. But they can also be mental – including erratic mood changes, loss of libido, anxiety or depression.

Hormonal contraception can be life-altering for some but tolerable for others. These changes will be different for each person depending on their natural hormone fluctuations and chosen method.

However, if someone is wanting to control their fertility without hormonal change, their choices become significantly limited.

Mental Strain

Contraception can be categorised into long and short-acting methods. Long-acting reversible contraceptives are sometimes referred to as LARCs. Examples of LARCs include the implant, the IUS and the IUD because they offer women highly effective pregnancy prevention over a long period of time.

Non-hormonal short-acting contraceptive methods come under two categories:

• Barrier methods: male condoms, female condoms, diaphragms, sponges & spermicide.
• Fertility tracking methods: using temperature and/or calendar tracking.

Both of these methods require significant amounts of mental energy. Barrier methods are single-use and must be used precisely every single time to be effective. Meanwhile, fertility tracking requires daily dedication to measure your cycle accurately.

One incorrect measurement or faulty product use puts women at risk of pregnancy. So not only do women face the mental strain of preventing pregnancy using non-hormonal short-acting methods – they face pregnancy paranoia and the emotional toll of navigating a potential unplanned pregnancy.

For some women, this mental strain is favoured above options that cause hormonal change. For others, they’re in desperate need of more reliable long-acting solutions.

Physical Pain

The only non-hormonal LARC available in the UK today is the copper IUD. It’s a T-shaped device wrapped in copper that sits in the uterus, preventing pregnancy by making the uterus an inhospitable environment.

The copper IUD has hardly changed at all since its invention in 1976. Not only is it the largest of all intrauterine devices but adequate pain relief is rarely offered during insertion. Research has also shown that the device can actually increase menstrual flow and pain in many women.

This means that if women want to avoid both hormonal change and the daily mental strain of avoiding pregnancy, they must opt for the copper IUD and face the associated physical pain.

It’s important to note that the side effects of the copper IUD won’t be the same for all women – some will find them tolerable, whilst others will choose to suffer knowing it’s their best available option.

So, do women really have reproductive autonomy with the options available today?

Ultimately, contraception is all about personal choice. But when we take a step back and look at the true nature of these choices – between hormonal change, mental strain and physical pain – we begin to question the presence of autonomy in these decisions.

The bottom line is that it’s 2022 and women deserve more non-hormonal long-acting reversible contraceptive options. To ignore the desperate need for innovation in this area is both a threat to reproductive autonomy and a disservice to women’s health worldwide.

Author: Eleanor Riches, Women’s+ Health Writer.