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Contraceptive Responsibility: Trust, Gender, and Ideology

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CONTRACEPTIVE RESPONSIBILITY: TRUST, GENDER, AND IDEOLOGY
By

Lisa Campo-Engelstein

A DISSERTATION
Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of
Doctor of Philosophy
Philosophy

2009

ABSTRACT
CONTRACEPTIVE RESPONSIBILITY: TRUST, GENDER, AND IDEOLOGY
By

Lisa Campo-Engelstein

In my dissertation, I explore how contraception inﬂuences women’s (and men’s)
autonomy to expose social justice concerns contraception raises. I take a broad, social
perspective and examine how dominant ideologies shape our attitudes and beliefs about
contraception, speciﬁcally whom we trust to use contraception and whom we think
should be responsible for contraception.

An important milestone for women’s rights was the discovery of long-acting,
reversible contraceptives, which enabled them to control their fertility. Yet, the ubiquity
of these contraceptives and the absence of such options for men, coupled with traditional
gender norms, has resulted in the social expectatiOn that women Should be the ones
responsible for contraception. Women are oppressively socialized to assume the burdens
of contraception, which impair their autonomy and reinforce their oppression. Men
generally beneﬁt ﬁ'om this arrangement because it enhances their autonomy by absolving
them of contraceptive blame, maintaining their bodily integrity, and granting them
greater sexual access to women.

A common justiﬁcation for this gendered division of contraceptive responsibility
is that women do not trust men to contracept. Empirical studies, however, show that
women do trust their male partners with contraception. Differentiating between

interpersonal trust and what I call “group trust” helps explain this tension. Both types of

trust depend upon and reﬂect ideologies, but the object of trust is a group in group trust
rather than an individual. Unlike individuals, who are identiﬁable and have known
characteristics, groups are amorphous with diverse and unconﬁrmed qualities. We
consequently tend to defer to dominant ideologies about groups in order to determine
their trustworthiness. Men as a group are not perceived to be trustworthy with
contraception because of ideologies about masculinity. Although women are held
responsible for contraception, they are distrusted with it due to the cultural stereotype that
they are irrational.

I argue that we should strive for Shared contraceptive responsibility between
women and men as a way of alleviating social injustices. I claim that men have a moral
duty to contracept according to the principle of nonmaleﬁcence and because their of
privileged social position. If we believe women have a moral duty to prevent harm to
potential and actual fetuses and children, then this duty should be extended to men as
well. Unprotected sex can also harm women by leading to unintended pregnancy.

While women should contracept to prevent unintended pregnancy, their ability to
control contraception, not to mention sex, is often minimized in heterosexual
relationships in a patriarchal society. Despite the dearth of male contraceptives, men’s
privileged social position gives them greater control over sexual decisions, including
choices about contraception. Achieving shared contraceptive responsibility requires a
profound restructuring of gender roles. I propose various strategies, like such as
developing long-acting reversible male contraceptives and changing the way we teach

sex education, that will engender a reconceptualization of gender roles.

ACKNOWLEDGMENTS

First, I would like to acknowledge my dissertation chair, Lisa Schwartzman. I
could not have asked for a better advisor and mentor: encouraging, supportive, and
helpful, while at the same time challenging and pushing me philosophically. Many
thanks, Lisa. Second, I would like to acknowledge my committee members, Len Fleck,
Marilyn Frye, and Hilde Lindemann, for their helpful comments on this dissertation.
Third, I would like to acknowledge Michigan State University Philosophy Department
faculty and graduate students. In particular, I would like to thank faculty member Fred
Gifford for his support during my graduate career. I would also like to acknowledge my
graduate student colleagues and friends Sonya Charles, Barry DeCoster, Rory Kraft,
Karen Meagher, Tricha Shivas, Dom Sisti, J.S. Swindell, Meredith Verrochi, and John
' Zillmer. They helped make my environment intellectually stimulating, as well as very
enjoyable. Fourth, I would like to acknowledge my partner, Matt Cerrato. Thank you for
helping me see the big picture and for your unending support. Lastly, I would like to
acknowledge my family. A big thanks to my parents for their continual and generous
support and for raising me a feminist. Also, I would like to thank my sister Jessa for

always being there for me and my sister Jenna for her inspiring passion.

iv

TABLE OF CONTENTS

LIST OF TABLES ............................................................................................................. iii
Introduction
1. Beyond Autonomy: Why Contraception Is an Important Ethical Issue ................. 1

Part I. Examining Ideology, Trust, and Gender: Why Are Women Generally Responsible
for Contraception and Why Is this Arrangement Unfair?

2. Contraceptive Burdens and Women’s Oppression ............................................... 15
3. Trust, Ideologies, and Contraception .................................................................... 47
4. The Role of Gendered Ideologies in Contraceptive Trust .................................. 102
Part II. Achieving a Just Contraceptive Arrangement: Why Should Men Also Contracept?
5. Paternal Responsibility and the Principle of Nonmaleﬁcence ........................... 150
6. Social Privilege and Unintended Pregnancy: Men’s Moral Duty to Contracept182
7. Achieving Shared Contraceptive Responsibility ................................................ 216
APPENDICIES ................................................................................................................ 240
REFERENCES ................................................................................................................ 249
v

LIST OF TABLES

TABLE 1: WOMEN AND CONTRACEPTION USE IN THE US.

(IN NUMBERS AND PERCENTAGES) ....................................................................... 237
TABLE 2: CONTRACEPTIVE FAILURE RATES, 2004 ............................................. 238
TABLE 3: CONTRACEPTIVE METHOD BY POPULARITY .................................... 239

TABLE 4: PERCENTAGE OF CONTRACEPTIVE USE BY WOMEN’S AGE ......... 240

TABLE 5: ANNUAL COST IN DOLLARS FOR CONTRACEPTION
(INCLUDES METHODS AND SERVICES) ................................................................. 241

TABLE 6: MEDICAL INVOLVEMENT FOR CONTRACEPTION MEASURED BY
PHYSICIAN VISIT AND PRESCRIPTION .................................................................. 242

TABLE 7: HEALTH-RELATED DAN GERS, SIDE EFFECTS, AND
NONCONTRACEPTIVE BENEFITS OF CONTRACEPTIVES .................................. 243

vi

Chapter 1. Beyond Autonomy: Why Contraception Is an Important Ethical Issue1

Although reproductive ethics encompasses many things, abortion is discussed
much more than other issues in political, academic, and media realms. Since the birth of
Louise Brown, the ﬁrst “test-tube” baby, in 1978, reproductive technologies have also
dominated these realms; Baby M, Dolly the sheep, and the McCaughy septuplets are just
three examples of stories about reproductive technologies that received signiﬁcant public
attention. With a couple of notable exceptions—forced or mandatory contraception for
women not deemed ﬁt for reproduction (namely, poor women, women of color, and
women with criminal records) and emergency contraception (which seems to have gotten
lumped in with the abortion debate)—contraception has received very little recognition as
an important ethical issue. Why is this? I argue that the focus on autonomy in bioethics,
feminist theory, and philosophy contributes to why contraception as an ethical issue is
neglected. Since the dominant perception of contraception is that it increases women’s
autonomy, many academics assume there are no ethical concerns to discuss. Once we
look beyond a narrow focus on autonomy and incorporate ideologies, trust, and
responsibility into our analysis, we not only paint a richer picture of our current
contraceptive arrangement, but we also can see the social justice issues it raises. These
social justice issues and their impact on autonomy make contraception an ethical issue

worthy of analysis by academics.

 

1 It is important to note that throughout this project I am discussing heterosexual activity unless otherwise
stated.

Why Is Contraception Ignored by the Public and the Media?

Before explaining why contraception is neglected in the academic realm, I
enumerate a handful of factors that contribute to the lack of attention contraception
receives in the media and by the public in comparison to abortion and reproductive
technologies. Part of my reason for doing this is that topics that generate media and
public attention often subsequently spark academic and political debates (e. g. Terri
Schiavo and euthanasia). First, contraception is much more common than either abortion
or reproductive technologies. Indeed, 98% of US. women have used some form of
contraception in their lifetime—a percentage that far exceeds the percentage of women
who have had an abortion or used a reproductive technology (The Alan Guttrnacher
Institute, 2008b). Such ubiquity has normalized contraception, making it more socially
acceptable and unthreatening (or at least less threatening).

Second, given the elevation of complex technology and of new discoveries in
science and medicine, contraception technologies are seen as “unexciting” and
“conquered” territory (except perhaps male contraceptives) because they do not do
anything radically new. Contraceptive research is not perceived to be as groundbreaking
as reproductive technologies research, so it does not generate much public excitement,
though the birth control pill was an important scientiﬁc breakthrough when it ﬁrst came
out.

Third, unlike abortion and reproductive technologies, contraception is not a
rallying point for speciﬁc groups and organizations. Contraception does not fuel
pronatalism like reproductive technologies do, nor does it stand in opposition to

pronatalism to the degree that abortion does. Falling between the two extremes of

reproductive technologies and abortion on the pronatalistic scale, contraception is ignored
for the most part since it cannot be used either to afﬁnn or deny pronatalism, except for
by those who believe sex is only for procreation.

Fourth, abortion and reproductive technologies, not contraception, are the main
reproductive issues for middleclass white women—women who have more money,
power, and social visibility and thus can more successfully make public demands.
According to Dorothy Roberts, “The primary concern of white, middle-class women
centers on laws that restrict choices otherwise available to them, such as statutes that
make it more difﬁcult to obtain an abortion” (300). For the same reason and because they
are more likely to seek out these services, reproductive technologies are important for
white middleclass women (Chandra and Stephen 39).

Fifth, contraception is not nearly as controversial as abortion or reproductive
technologies. Part of the reason abortion and reproductive technologies are so
controversial, and especially so for abortion, is that more is at stake than just abortion and
reproductive technologies; these issues represent political ideologies. Contraception is not
nearly as contentious because it is typically viewed positively, or at least neutrally. The
dominant public perception of contraception is that it is both a need and a boon for
women. In fact, contraception is sometimes viewed as a panacea for women’s inequality.
Besides religious objections to contraception (e. g. that contraception takes a life), most
public concerns regarding contraception are not about contraception itself. Rather, they
tend to be about the relationship between contraception and autonomy, especially how
limiting women’s access to contraception inﬁinges upon their freedom. For example,

recent price increases for contraception on college campuses have led to worries that

women will not be able to afford contraception and therefore will not be able to exercise

their reproductive autonomy (Davey).

Why Is Contraception Neglected in the Academic Realm?

The dominant cultural view of contraception as a source of women’s
empowerment extends to the academic realms of bioethics, feminist theory, and
philosophy. Clearly, contraception has dramatically improved women’s lives; there is no
disagreement about that. What is surprising is that there is little to no debate on other
aspects of contraception. This lack of discussion does not reﬂect a consensus; rather, it
reveals an overlooked and thus unexplored topic. Part of the reason contraception is
neglected as an academic topic is due to the strength of the dominant view that it is a
positive force in women’s lives. Since contraception is often unquestioningly accepted as
a tool in increasing women’s autonomy and reducing their oppression, there is little
critical analysis of it. Such a one-sided perspective explains why most academic work on
contraception centers on how it affects women’s autonomy. Speciﬁcally, academic
discussions have focused on how denying women contraception or forcing them to take it
inhibits their autonomy. For example, A1 Riyami et a1. discuss how patriarchal
arrangements limit women’s ability to use contraception and hence their reproductive
freedom despite other factors that tend to promote contraceptive utilization, like
education and employment. Discussions of forced contraception are rarer, but are
exempliﬁed by Dorothy Roberts’s work on how proposed laws target poor women of

color’s autonomy by mandating Norplant use.

Taking a broader perspective, most academic debates on contraception have
revolved around autonomy because autonomy is a centerpiece in both bioethics and
feminist theory. Since the emergence of the ﬁeld of bioethics in the 1970s, autonomy has
been a prominent issue. As Onora O’Neill asserts, “Much of medical ethics has
concentrated on the individual patient, her rights and her autonomy; demands that
medical professionals respect autonomy and rights have become a constant refrain”
(2002, 4). We see this focus on autonomy in all realms of bioethics, in topics as diverse
as organ transplantation, healthcare allocation, and clinical research. Moreover, the way
autonomy is deﬁned is usually the same throughout various realms. O’Neill concurs: “In
bioethics, and in particular in medical ethics, autonomy has most often been understood
as a feature of individual persons. It is generally seen as a matter of independence, or at
least as a capacity for independent decisions and action” (ibid. 23). This conception of
autonomy upholds individual, independent choice as the key to being autonomous.

A similar understanding of autonomy is also common in feminist theory. One of
the central tenets connecting all varieties of feminism is the promotion of women’s
autonomy, which is often cashed out as, or at least includes, individual, independent
choice. The goal of improving women’s lives and ending their oppression is intrinsically
intertwined with enhancing their autonomy. Consequently, much feminist theoretical and
practical work has been devoted to ﬁnding ways of increasing women’s autonomy. One
prevalent method is to empower women with more choices and with the ability to make
their own decisions. There are plenty of examples of this in reproduction, such as
legalizing abOrtion, pushing for women-controlled contraception, and ﬁghting for

insurance coverage of reproductive technologies.

That the prevailing conception of autonomy in bioethics and feminist theory
focuses on independent decision-making and choice helps us to understand why little
critical analysis has been directed at contraception by academic feminists and
bioethicists. The development of women-controlled contraceptives gives women more
choices and enables them to make independent decisions. Thus, women are more
autonomous thanks to contraception. End of story, at least according to an individual,
independent choice conception of autonomy. Because this conception of autonomy
reduces autonomy to individual, independent choice, when we rely upon it, we are unable
to recognize how our autonomy can be diminished despite more choices and independent

decision-making.

Beyond Autonomy: Why Contraception Is an Important Ethical Issue

We need to look beyond the limited conception of to individual, independent
choice autonomy, as it conceals many ethical issues in contraception. Instead, I examine
three topics that receive much less attention in both bioethics and feminist literature—
ideology, trust, and responsibility—as they relate to contraception. Exploring the
complex ways these three topics interact will not only expose unethical contraceptive
issues and arrangements, but it will also reveal a richer and more accurate understanding
of how contraception affects women’s (and men’s) contraceptive and overall autonomy
than by relying on individual, independent choice autonomy. Contraception raises
concerns of social justice that are obscured when we focus on people as independent
beings making individual choices. Roberts makes this same point in discussing

reproduction more generally:

Reproductive liberty must encompass more than the protection of an

individual woman’s choice to end her pregnancy. It must encompass the

full range of procreative activities, including the ability to bear a child, and

it must acknowledge that we make reproductive decisions within a social

context, including the inequalities of wealth and power. Reproductive

freedom is a matter of social justice, not individual choice. (1997, 6)
Conceptualizing reproductive freedom as something individuals merely choose to
exercise denies the ways it is experienced within a social context and hence bound up in
various power dynamics. In order to disclose oppressive patterns, we must take a broader
perspective than just the individual and investigate reproductive freedom on the social
level. According to Marilyn Frye’s inﬂuential account of oppression, oppression happens
based on one’s membership in a group and therefore cannot be detected if we only see
independent and free-ﬂoating individuals—individuals who are not part of various social
groups (1983, 8). Looking at individual women rather than communities of women
makes it easier to overlook the deeply entrenched gender norms and ideologies in laws,
institutions, and cultural practices that shape women’s reproductive freedom.

In this project I paint a more nuanced picture of how contraception affects
women’s autonomy in lieu of the dominant understanding that contraception simply
augments women’s autonomy. While contraception deﬁnitely increases women’s
autonomy in certain ways, by incorporating social forces, like patriarchy, into our
analysis, we discover how contraception also decreases women’s autonomy in rarely
acknowledged ways. Additionally, we can reveal how the current contraceptive
arrangement affects men and their autonomy; according to individual, independent choice
autonomy, contraception has little if any affect on their autonomy because women-

controlled contraceptives are not thought to increase men’s choices or ability for

independent decision-making (though they do affect men’s ability to decide whether to

father a child). Taking a social perspective, I examine how dominant ideologies Shape our
attitudes and beliefs about contraception, Speciﬁcally whom we trust to use contraception
and whom we think should be responsible for contraception. I choose to analyze trust and
responsibility not only because they are both neglected topics within bioethics and
feminist theory that raise important ethical concerns, but also because they reﬂect and
reify social beliefs. Drawing on the work of other feminist trust theorists, I develop my
own approach to trust to show that when we trust, we typically expect others to act in
according with particular ideologies. Though my use of the concept ‘responsibility’ is
less precise—I defer to a general understanding of this term—I claim that ideologies are
also a factor in whom we hold responsible. Scot Yoder echoes this point: “The
expectations that deﬁne the limits of moral responsibility will depend on the particular
contexts in which we hold people responsible, and thus on our interests, values, and
social practices” (27). Identifying the ideologies inﬂuencing whom we consider
trustworthy and whom we hold responsible in the realm of contraception gives us a
deeper understanding of the social forces involved. Examining this complex interplay
among ideologies, social forces, trust, and responsibility provides us with the broad
perspective needed to look beyond individual reproductive autonomy and expose
oppressive patterns and issues of social justice in contraception. In particular, this
perspective allows us to recognize how women’s contraceptive and overall autonomy is

unjustly inhibited by their cultural environment and their social group membership.

Chapter Outline of this Project

This project is divided into two sections. The ﬁrst section (chapters 2-4) addresses
the current contraceptive arrangement2 in the United States: what it is, why it is this way,
and what its effects are on women and men. I argue that women are generally saddled
with full contraceptive responsibility due to gender ideologies that shape whom we hold
responsible and whom consider trustworthy with contraception. This arrangement is
unjust since it limits women’s autonomy, thereby reinforcing their oppression, while
augmenting men’s privilege. The second section (chapters 5-7) is devoted to my
normative argument about our contraceptive arrangement, which is ultimately that
women and men Should share contraceptive responsibility as a way of alleviating social
justice concerns. In order to buttress this position, I argue that men have a moral duty (or
responsibility) to contracept according to the principle of nonmaleﬁcence and because
their of privileged social position.

I begin chapter 2 by providing a history of contraceptive responsibility,
highlighting that prior to the mid-twentieth century, contraception was typically
considered men’s responsibility or at least a shared responsibility between women and
men. After the invention of long-acting, reversible contraceptives (LARCS),
contraceptive responsibility transformed into women’s responsibility. Although
contraceptives for women, especially LARCs, have dramatically increased women’s
reproductive choices and their ability to make independent reproductive decisions,
contraception has also had a negative impact on women’s autonomy. I argue that the

current contraceptive arrangement is unfair for women because they are usually expected

 

2 While there are many different contraceptive arrangements in the US, I am focused on the dominant
arrangement, which is why I use the single rather than the plural. I will provide more information on this
dominant arrangement in the next chapter.

to assume full contraceptive responsibility and its associated burdens, such as ﬁnancial
cost and health-related side effects, which often impair their autonomy. This situation is
especially troubling because, even though many women may want to contracept and may
in fact beneﬁt from doing so, they are not unrestrictedly making this choice. Rather, by
drawing on Paul Benson’s work, I claim that women are oppressively socialized to be
responsible for contraception. This socialization inhibits women’s autonomy both by
inﬂicting noncompliance penalties on women who do not contracept and by instilling
women with the false belief that part of being a woman is taking care of reproductive
matters.

Chapter 3 opens with a question: why do mass media journalists and those in the
ﬁeld of contraception research and development tend to assume that women will not trust
men to contracept despite empirical evidence that women do trust their male partners
with contraception? I believe the answer lies in differentiating between trust on the
individual level and trust on the group level. Both types of trust depend upon and reﬂect
ideologies. Borrowing from Amy Mullin’s conception of trust as following social norms
and Carolyn McLeod’s conception of trust as having moral integrity, I develop my own
account of interpersonal trust as the expectation that people will act according to moral
ideologies in the relevant domain. I then deﬁne what I call “group trust,” which is similar
to interpersonal trust in most ways except that the object of trust is a group rather than an
individual. Because the object of trust is amorphous and not personally known in group
trust, people tend to defer to cultural stereotypes about groups in order to determine if the
group upholds the ideology and if the group is competent to follow this ideology. In the

last part of this chapter, I bring up some contraceptive ideologies that play a role in trust.

10

 

f

Presenting my conceptions of interpersonal and group trust and identifying various
contraceptive ideologies sets the stage for me to analyze why many do not think women
trust men to contracept and, additionally, to explore perceptions about women’s
trustworthiness with contraception.

Chapter 4 examines how gender ideologies affect contraceptive trust. I posit that
men as a group are not trusted to contracept due to dominant ideologies of masculinity.
Some of these ideologies portray men as incompetent, a quality that typically obstructs
trust. For example, the cultural beliefs that men have uncontrollable libido and that they
have trouble mastering domestic tasks suggest that they will not be competent to
contracept correctly and consistently. Another reason men are often viewed as
untrustworthy to contracept is that they are generally viewed as not morally valuing
contraceptive ideologies. In particular, it is doubted that men morally value self-sacriﬁce
for the following reasons: they are thought not to be as Concerned about preventing
pregnancy, they are socialized to be independent and self-interested, and they belong to
the privileged group and thus are less accustomed to making sacriﬁces. Prima facie,
women as a group are trustworthy with contraception because of their association with
the private realm and the expectation that they are self-sacriﬁcing. Furthermore, trust and
responsibility usually go hand-in-hand, so it would seem that women are trusted. Yet, I
argue that women as a group are not trusted to contracept, as evidenced by the numerous
laws, policies, norms, and social forces (e. g. normalization and surveillance) that limit
women’s reproductive autonomy. The reason for this distrust is their perceived
incompetence due to cultural ideologies that they are irrational and that they have a

strong desire to become mothers. I claim that women are given contraceptive

ll

responsibility despite the fact that they are not trusted because this arrangement beneﬁts
men.

Chapter 5 marks the transition to the second section of this project in which I
make normative claims about how the contraceptive arrangement ought to be. I begin by
highlighting a double standard with reproductive and contraceptive responsibility:
women are generally held morally (and sometimes legally) responsible for fetal and child
harm (e. g. Fetal Alcohol Syndrome and “crack” babies), yet men are not. I suggest that
this discrepancy is the result of sexist ideologies, such as the belief that women’s bodies
are permeable and hence dangerous—a threat to an innocent fetus. Often, claims for
women’s responsibility are based on the principle of nonmaleﬁcence. I extend this
principle to men’s actions to argue that men have a moral duty to contracept if their
behavior will lead to health-related, economic, and/or social harms, broadly construed, to
potential fetuses and children.

I make a similar argument in chapter 6, but instead of looking at potential beings,
I turn to harms inﬂicted on people who already exist, women. The main harm I am
concerned with is unintended pregnancy, for it often engenders health-related, economic,
and social harms. While women should contracept to prevent unintended pregnancy, their
ability to control contraception is often minimized in a patriarchal society and in
heterosexual relationships. I draw from the work of Catharine MacKinnon and Andrea
Dworkin to demonstrate how men control sex and use it to objectify and subordinate
women. This power difference impedes women’s ability to use contraception themselves
and/or to negotiate that their partner to use contraception. I argue that, despite the dearth

of male contraceptives, men’s privileged social positioning enables them to more easily

12

contracept. For this reason and the fact that men’s failure to contracept can harm women,
I conclude that men engaged in heterosexual activity who are not interested in fathering a
child have a moral duty to contracept. Men in monogamous relationships are included in
this claim because relying on just women to contracept is problematic for at least two
reasons: it reinforces a gendered division of labor and it demands another type of bodily
invasion from women.

In chapter 7, I argue that women and men should share contraceptive
responsibility as a way of alleviating the social injustices women generally face by being
fully responsible for contraception, including limited autonomy, contraceptive burdens,
and distrust. Shared responsibility means that women and men are both responsible for
contraception—an arrangement that requires open conversations between partners (be
they long-terrn lovers or one night stands). Achieving Shared responsibility will not be
easy, nor will it be quick. While practical strategies are needed to realize this goal, they
alone are not sufﬁcient. Deeper social change, and in particular reconceptualizing gender
ideologies, must also occur. This sort of change requires both top-down and bottom-up. I
suggest three such strategies that I believe will challenge our current dominant gender
and contraceptive ideologies and cultivate new ones. First, we need to develop more
contraceptives for men, especially LARCS. Second, we need to teach and promote Shared
responsibility for contraception in every realm: health care, families, schools, and society.
Third, we need to empower women and strive towards more equal relationships between
women and men.

These strategies will affect realms other than reproduction, which is precisely the

point. Our current contraceptive arrangement cannot change without change in other

13

realms and change more broadly. The reason for this, which shines through in the case of
contraception, is the interrelated nature of realms and the ideologies that run through
them. Contraception is a great example of how ideologies affect everyday life: whom we
trust, whom we hold responsible, and what sorts of policies and laws we support. The
attitudes and decisions that emerge from ideologies have real consequences for real
people. In the case of contraception, these attitudes and decisions have produced an
unfair arrangement that impairs women’s autonomy. Most discussions of contraception
have focused on independent, individual choice, which has precluded recognition of the
ways in which contraception decreases women’s autonomy in addition to increasing it. It
is only by examining these ideologies, and how they Shape trust and responsibility, that

these social justice concerns become visible.

14

Chapter 2: Contraceptive Burdens and Women’s Oppression

The burdens women as a group experience with pregnancy and childcare has
received copious attention from feminist theorists and others (see, for example, Mullin
2005a, Kukla, Purdy, and Raymond). In contrast, there have been very few discussions,
let alone detailed analyses, of the burdens women face contracepting (Oudshoom and
Beck-Gemsheim are notable exceptions). Part of the reason for this is that the topic of
contraception in general has been neglected, as I pointed out in the previous chapter.
Another reason is that most references to contraception are about women’s
empowerment, not contraceptive pitfalls. In a way, it is understandable that discussions
typically center on the beneﬁts of contraception since women’s ability to control their
reproduction has vastly improved their quality of life. When compared to the risks of
pregnancy and childbirth, many claim the contraceptive burdens are not only acceptable,
but also minimal (Hardon 1992). Furthermore, since many women do not use
contraception (for a variety of reasons, including lack of access, cost, and dislike of side
effects), numerous discussions about contraception, especially those involving social
scientists, policymakers, and health advocates, revolve around the ultimate goal of getting
more women to contracept. Because these actors examine the barriers that prevent
women ﬁ'om contracepting, they do in fact recognize many of the burdens associated
with contraception. Yet, they rarely acknowledge how these burdens affect women
outside of causing them to not use contraception. In this vein, they look for ways to
alleviate these burdens, such as subsidized contraception and methods with fewer

negative side effects, yet rarely acknowledge the systemic injustice women face due to

15

the expectation that they will assume full contraceptive responsibility. The fact that
women are expected to deal with all the health risks of contraception is commonly raised,
but it is generally not discussed in the broader context of women’s oppression.
Additionally, even though some authors suggest that men should also be involved in
contracepting, the focus of contraceptive discussions is still women—a focus that is
rarely questioned and that reinforces the “naturalness” of women’s contraceptive role.

My goal in this chapter is to begin to ﬁll this gap in the literature by analyzing the
current state of contraception in the United States and revealing how it perpetuates
women’s oppression. I began by providing a brief history of contraceptive responsibility
in the ﬁrst section. I show that, prior to the mid-twentieth century, women and men
equally participated in contracepting because most of the available methods could only be
used during sexual activity, immediately afterwards, or were related to the timing of
sexual activity. Contraceptive responsibility was consequently shared between women
and men, though some claim that it was mostly men’s responsibility due to the popularity
of the condom and to traditional gender norms. After the invention of the pill and other
long-acting, reversible contraceptives (LARCS), contraceptive responsibility became, and
stayed, aligned with dominant norms of femininity.

In the second section, I seek to answer empirical three questions in order to
provide evidence for the contraceptive burdens women face: Who contracepts today and
what methods do they use? How much does contraception cost? What are the health-
related side effects and noncontraceptive beneﬁts of contraceptives? I devote a subsection
to each of these questions. In the ﬁrst subsection, I point out that there is a large disparity

both in the number and the diversity of contraceptive methods for women and men. In

16

particular, there are no LARCS for men, while many exist for women. These data show
that women alone are responsible for contraception over two thirds of the time and that
they are involved in practically all contraceptive use. In the second subsection, I uncover
that female contraceptives tend to be expensive because almost all of them require
medical involvement. Of female contraceptives, LARCs are generally the most costly
since both a doctor’s visit and a prescription is usually needed to use them.
Contraceptives that depend on male participation, with the exception of a vasectomy,
tend to be the cheapest because neither a physician visit nor a prescription is necessary.
Although female contraceptives tend to be medicalized—that is, reliant on physician
involvement—they are often not covered by private health insurance companies, which
forces women to pay out of pocket for them. In the third subsection, I point out that the
negative side effects associated with female contraceptives are greater and more serious
than the ones entailed by male contraceptives. In particular, LARCs have severe side
effects. However, the pill, the most popular LARC, also has numerous noncontraceptive
beneﬁts and is sometimes prescribed precisely for these beneﬁts.

Finally, in the last section, I describe how the answers to the three empirical
questions expose an oppressive pattern for women. Women are the ones who bear most,
and sometimes all, of the burdens of contraceptive responsibility. Men beneﬁt from this
situation because they typically do not have to assume contraceptive responsibility and
suffer from its associated burdens. This arrangement is unfair not only because it upholds
unequal power dynamics, but also because women are oppressively socialized to assume

full contraceptive responsibility.

l7

Historical Overview of Contraceptive Responsibility

In order to understand the current state of contraception in the US, we must ﬁrst
understand its history. Before the “contraceptive revolution” of the 19508 and 19603,
which lead to the development of hormonal and long-acting contraceptives, notably the
pill, men actively participated in many forms of contraception. One reason for this is that
contraceptive use was tied to the act of sex itself or to the timing of sex; therefore men
had to be involved. All of the available contraceptives were used during sex, such as
condoms, diaphragrns, sponges, and withdrawal; immediately following sex, like
douches; or were related to the timing of sex, as in the case of the rhythm method. That
men’s participation was needed to contracept, coupled with dominant gender roles,
contributed to the view that men should be involved with contraception. Patricia
MacCorquodale illuminates:

Historically, contraceptive use has been seen as the man’s responsibility.

While this attitude may have originated with the early invention and

extensive use of the condom, it has been reinforced by gender-role

stereotypes. Insofar as men are expected to be protective, rational,

objective, active, dominant, and independent, the traditional gender role _

accentuates the male role as decision maker. (57-5 8)
According to MacCorquodale, dominant ideologies about men solidiﬁed contraception as
men’s responsibility, as they, not women, were assumed to have the necessary
characteristics to make decisions about contraception. The belief that men were held
responsible for contraception is evidenced by the fact that prior to the 19603, if a Single
man got a single woman pregnant, he was generally expected to marry her. The ideology
behind this expectation was that a man Should play a role in contracepting and if a

woman unintentionally became pregnant, he was supposed to take responsibility for his

actions and omissions by marrying her. While men may have been expected be

l8

responsible for contraception, women were supposed to be “guardians” of sex, setting the
boundaries of what was acceptable behavior (i.e. deﬁnitely not intercourse) (Coontz).
This ideology still exists today and is explicitly taught in various abstinence only
programs3 (Doan and Williams 106).

Other authors and evidence suggests that while men were expected to participate
in contraceptive use and decisions, it was also assumed that women would play a role.
That is, both women and men were expected to take responsibility for contraceptive. The
reason for this, argues Nelly Oudshoorn, is that “Prior to the introduction of new
contraceptives for women in the 19603, no stabilized conventions existed concerning the
relationships between gender identities and contraceptive use” (13). Because the
availability and effectiveness of contraceptives was relatively balanced between women
and men, there was no dominant norm identifying contraceptive responsibility with just
one group. We see this in the fact that both female and male contraceptives experienced
popularity in the ﬁrst half of the twentieth century: commercial douches were the most
popular type of contraception in the 1940s and condoms in the 19505 thanks to
improvements in condom quality and burgeoning awareness of the ineffectiveness of
douches (PBS).

Although many believe that dominant ideologies Shifted in response to the
invention of the pill, Andrea Tone argues that this change emerged earlier, in the 19305.
Due to the Comstock Law of 1873, an anti-obscenity act that explicitly includes

contraceptives as obscene material and prohibits their distribution via mail or interstate

 

3 For example, the following passage appears in the abstinence-only student workbook, Sex Respect: The
Option of True Sexual Freedom: “because they generally become physically aroused less easily, girls are
still in a good position to slow down the young man and help him learn balance in a relationship” (12). For
more examples of the way abstinence-only education teaches girls to be the “guardians” of sex, see chapter
4 of Doan and Williams.

19

commerce, women had trouble accessing contraceptives, as clinics and private doctors
were often not very convenient, discrete, or affordable (PBS; Tone 313). Seeing an
opportunity to make a lot of money (and they did—in 1938 alone, they earned $250
million), the contraception industry began a campaign to encourage women to use their
“feminine hygiene” products (Tone 306). Since they were labeled as hygiene products
rather than as contraceptives, they were outside the scope of the Comstock Law. Tone
explains how these hygiene products paved the way for the new dominant ideology that
women should be the ones contracepting:

The success of contraceptive manufacturers’ campaign was twofold: not

only did it encourage more women to use birth control, but it also ensured

that the single largest proportion of those who did used female-controlled,

commercially acquired contraceptives. The successful typecasting of

women as contraceptive consumers reveals the centrality of industry to the

history of birth control in America. (Tone 309)
By identifying women as the ones responsible for contraception, this campaign
challenged the dominant belief that contraception was both women’s and men’s
responsibility, or mainly men’s responsibility according to MacCorquodale. In
challenging the dominant ideology and presenting a counter-ideology, this campaign laid
the groundwork for the ideology that women should be responsible for contraception to
become dominant.

Most people agree that the major turning point in contraceptive history is the
discovery of the female pill. The pill was the ﬁrst contraceptive that was not used during
or after sex or related to the timing of sex. The pill severed the link between sexuality and

reproduction. It was a huge victory for women’s rights, as it allowed women to control

their fertility outside of all sexual activity and without men’s participation or knowledge.

20

 

Moreover, the pill was, and still is, signiﬁcantly more effective than reversible barrier
methods.

The FDA approved the pill as a contraceptive in 1960 (it was originally approved
in 1957 to treat severe menstrual disorders) and it was immediately popular. The number
of American women using the pill increased exponentially, from 1.2 million in 1962 to
6.5 million in 1965 to 10 million in 1973. By 1964, the pill was the most popular form of
reversible contraception, with 25 percent of all couples choosing it (PBS). Today, the pill
remains the most popular type of reversible contraception, and in fact is the most popular
type of all contraceptives (Table 3).

The overnight popularity of the pill as well as the subsequent focus of
contraceptive research and development on female methods reinforced the shift in
ideology that began in the 19303: that women were the ones who are responsible for
contraception. After the invention of female LARCs, “Men, no longer required to use
condoms or to practice withdrawal, were essentially absolved from contraceptive
decisions. Consequently, both researchers and service providers have focused almost
exclusively on women” (Edwards 77). This focus on women corresponds with and
reinforces the dominant norms that women should contracept and that men play no, or a
limited role, in contraception. Moreover, the success of the pill, and other female LARCs,
strengthens the image of women as contraceptive consumers that emerged in the 19303,
ﬁnther distancing men from wntraceptive decisions and use.

The case of contraception shows how technology shapes ideology. The current
dominant contraceptive ideology is due, at least in part, to the available contraceptive

technology: the plethora of female contraceptives and the paucity of male contraceptives.

21

Oudshoom asserts: “The predominance of modern contraceptive drugs for women has
disciplined men and women to delegate responsibilities for contraception largely to
women. Contraceptive technologies thus constituted strong alignments between
femininity and taking responsibility for reproduction” ( l 4). Elisabeth Beck-Gemsheirn
echoes this claim, stating “Planned parenthood, at ﬁrst a new option, now turned into a
kind of duty [for women] More precisely, contraceptive technology became
contraceptive ideology” (32).

This ideology has become so normalized and embedded in our culture that both
women and men typically assume that women will take responsibility for contraception, a
point I will return to later. Consequently, there is sometimes little discussion about
contraception between sexual partners. As Jacqueline Darroch explains, “The heavy
reliance on methods independent from intercourse has meant that sexual partners do not
need to alter their behavior around intercourse or even discuss contraception in the
context of sexuality” (90). Especially prior to the HIV/AIDS epidemic, men would often
assume women were using a LARC, so they would not bring up contraception nor would
they contracept. An example of this is seen in the movie The Adventures of Sebastian
Cole, which takes place in 1983. Teenager Sebastian’s stepfather asks him if he is being
responsible about sex and Sebastian replies that every girl in high school is on the pill.
Here, Sebastian is assuming that all girls are contracepting at least partially because of
this dominant ideology (and perhaps also because he assumes that they are afraid of
- becorrring pregnant). For both Sebastian and his stepfather, the main reason to use
contraception is to avoid unwanted pregnancy. Since many people today also want to

prevent the spread of STDs, they must use condoms (perhaps in addition to another type

22

of contraception). Male condoms have been around longer and so are more established
and better known by the public, which is probably at least part of the reason why they are
more popular than female condoms. Although the prevalence of condom use increased in
the late 19803 and early 19903 due to the HIV/AIDS scare, female contraceptives remain
the most popular methods by far, suggesting that the dominant contraceptive ideology

remains strong despite the concern to prevent STDs.

Overview of the Current Contraceptive Situation in the United States
Who Contracepts and What Methods Do They Use?

The dominant ideology that women should be the ones contracepting shines
through in the fact that women alone do the vast majority of contracepting. Moreover, the
cultural assumption that women should be responsible for contraception is reﬂected in the
methodological approach of social science research on contraception: most of them take
women as the focus of their studies even when examining the prevalence of male
methods. For example, the data in Table 4, originally published in Hatcher et al.,
summarize the contraceptive methods women rely upon, regardless of whether they are
female or male methods. Studies that compare couples’ statements on what
contraceptives methods they are using have found women and men report quite
differently (Becker 176).

Almost all women—98 percent—ages 15-44 who have ever had (heterosexual)
sex have used at least one type of contraception (The Alan Guttrnacher Institute, 2008b).

i There are 62 million women of reproductive age (ages 15-44) in the United States and 62

percent of these women are currently using contraception. (Of the remaining 38 percent

23

of women of reproductive age, 30 percent do not need to contracept for one of the
following reasons: they are infertile, pregnant, postpartum, trying to become pregnant,
have never had sex, or are not sexually active.) Sixty nine percent of the 62 million
women of childbearing age, 42 million, are sexually active, but do not want to become
pregnant. In order to prevent pregnancy, 89 percent of these 42 million women
contracept. This leaves approximately 7 to 8 percent of all fertile women ages 15-44 who
do not want to become pregnant who are not contracepting (Table 1). Given that the
likelihood of pregnancy is 85 percent if no contraception is used, these women are at a
serious risk for unintended pregnancy (Hatcher foreword). Of course, unwanted
pregnancies can occur even when people are contracepting. Shockingly, 50 percent of
unintended pregnancies in the US. happened to people who were using some method of
contraception (Nass and Strauss 18). Perhaps this high rate is less surprising when we
consider that a third of teenagers who use contraception use it incorrectly (Knudson 113).
It is much easier to incorrectly utilize user dependent contraceptives like barrier methods,
the pill, the patch, the vaginal ring, rhythm, withdrawal, and abstinence, which is
reﬂected by the large difference between their failure rates for perfect use versus for
typical use (See Table 2). In contrast, professionally administered contraceptives—
sterilization (female and male), IUDS, Norplant, and Depo Provera—have a much smaller
difference between their failure rates for perfect use and for typical use. Moreover, they ,
have lower overall failure rates than ones that are user dependent (Table 2).

There are eleven female-only contraceptive methods, including sterilization (tubal
ligation); barrier methods (the diaphragm, the sponge, the cervical cap, and the female

condom); hormonal LARCs (the pill, the patch, injectables, implants, the vaginal ring,

24

and a progestin-releasing IUD); and a nonhormonal LARC, other types of IUDS. In total,
67.3 percent of contraceptive use depends on these female-only methods. LARCS
constitute 39.1 percent of all contraception use. They are the largest subgroup of all
contraceptive methods, with sterilization (both female and male) not too far behind at
36.2 percent. The pill is not only the most popular LARC, but it is also the overall most
popular method of contraception at 30.6 percent of all contraceptive use. Tubal
sterilization is a close second at 27.0 percent (Table 3). As seen on Table 4, the pill is by
far the most popular contraceptive for women in their teens and twenties: over a third of
women ages 15-19 and ages 25-9 use the pill, while almost half of women ages 20-24
rely on the pill. The popularity of the pill for women in their teens and twenties can be
attributed to the fact that many of these women want to preserve their fertility (they may
want to have biological children in the future), yet may not need to rely upon condoms
because they are in monogamous relationships. As women get older and decide they do
not want any more children, they often turn to a permanent contraceptive, which explains
why the prevalence of sterilization increases as women age. The popularity of female
sterilization increases about ten percentage points with every ﬁve year span, topping off
at 46.7 percent for women ages 40-44 and making it the most common form of
contraceptive for women in their forties. The remaining forms of female contraceptives
account for just 9.7 percent of total contraceptive use.

In contrast to the large number and variety of female contraceptives, there are
only two male only methods: vasectomy and condoms, which constitute 9.2 percent and

18 percent of contraceptive use, respectively.4 Combined, these two male methods make

 

4 Since spermicides are generally not used alone, but instead are usually used with barrier methods, I am
not counting them as a separate contraceptive method.

25

up just over a quarter (27.2%) of all contraception. (It is worth noting that male methods
account for only 17 percent of contraception use in the developing world (N ass and
Strauss 112).) The percentage of people relying upon vasectomies as their contraceptive
method rises slowly during women’s twenties and thirties and reaches a high of 19
percent for women ages 40-44 (Table 4). Male condoms are the second most common
contraceptive for teenagers at close to thirty percent. Their popularity remains in
percentages in the twenties for women in their twenties and then drops to percentages in
the teens for women in their thirties and forties. The decrease in condom use and the
increase in vasectomies at women get older makes sense, as women in the thirties and
forties are more likely to be in long-term monogamous relationships in which they are not
concerned about spreading STDS, but do want to permanently prevent pregnancy.

The prevalence of condom increased by almost 50 percent from the late 19803 to
the mid-19903 after the US. Surgeon General reported that condoms prevent the spread
of HIV and other STDs (Hatcher 331). However, although condom use has gone up, its
overall use and knowledge about it remain low, especially in light of the ubiquity of
STDs (a recent CDC press release estimates that one in four teenage girls has an STD).
According to research by Hatcher et al., “Only 20% of people who had 3 or more partners
in the past 3 years always used condoms with their primary partner. Although knowledge
of AIDS is very high, less than half of those surveyed said using a condom is a very
effective way to prevent HIV” (15). While the lack of knowledge about condoms’
effectiveness clearly contributes to their low use, as I will discuss in next chapter 4,

dominant ideologies about masculinity also play a role.

26

 

In addition to female and male contraceptives, there are two methods—
withdrawal and abstinence—that require participation ﬁ'om both partners (Table 3).
Together, they account for just 5.6 percent of all contraceptive use. Including these two
methods, men are involved with contracepting nearly one third of the time (32.8%). As
previously mentioned, women alone are responsible for contraception in over two thirds
of all cases. If we include withdrawal and abstinence, women participate in contraception
in close to three fourths of all sexual encounters (72.9 %). If we add male condoms to this
ﬁgure—and women often do initiate and participate in male condom use—then women
are involved in 90.9% of all contraceptive use. Women’s involvement is practically three
times as great as men’s. The only form of contraception that women do not actively
participate in is vasectomy, which accounts for less than ten percent of all contraceptive
methods used. Men, in contrast, are involved in only four out of the 15 methods (the 14
listed on Table 3 plus the vaginal ring) and only the male condom is in the double digits

for popularity of use.

How Much Does Contraception Cost?

For countries with universal health care systems, the price of contraception would
probably not play a role in individuals’ choices regarding which contraceptive method to
choose for themselves. However, since the US. has a private insurance system, cost often
does factor into people’s health care decisions. The 45.8 million Americans who are
currently uninsured (15.7 percent of the total population) have to pay for all medical
expenses out of pocket (US. Census). One in ﬁve women aged 15-44, that is, women of

reproductive potential, lack health insurance. These women are 30 percent less likely to

27

report using prescription contraceptives than women with health insurance (Culwell and
Feinglass 226). This ﬁnding is not surprising given that prescription contraceptives are
not only more expensive than non-prescription contraceptives, but they also involve the
cost of a doctor’s visit. Yet, this ﬁnding is troubling because it shows that ﬁnancial
concerns limit women’s contraceptive choices, often leading them to rely on less
effective, though cheaper, methods.

Even having insurance does not obviate ﬁnancial concerns. Copayments can be
high and often add up quickly. Additionally, insurance companies do not cover all health
care needs. Patients themselves must pay for drugs and services that their insurance
companies do not cover. Most insurance companies do not cover contraception, even
though they pay for other “optional” drugs for men, like erectile dysfunction drugs. As
Sheldon Segal exclaims, “Insurance Company Logic: $10 for 1 erection—we’ll pay; $1
for 10 years of contraception—we won’t pay” (86). As a result, women pay 68 percent
more out of pocket toward their health care than men of the same age. Only half of the
states mandate insurance companies to cover contraception to the same extent as they do
for other prescription medications. Half of these states have provisions in place for
providers, plans, or employers to deny contraceptive coverage for religious or moral
reasons (Knudson 115).

Contraceptives range in price from free for withdrawal and rhythm to thousands
of dollars for a tubal ligation. Although sterilization (both female and male) is the most
expensive type of contraception, it is more cost effective over the long run because it is a
one-time service (Table 5). The large upfront cost for sterilization, however, can be

prohibitive for some people. For people with health insurance, sterilization is often an

28

appealing contraceptive option cost-wise because insurance plans are more likely to
cover it than reversible contraceptives, so people do not have to pay out of pocket
(Sonﬁeld et al. 73).

Besides sterilization, LARCs are generally the most expensive form of
contraception. LARCs are just as the name describes—long—acting, but not permanent—
so they need to be maintained. Women take a pill daily, replace their patch or vaginal
ring monthly, get their injection every one or three months, or have their implant or IUD
removed and replaced every number of years. Maintaining these methods is expensive
because it requires medical involvement. Women have to see a health care professional in
order to get a prescription for the pill, patch, ring, or injectable (Table 6). Since these
prescriptions get written out in women’s names, the women are, by default, the ones who
pay for contraception and whose insurance (assuming they have insurance) gets billed.
Women also have to see a health care professional in order to receive their injection,
implant, or IUD and to have the latter two removed. The upfront and backend costs for
implantation (which can run hundreds of dollars) and removal of implants and IUDS
prevent some women from choosing these contraceptives. In the majority of cases, the
type of health care professional that women must see is limited to physicians, health care
professionals that are typically more expensive and less accessible (Grossman et al.
796).5 To summarize, in order to use LARCS, women must see a physician, which means
paying for the doctor visit in addition to the contraceptive method. The cost of these
doctor visits can add up quickly, especially for contraceptive methods that necessitate

seeing the doctor on a regular basis, like monthly inj ectables. LARCS are not the only

 

5 As Grossman et al. discuss, there is compelling evidence that many contraceptives would be just as safe
and effective if they were demedicalized; that is, if they no longer required physician regulation.

29

type of contraception that depend on physician regulation. Two of the four female-only
barrier methods, diaphragrns and cervical caps, also require physician involvement, as
doctors “ﬁt” patients with these contraceptives. Additionally, as a surgical procedure,
sterilization mandates physician involvement. But, neither barrier methods nor
sterilization require a prescription.

Only two of the eleven female-only contraceptives—the sponge and the female
condom—do not require seeing a physician. This means that 82 percent of female
methods require at least one physician visit in order to acquire the contraceptive.
Moreover, 36 percent of female methods require a prescription, which means women
must continually renew their contraceptive by going to the pharmacy or doctor (Table 6).
Most doctors will not continue renewing prescriptions without seeing their patients
yearly, so the initial visit when the doctor prescribes the contraceptive is not enough to
ensure continued access to the contraceptive. Vasectomy is the only male contraceptive
that involves a physician, and no prescription is needed. All other methods that require
men’s participation (male condoms, female condoms, withdrawal, and rhythm) can be
accessed over the counter, meaning no doctor’s visit is needed (Table 6). Evidence shows
that the medicalization of contraception—that is, positioning physicians as gatekeepers to
contraception—increases cost and decreases access (Grossman et al.). People in a recent
study echo this ﬁnding: in evaluating what contributes to unplanned pregnancy, 54
percent stated cost as an obstacle to contraception use and 66 percent claimed that an

inability to obtain contraception played a role (Mauldon 27).

30

What Are the Health-Related Side Effects and Noncontraceptive Beneﬁts of
Contraceptives?

As seen in Table 7, there are health-related disadvantages (dangers and side
effects) for almost all types of contraception. The only contraceptive without any
associated dangers is the female condom. Besides the female condom, all of the women-
only methods have serious health-related dangers and side effects. The dangers and side
effects of LARCs are especially great because pumping an otherwise healthy body with
extra hormones can cause signiﬁcant problems. For example, Hatcher et al. list the
dangers associated with the most popular LARC, the pill, as “cardiovascular
complications (stroke, heartattack, blood clots, high blood pressure), depression, hepatic
adenomas, possible increased risk of breast and cervical cancers” (241). Brochure inserts
for the pill warn of over 50 possible side effects (Knight and Callahan 112). Potential side
effects of the pill include nausea, headaches, dizziness, spotting, weight gain, breast
tenderness, chloasma (facial Skin pigmentation), irritability, anxiety, depression, changes
in libido, vaginitis, gum inﬂammation, and increased urinary tract infections (Hatcher et
al. 241; Knight and Callahan 113). While some of these side effects diminish and
sometimes disappear after the ﬁrst few months as the body acclimates to the change in
hormonal levels, some side effects persist. The patch and the ring presumably have the
same Side effects as the pill as they are all forms of combined hormonal contraception
(Hatcher et al. 241). Other LARCS have equally serious side effects as the pill, such as
uterine perforation, anemia, allergic reactions, pathologic weight gain, hair loss,
menstrual cramping, spotting, possible bone loss, and adverse effects on lipids. Even

female barrier methods excluding the female condom have the potential for adverse side

31

effects like vaginal and urinary tract infections, toxic shock syndrome, pelvic pressure,
allergy, and vaginal irritation (Table 7).

Some dismiss these side effects as “minor.” However, to the women who
experience them, they often are far from minor. In fact, the most common reason women
discontinue contraceptives, especially LARCS, is due to side effects (N ass and Strauss
119). The fact that most forms of contraception have discontinuation rates approaching
50 percent after one year of use shows that many women ﬁnd side effects sufﬁciently
intolerable to abandon their current contraceptive method (ibid. 125-6). When women
discontinue a highly effective method, like a LARC, they typically turn to a less effective
method, a nonLARC, because the side effects associated with nonLARCS are less
Signiﬁcant than the side effects common to LARCS (ibid 20). It is important to note that
just because women continue to use a particular contraceptive rather than discontinue it
does not mean that they like it and/or are not bothered by the side effects. Indeed, women
may continue contracepting with a speciﬁc method despite the side effects because they
view it as their best worst option (ibid 115-6). Side effects not only cause women to stop
contracepting, they also prevent them from starting to contracept with a new method. For
example, many women are deterred from using LARCs due to their fear of potential side
effects (ibid. 125-6).

The side effects associated'with male contraceptives are not as severe as those for
female contraceptives. Part of the reason for this is that there are no male LARCS, and
LARCs typically have the most serious side effects. But the two available male-only
forms of contraception—condoms and vasectomy—also carry fewer risks than their

corresponding female-only contraceptives, female barrier methods and tubal ligation,

32

respectively. The only health-related danger for male condoms is allergy to latex, which
can take one of two forms: “delayed hypersensitivity,” which consists of a rash in the
area of contact or “immediate reaction” (anaphylaxsis), which can lead to low blood
pressure, trouble breathing, and even death (Medicinenet). While some people are born
with latex allergies, these allergies are most commonly seen in people who have high
exposure to latex (ibid). Severe anaphylactic reactions to latex are rare and are usually
associated with medical procedures, not condom use (Mansell). For men who know they
have a latex allergy, the health-related side effect of condoms can be easily avoided by
using nonlatex condoms, available in polyurethane and lambskin (though the latter does
not protect against STDs). Although female condoms have no adverse health effects,
other female barrier methods have the potential to cause a variety of negative side effects,
as mentioned above.

Vasectomy also carries fewer risks than female counterpart, tubal ligation. Both
forms of sterilization carry the following health-related risks: infection, pain, anesthetic
complications, and psychological reactions (Table 7). Few of the side effects of a
vasectomy are long lasting, whereas a tubal ligation can lead to long-terrn complications.
Tubal ligation runs the risk of abnormal bleeding, bladder infections, high risk of ectopic
pregnancy (if women get pregnant), and post-tubal sterilization syndrome, which can
include irregular and painful periods, mid-cycle bleeding, or no periods. Laparoscopy is
the most common technique for female sterilization and the procedure itself poses greater
risks than the procedure for vasectomy. The main reason for this is that tubal ligation is a
more complex surgery even though, like vasectomy, it is an outpatient procedure. Tubal

ligation surgery lasts double as long as vasectomy surgery (30 minutes versus 15

33

 

minutes) and involves double the incisions as vasectomy (two versus one). Whereas only
local anesthesia is used for a vasectomy, either local or general anesthesia is administered
for a tubal ligation (F WHC). In sum, “Compared with female sterilization, a vasectomy is
simpler, safer, cheaper, and similar in effectiveness (Knight and Callahan 286-7).

Not all the effects of contraceptives are bad. As seen in Table 7, there are
noncontraceptive beneﬁts for most forms of contraception. For instance, both the female
and male condom protect against STDS. The positive effects of the pill are probably the
most well known: the pill generally “decreases menstrual pain, PMS, and blood loss;
protects against symptomatic PID, some cancers (ovarian, endometrial) and some benign
tumors (leiomyomata, benign breast masses), and ovarian cysts; reduces acne” (Hatcher
et al. 241). Doctors sometimes prescribe the pill to women precisely because of these
noncontraceptive beneﬁts. For example, a doctor may prescribe the pill for a woman with
ovarian cysts in order to prevent further cysts from growing. Other LARCS (except IUDs
that are not progestin-releasing) may also provide noncontraceptive beneﬁts including
reducing the risk of seizures, protecting against ovarian and endometrial cancers, and
decreasing menstrual cramps, pain, and blood loss (ibid.). However, these other LARCs
are rarely prescribed solely for noncontraceptive use, implying that there are other
medications that are better suited to treat the symptoms in part because they have a more

favOrable risk/beneﬁt ratio.

Contraceptive Burdens and Women’s Oppression
Relying on the empirical information presented in the last section, I argue that the

current contraceptive arrangement, in which women participate in the use of almost all

34

 

contraception and alone are responsible for two thirds of contraception, is unfair. This
arrangement is unfair because it involves an oppressed social group, women, taking on
the majority of the responsibility, and hence the associated burdens, of contraception,
while the privileged social group, men, are typically relieved of this responsibility and its
corresponding burdens.

Let me begin by outlining some of the burdens women face (often alone) in
starting and maintaining contraceptive use. They see their physician to access nearly all
forms of contraception. They visit the pharmacy if their chosen form of contraception
requires a prescription. They pay for the doctor’s appointment and the prescription. They
learn to correctly use their contraceptive. Moreover, in order successfully contracept, they
must gain general knowledge about both their contraceptive and reproduction (for
example, women on the pill need to know that antibiotics can reduce the effectiveness of
this method). In many cases, they regulate their contraceptive use; for example, they must
remember to take their pill daily or they must anticipate sexual activity and insert their
barrier method beforehand. They deal with side effects, which can be quite serious. They
decide whether to continue with a particular contraceptive method or to switch methods
(the latter would involve all the previous steps all over again). They feel the weight of
contraceptive responsibility on their shoulders, the stress, worry, and anxiety that such
responsibility produces. They suffer guilt and blame from others if an unintended
pregnancy occurs.

Not being responsible for some or all of these burdens is a signiﬁcant boon for
men. They typically do not have to dedicate time and energy to contraceptive care, pay

out of pocket for the usually expensive and sometimes frequent (e. g. monthly, four times

35

a year) supply of contraceptives, acquire the knowledge about contraception and
reproduction needed to effectively contracept, deal with the medicalization of one’s
reproductive health, endure the bodily invasion of contraception, suffer the health-related
side effects and the mental stress of being responsible for contraception, and face the
social repercussions of their contraceptive decisions (such as whether to use a particular
contraceptive or to switch contraceptives) and the moral reproach for contraceptive
failures. People who contracept have to devote and sacriﬁce many aspects of themselves
and what they value: their body, health (physical and mental), time, money, etc. These
contraceptive burdens, devotions, and sacriﬁces limit people’s freedoms. Since men are
frequently not responsible for contraception, they are absolved from these burdens and
thus their freedom is not inﬁinged upon.

Women, in contrast, have minimized freedom since they are typically responsible
for most, and sometimes all, contraception. Contraceptive responsibility and the burdens
it entails reinforce women’s already disadvantaged social positioning. These burdens are
more wires in the birdcage, to borrow Marilyn Frye’s analogy for oppression (1983).
Separately, these burdens may seem insigniﬁcant, but when we look at them together
within the social context of patriarchy, we recognize that they work systemically as a
network that limits women’s opportunities. Indeed, these burdens not only negatively
affect women within the reproductive realm; they also have the potential for far-reaching
effects in other realms. For example, that women have to shell out their own money for
contraception (and for their reproductive care more generally) whereas men typically do
not puts women in a worse off economic state. Another example: the negative side effects

women can experience from contraceptives can prevent them from participating in

36

activities and can reduce their self-conﬁdence (they worry about hair loss, weight gain,
and spotting).

Some may object to my position that the current contraceptive situation is unfair
and claim that since there are many more reversible contraceptive options for women
(versus the one option for men, male condoms), it makes sense for women to assume
contraceptive responsibility. Furthermore, some may state that the fact that the diversity
of options is much greater for women is also a good reason women should be the ones
contracepting. Women can choose from among sterilization, four barrier methods, and six
LARCS. This argument boils down to the belief that those who have more (both in
number and variety) options should take responsibility because they are better equipped
to do so (given their expanded range of choices).

Yet, as Barry Schwartz argues, more options do not necessarily translate into
enhanced autonomy. In fact, more choices of goods and services “may impair freedom by
taking time and energy we’d be better off devoting to other matters” (Schwartz 4). While
the number of female contraceptive methods may not seem overwhelming, there is still a
lot of information to wade through in order for women to decide upon which method best
suits their needs. Most women settle on the pill, but there is not just one type of pill; there
are over 40 (NWHCR). Since the pill requires a prescription, it seems fair to assume that
doctors assist women in making such decisions (or in some cases, just make the decisions
for them). However, the relatively recent shift in medicine from the all-knowing,
paternalistic doctor to the doctor who presents a variety of choices and has the patient
make a decision means that the patient must undergo the stress of a decision making

process. In Schwartz’s words, “The combination of decision autonomy and a

37

proliferation of treatment possibilities places an incredible burden on every person in a
high-stakes area of decision making [like contraception] that did not exist twenty years
ago” (33). In sum, the mere fact that women have a greater array of contraceptive choices
than men does not necessarily mean that women have increased autonomy and thus are

better equipped to make contraceptive decisions. According to Schwartz’s argument,

women’s contraceptive autonomy is actually impeded due to the overwhelming number I
of choices. 1i
Men’s contraceptive autonomy, in contrast, cannot be said to be inhibited by an 1

abundance of options. However, I do think it is fair to claim that their autonomy is
limited by a lack of choices, especially since there are no male LARCS. Just as too many
choices can minimize our autonomy, so too can too few choices. Yet, despite the fact that
men’s only reversible contraceptive option is the male condom, this does not mean that
men have no moral obligation to contracept. Indeed, minimal options do not relinquish
our responsibilities, though they can make it more difﬁcult to fulﬁll these responsibilities.
For example, politicians, policymakers, children’s advocates, the media and probably
most people would not claim that parents who have access to fewer choices of food have
less of a responsibility to feed their children than parents who have access to numerous
and diverse food options. While the ﬁrst group of parents may have more trouble
providing their children with balanced and delicious meals, their responsibility to feed
their children is not diminished. Likewise, the limited availability of male contraceptives
does not reduce men’s contraceptive responsibility.6 The fact that women have more and

perhaps better reversible contraceptives available to them is not a reason why men should

 

6 As the philosophy saying goes “ought implies can.” There are contraceptive options for men—male
condoms and vasectomy—there are just fewer of them than are available for women. So, men can
contracept.

38

not contracept, nor does it mean women should automatically assume full contraceptive
responsibility. I make a positive case for why men have a moral duty to contracept in
chapters 5 and 6.

The paucity of male contraceptives is problematic not because it affects men’s
contraceptive responsibility, but rather because it makes it more difficult for men to
contracept and because it means that contraception is often shoved onto women. It is
especially troubling that there are no male LARCS given their popularity and their unique
characteristics. The absence of male LARCS means that if people are looking for certain
qualities in their contraceptive, then their only choice is to depend on the women to
contracept. LARCS combine two desirable characteristics of sterilization and barrier
methods: the long-acting nature of sterilization and the reversibility of barrier methods.
Since there are no LARCS for men, women must be the ones to contracept if they (and
their partner) want a contraceptive method that is both long-acting and reversible.
Another reason LARCS are so popular is that they, along with sterilization, have the
lowest failure rates both for perfect use and actual use (Table 2). If people do not want to
rely upon sterilization as their contraceptive method (perhaps they would like to have
biological children in the future), yet are concerned about using the most effective forms
of contraception, then their choices would be limited to LARCS—that is, women-only
methods.

We need more male contraceptives, particularly male LARCS, so that men can
more easily and effectively contracept and so that women are not saddled with most or all
contraceptive responsibility. However, more male contraceptives alone will not

necessarily result in an equally shared contraceptive arrangement. Gender ideologies play

39

a signiﬁcant role in who should be responsible for contraception, as seen in the case of
sterilization. Unlike the case of reversible contraceptives, the availability of permanent
contraceptives is equal for women and men; both have one option available to them, tubal
ligation for women and vasectomy for men. This equality of options might lead one
might expect similar rates of tubal ligation and vasectomy. Yet, tubal ligation is
practically three times more common in the US. (27 percent versus 9.2 percent for
vasectomy). Worldwide, the same pattern stands: tubal ligation is much more prevalent
than vasectomy. In fact, only two countries, Britain and the Netherlands, have vasectomy
rates that are equivalent to tubal ligation rates (Ringheim 88, footnote). What can explain
this large discrepancy? Gender ideologies seem to be (at least part of) the answer. Nelly
Oudshoom elucidates:

In the second half of the twentieth century, the idea that women were

responsible for contraception thus became the dominant cultural narrative

as it was materialized in the contraceptive technologies, social

movements, and in the gender identities of women and men.

Consequently, contraceptive use became excluded ﬁ'om hegemonic

masculinity. (14-15)
The alignment of femininity with contraceptive responsibility explains why tubal ligation
is ubiquitous while vasectomy is not. Contraceptive responsibility is not part of the
dominant cultural narrative of masculinity and consequently men are usually less inclined
to be sterilized. Women, in contrast, associate contraceptive responsibility with
femininity and thus feel like part of their duty as women is to contracept, including
sterilization.

The case of sterilization shows how strong gender ideologies run. Even though

vasectomy is a cheaper, simpler, and safer procedure and thus would probably be the best

“objective” choice for monogamous couples who want a permanent contraceptive

40

method, men are far less likely to be sterilized. That vasectomy is more effective (0.1
percent failure rate versus 0.5 percent for tubal ligation, though this difference is
probably not statistically signiﬁcant (Table 2)) and that the health-related burdens
associated with tubal ligation are greater in number and in seriousness than for vasectomy
are usually not enough to sway people to choose vasectomy over tubal ligation. The
gender ideologies regarding contraception are so deeply embedded in our culture that
couples often overlook good reasons for having a vasectomy rather than a tubal ligation.
Tubal ligation is consequently more popular and hence, like with reversible
contraception, women typically bear the burden for permanent contraception. In order to
move toward an equitable contraceptive arrangement we must alter our dominant gender
ideologies, a task I discuss in more detail in the last chapter.

Although some readers may concur that women are unfairly saddled with the
burdens of contraception, they may claim that this situation is much better than women’s
situation before the invention of the pill and other LARCS. The pill gave women the
ability to independently and successﬁrlly regulate their reproduction. Prior to the pill,
many of the contraceptive methods relied on male participation, making women
dependent on men’s decisions. Even if men and women both agreed to contracept, the
available methods had high failure rates. Not only was the pill much more effective than
other available methods, but it also was the ﬁrst contraceptive that was long-acting,
reversible, and not related to the timing of sexual activity. Because of the pill’s
characteristics, women could now regulate their fertility without the consent, knowledge,
or participation of their partners. Being able to control their fertility has improved

numerous aspects of women’s lives outside of reproduction. Indeed, “The degree of

41

control women are able to exercise over their reproductive lives directly affects their
education and job opportunities, income level, physical and emotional well-being, as well
as the economic and social conditions the children they bear will experience” (Nadine
Taub quoted in Andrews xiii).

I completely agree that the pill has dramatically improved the lives of women by
enabling them to autonomously and effectively control their fertility. And this was
precisely the goal of birth control advocate Margaret Sanger, who was the impetus for the
discovery of the pill in the US by dreaming of a type of contraceptive, a “magic pill,”
that was as easy to take as aspirin (PBS). It Should come as no surprise that “The three
peaks of the political campaign for reproductive freedom—the 18703, the 19103, and the
19703 and 19803—coincided with peaks of women’s rights struggles” (Gordon 482).
Feminists believed in and fought for greater reproductive freedom, including the
women’s ability to autonomously and discretely control their fertility. There is no
question that, due to the pill and other contraceptive advances, the contraceptive situation
women in the US. face today is vastly better than it was 60 years ago.

That said, however, the current contraceptive situation is still unjust. Women bear
the brunt of contraceptive responsibility and the burdens it entails. In a way, the current
contraceptive arrangement is more problematic than the previous one because its
injustices are often hidden, or at least sidelined, by the dominant rhetoric of women’s
empowerment and equality. This sends the message that women should be content and
grateful for the current situation, thus marginalizing and even silencing any complaints or

suggestions for improvements that women may have.

42

 

Furthermore, this situation is unjust because women are oppressively socialized to
assume full contraceptive responsibility. To understand how this is the case, it is useful to
look at Paul Benson’s work on oppressive socialization. Benson is concerned with
developing an approach to autonomy that can account for the fact that certain types of
socialization—speciﬁcally, oppressive socialization—can impair autonomy, while non-
oppressive forms of socialization do not. Benson presents two types of socialization that
are oppressive: “(1) coercive socialization that inﬂicts penalties for noncompliance with
unjustiﬁable norms and (2) socialization that instills false beliefs that prevent people from
discerning genuine reasons for acting” (Meyers summarizing Benson’s view, 478). He
uses the example of socialization of feminine appearance to explicate both types of
oppressive socialization. The unjustiﬁable norms in ﬁrst type of oppressive socialization
are feminine beauty norms, which entail the “near constant effort to measure up to
complicated and ever-changing standards governing one’s looks” so as to be sex objects
for men (Benson 386). Women who challenge this expectation are stigmatized and
punished: “Women'learn that their prospects for satisfying their basic interests in
meaningful work, material security, social acceptance, and so forth can be expected to
suffer dramatically if they do not achieve enough success at maintaining themselves as
desirable sights for men’s eyes” (Benson 387). More speciﬁcally, women who do not
comply with this norm may be less likely to have friends and romantic partners and may
be less likely to economically succeed (studies show that “plain” people make less money
than “beautiful” people (Engemann and Owyang)). The second way the socialization of
feminine appearance is oppressive is that it teaches women a falsehood that interferes

with their decision making: that “feminine appearance is a necessary ingredient of a

43

woman’s personal worth” (3 88-9). Women internalize the belief that their personal value
is tied up in their appearance, which leads them to misconstrue some of the reasons there
for them to act. For example, women may choose to get up early in the mornings to “ﬁx
themselves up” rather than getting much needed sleep because they believe their looks
are a priority over their rest. Intemalizing these falsehoods inhibits women’s autonomy
by preventing them ﬁom competently developing critical reﬂection skills regarding

reasons to act in certain ways. Often women’s critical competence becomes fragmented:

 

they are receptive to reasons in certain realms, but not others (Benson 397).

rprw ..
. '1 -

Like the socialization of feminine appearance, the socialization of contraceptive
responsibility (as well as reproductive and childcare responsibility more broadly) is
oppressive in both ways. First, the expectation that women should assume full
contraceptive responsibility is unreasonable, as it places the onus of responsibility for
something that involves two people on just one person and that person is determined
based on her social group membership. Moreover, as I argue in chapter 6, women’s social
positioning often makes it difﬁcult for them to contracept. Yet because women are
coercively socialized to contracept, women who do not contracept face noncompliance
penalties, such as being labeled irresponsible or loose, or being accused of trying to
“trick” men into marriage through pregnancy. Single women who become pregnant are
stigmatized and blamed for their situation, while typically little to no blame is directed
toward men. Women in monogamous relationships who do not contracept (and who are
not trying to conceive) are often thought to be neglecting one of their domestic and
feminine responsibilities. Furthermore, they are sometimes viewed as selﬁsh because

they want their male partner to contracept even though using condoms may decrease his

44

pleasure and having a vasectomy is often thought to be a type of emasculation. In sum,
“In an age of planned parenthood and unlimited contraception, those [namely women]
who do not want to use contraception gradually become ‘different,’ then ‘suspect’
(naive, backward, irrational). Now the nonuse of contraception becomes stigmatized”
(Beck-Gemsheim 33).

Second, the socialization of contraceptive responsibility instills women with the
false belief that a necessary part of being a woman is taking care of reproductive and
childcare matters, including contraception. Interwoven with this belief are gender
ideologies about women, such as that they are naturally better caretakers and that they
Should be self-sacriﬁcing. I will return to these ideologies in the next chapters. This false
belief impairs women’s ability to determine genuine reasons for acting. For example, if a
couple decide that sterilization is their best contraceptive option, the woman may claim
that she should be the one sterilized even though she has a history of severe adverse
reactions to anesthesia. What motivates the woman in this case is the falsehood that
women should assume contraceptive responsibility. Because she believes that
contraceptive responsibility is an integral aspect of being a woman, she volunteers to be
sterilized despite the serious health risk to herself.

The socialization of contraceptive responsibility interferes with women’s
autonomy by leading them to make choices that they probably would not make if there
were not such strict noncompliance penalties (assuming they had not internalized the
oppressive belief). Additionally, this impairment of their autonomy causes them to make
decisions that are often not in their best interest. Women typically choose to be fully

responsible for contraception even though doing so can be quite burdensome for them.

45

Since they have internalized the belief that they alone ought to be responsible for
contraception, many women do not recognize that there are good reasons for men to
share contraceptive responsibility. “A culture’s ultimate defensive weapon [against
change] is to make alternative ways of life unimaginable or imaginable only as bizarre or
loathsome specimens” and this is precisely what oppressive socialization does (Meyers
2000, 487). In portraying men contracepting as absurd or highly undesirable, oppressive

socialization teaches women that they should be the ones contracepting. What is so

 

insidious about oppressive socialization is that it gives the impression of choice—that If
women autonomously choose to contracept—rather than acknowledging the coercive
factors that leave women little choice but to contracept.
Women’s belief that contraception is their responsibility is further buttressed and
reinforced by other gendered and oppressive forms of socialization as well as gender
ideologies. In the next two chapters, I will examine how our attitude of trust inﬂuences
who politicians, contraceptive researchers and developers, the media, and everyday
people think should be responsible for contraception. I will argue that the perceptions that
men are untrustworthy with contraception while women are innately suited for
reproductive tasks strengthens women’s (and men’s) belief that women alone should

contracept.

46

Chapter 3. Trust, Ideologies, and Contraception

In 2006, various mainstream news organizations in the English-speaking world
picked up the story that male contraceptives were just around the corner, approximately
four to ten years away from hitting the market. 7 In addition to conveying information
about these new male contraceptives, a common theme running through the stories was
the issue of trust, speciﬁcally, the question of whether men would and should be trusted
to be responsible for contraception. It is very telling that trust, not empowerment or
autonomy, was the common theme. The concepts of empowerment and autonomy are
usually central to discussions of female contraceptives. Although trust is rarely explicitly
mentioned in discussions of female contraceptives, women’s trustworthiness is in fact a
signiﬁcant factor in contraceptive matters, shaping individual relationships, social norms,
and public laws and policies. That discussions of trust are absent in practically all
discussions of female contraceptives, but included in most discussions of male
contraceptives, reﬂects dominant ideologies of gender roles and responsibilities.

Many of the articles about male contraceptives deal speciﬁcally with whether
women would trust men with contraception. Some articles look at individual women’s
perspectives, such as Jennifer Christrnan in “What’s in a Dame? Would He Even Take
the Pill, If He Could?”: “I asked some [female] friends if they would trust men, if male

contraception became available, to bear the birth. control responsibility. Not one of them

 

7 Mainstream mass media articles on male contraception published in 2006 include Bourke, Callaghan,
Christman, Glenda Daniels, Eyre, Godson, LaMotta, Levenson, Macrae, Mason, No author (Male pill has
no lasting ill-effects, study reveals), No author (Male pill may put the men in control of conception), No
author (Sperm production recovers completely after stopping hormonal contraception), No author (Will
birth control be his job?), No author (Would a male contraceptive pill work?), Nuzzo, Pirani, Randle,
Richard & Judy, Ross, Sarler, Traister, and Wharton.

47

said yes.” Other articles ostensibly discuss women’s perspectives, but really seem to be
talking about what the authors or particular groups of individuals believe to be women’s
perspectives. Take a look at these two quotations: “the ﬁeld of male contraceptive
development has been plagued by whether women will trust their contraceptive
protection to a male method that they cannot verify is being used” (Darroch 91) and
“critics [of male contraception] argue that men do not have the same motivation to
prevent pregnancy and this will make it hard for some women to trust a man who says he
has taken his [contraceptive] tablet” (Macrae). While the ﬁrst quotation is one view from
the ﬁeld of male contraceptive development and the second reﬂects the view of some
male contraception critics, both of these views are in fact these groups’ speculation about
women’s opinion on trusting men with contraception. Few mass media articles I read had
empirical evidence for women’s thoughts on this topic, so the views of these two groups
seem based mainly on social perceptions and ideologies. Interestingly, one mass media
article that included empirical evidence, gathered from a survey of 1,900 women in
Scotland, China, and South Aﬁica, showed that only two percent of women would not
trust their partner to use male contraceptive hormones (a form of male contraception)

(N uzzo). Some other articles about men participating in clinical research trials for male
contraceptives did not give statistics on whether their female partners trusted them to be
responsible for contraception; however, I assume that all the women trusted their male
partners because they agreed to join the trials and not use any other form of contraception
(Scott). Furthermore, social science studies published in academic journals conﬁrm that
women in committed relationships would trust their male partner to use contraceptives

(Glasier et al., 2000; Martin et al., 2000; Weston et al., 2002). Also, many couples

48

already rely on male contraception, which presumably means that these women trust their
male partners to use contraception. It is probably easier to trust men to use the available
contraceptive methods Since both condoms and withdrawal take place in the presence of
women and vasectomy is a permanent procedure. In sum, although the empirical
evidence shows that most women do trust their male partners to contracept, most articles
I read claim that women will not trust men.

Hence, there is a disconnect between social perceptions and women’s actual
views on men’s trustworthiness. I believe this disconnect can be explained by
distinguishing between trust for individuals and trust for groups. On an interpersonal
level, women generally trust their male partners with contraception. Yet, many—such as
some mass media journalists, critics of developing new male contraceptives, and many
groups and individuals in the ﬁeld of contraceptive research and development (e. g.
pharmaceutical companies, scientists, healthcare professionals)—assert that women
distrust men as a group with contraception. This belief emerges from gendered and
contraceptive ideologies and is reﬂected in semi-conscious actions individuals and groups
take, such as journalists writing that women will not trust men with contraception and
pharmaceutical companies choosing not to research male contraceptives. Those who
think women distrust men to contracept are not themselves engaged in relations of trust,
but rather are making claims about women’s relations of trust with men regarding
contraception. These claims do not seem to be based on empirically grounded evidence,
but rather one’s worldview, which is shaped by dominant ideologies. Although some
authors present their views as empirically based, such as Christman who surveys “some

ﬁiends,” it seems odd that they did not do any research on the topic. We typically expect

49

journalists and reporters to provide an “objective,” fact-based story. We even expect
people who write editorials to rely on facts and not just present an unsubstantiated
opinion. The ideologies at play in contraception seem so deeply embedded in our culture
and our individual consciousness (and subconsciousness) that the authors of these articles
do not even seem aware that they are deferring to ideology rather than facts.

My goal in this chapter and the next one is to illtmrinate some of the ideologies

that lead many people, especially mass media journalists and those in the ﬁeld of

 

contraception research and development, to assume that women will not trust men to

III—

contracept. This chapter is divided into two parts. The ﬁrst part centers on trust. I begin
by examining some of the feminist literature on interpersonal trust and, in particular, the
work of Amy Mullin and Carolyn McLeod. After outlining their conceptions of
interpersonal trust, I draw on speciﬁc aspects of their approaches to build my own
conception of interpersonal trust. Based on this conception, I postulate a type of trust that
takes place not on an interpersonal level, but on a group level: what I call “group trust.”
Instead of analyzing whether one trusts an individual, in group trust we analyze whether
one trusts a particular group of people. In the second part of this chapter, I explore some
contraceptive ideologies, including the cultural understanding of contraception as private
and taboo and the social norm that those involved in reproductive matters should be self-
sacriﬁcing. Laying out my conceptions of interpersonal and group trust and identifying
various contraceptive ideologies sets the stage for me to analyze why trust is such a
prominent theme in these mass media articles about male contraception and, just as

importantly, why it is virtually absent in articles about female contraception.

50

CONCEPTIONS OF TRUST
Mullin and McLeod: Two Feminist Conceptions of Trust

While various feminist theorists deﬁne trust differently, the common theme
running through all of these accounts is that trust is an attitude concerning our
expectations of others. When we trust, we expect others to act in ways that are either
helpfully (or at least not harmfully) directed at us (or at the subject of trust) or we expect
that we and the object of trust share a belief in the “right” way to act. Both Mullin and
McLeod insist that, in interpersonal trust, the truster must believe that the trusted afﬁrms
the same norrn(s) or position(s) that she does in a particular domain. Mullin claims “we
assume that the one we trust shares our own commitment to a particular social norm
which we take to govern the trusted one’s behavior in some speciﬁc domain” (2005b,
316). Likewise, McLeod states, “My trust, then, must entail the expectation that there is
some Similarity between what she and I stand for, morally speaking, in the relevant
domain” (465-6). One of the important differences between these two theorists is that
Mullin thinks what is shared between truster and trusted is a social norm, while McLeod
asserts that it a moral claim. I will now describe and critique their approaches in more
detail.

In recognizing social groups and incorporating social norms into her conception
of trust, Mullin contextualizes and situates trust in our cultural reality. Indeed, Mullin
explicitly posits that trust is mediated by social forces rather than something that occurs
between free-ﬂoating individuals. She says that trust is grounded in our expectations that
people follow social norms—placing society’s, and not just the individual’s, perspective

at the center of trust. Mullin claims that social norms and other people besides the person

51

trusting and the person trusted not only play a role in trusting, but also in recognizing and
understanding trust. For example, she states, “Since social roles and norms shape the
content of trust, and trust is not solely of the interaction between truster and truster, it
makes sense for the parties in a dispute about trust to ask other people questions” to help
resolve whether there was a betrayal or not (2005b, 325). In sum, while Mullin’s account
of trust is of interpersonal relationships, by basing trust on adherence to social norms, she
integrates social forces and the complex interplay between social forces and individuals
into her conception of trust.

Though Mullin’s conception of trust rests upon shared social norms, sharing a
social norm is not enough to trust another. The reason a person values the social norm
also plays a role in trusting. According to Mullin, “examples of trust are united by the
central notion of the trusted’s commitment to a certain norm for its own sake, rather than
merely for rewards which can follow from adherence to it” (2005b, 322). Mullin’s
distinction between trust and reliance boils down to the difference between valuing a
social norm for intrinsic reasons and valuing a social norm for instrumental reasons.
When we value social norm X intrinsically, we are internally committed to X for its own
sake. This type of deep commitment merits trust because it motivates us to make acting in
a way that promotes X a priority. In contrast, when we value X instrumentally—we value
X only for what it will get us, not for its own sake—we are not trustworthy because there
is a greater probability that we will not act in a way to promote X. If acting to promote Y
(be it a social norm or not) allows us to reach our goal better or faster, then our
instrumental value of X may not be enough to persuade us to pursue X rather than Y. It is

for this reason that we can only be relied upon, not trusted, to act according to X.

52

In contrast to Mullin’s approach, other well-know conceptions of trust, such as the
goodwill approach8 and the moral integrity approach, only implicitly incorporate social
forces. According to these conceptions, trust is based on our expectations of how others’
actions will affect uS—making the trusting individual the only focus. For example,
Annette Baier, a proponent of the goodwill approach, puts the individual at the center of
trust, claiming, “When I trust another, I depend on her good will toward me” (1986, 235).
Trudy Govier, a moral integrity theorist, makes a similar move, stating “When we trust
others, we expect them to act in ways that are helpﬁrl, or at least not harmﬁrl to us” (17).
In focusing on the individual’s viewpoint, the ways in which social forces inﬂuence the
individual’s expectations get sidelined. For example, the goodwill approach and the
moral integrity approach both assert that we trust people who we expect will act
according to these characteristics. Yet, what we consider good will and moral integrity
depends on dominant norms and ideologies. By not directly addressing the role social
forces play in interpersonal trust, these other accounts give the impression that trust is
something that occurs between two atomistic individuals.

Although Mullin avoids the pitfall of conceptualizing trust as practically devoid
of social context, her approach is not without its problems. One potential critique of
Mullin’s approach is that trust depends on social norms, many of which are not only
problematic, but also oppressive. The concern here is that in accepting her approach, we
are reinforcing and reifying these oppressive social norms. This criticism does not hold,
as it is a misreading of Mullin. Mullin’s account of trust seeks to represents what is

occurring on a descriptive level when we trust, not on a normative level. If her account

 

8 For more on the goodwill approach, see Annette Baier and Karen Jones.

53

involved a normative argument, then I think this criticism would be relevant. But because
Mullin is merely describing how we trust, this critique does not reveal a problem with her
account, only with oppressive social norms.

A more signiﬁcant critique of Mullin is that she seems to reduce trust to social
norms. AS many examples can easily show, following social norms is not a sufﬁcient
condition for trust. For instance, there is a social norm in the United States that people
stand in elevators facing the doors. If I were to go into an elevator and stand with my
back to the door, thus looking at everyone else in the elevator, I would be violating the
unspoken social norm of how to act in elevators. And while I am sure people would be
uncomfortable—in fact, I know people would be uncomfortable because I have broken
this social norm before——I do not think it is right to say that they would feel like their
trust in me had been betrayed in that domain. The others in the elevator would probably
ﬁnd me odd and may be confused by my behavior, but I doubt they would describe their
feelings as betrayal; betrayal is too strong of an emotion for this situation. They might
expect me to break other social norms that have to do with social customs, such as
drinking soup from the bowl rather than using a spoon, yet this does not mean they
distrust me.

Perhaps Mullin would respond that trust involves more than just abiding by social
norms; the reason the trusted person values the social norm also plays a role. In the case
of trust, we assume that the trusted person intrinsically, rather than instrumentally, values
the social norm. Mullin might retort that the others in the elevator do not feel betrayal
because they do not think that I intrinsically value the social norm of how to stand in an

elevator. If they did think I intrinsically valued this social norm, then they would feel like

54

 

I had broken their trust. However, since this is an example of a social norm that is rarely
intrinsically valued, it makes sense that the others do not feel betrayal. (If they believe
that I instrumentally value this social norm, then they may feel that I have been
unreliable.) Mullin might claim that another situation, one in which people generally
intrinsically value the social norm at play, would Show that her conception of trust is not
reducible to just social norms.

Yet, I am skeptical that the distinction between intrinsic and instrumental does the
sort of work for her theory that she may think it does. That is, this distinction is riddled
with problems to the extent that it detracts from her approach rather than strengthening it.
Before we can even decide whether a person intrinsically or instrumentally values a
social norm, we have to determine which social norm is at play. This is often not easy,
since social norms are generally not discrete, unconnected beliefs. Furthermore, there
may be more than one social norm that motivates a person to act in a particular situation.
In order to determine someone’s trustworthiness or reliability according to Mullin’s
approach, we must ﬁrst know which social norrn(s) she is committed to and then we can
determine whether she intrinsically or instrumentally values it (them). Yet, ascertaining
whether someone intrinsically values a social norm is no simple feat. As Mullin herself
states, trust is rarely explicit (2005b, 325). Consequently, there is typically little to no
discussion of what social norm governs the speciﬁc domain of trust and whether the
trusted person intrinsically values it. The result is that the subject of trust must make
assumptions about the values held by the object of trust based on what can be very
limited information. In sum, identifying and assessing how people value social norms is

an arduous process.

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A deeper problem with the distinction between intrinsically and instrumentally
valuing social norms is that it is conceptually unclear and confusing. The idea of
instrumentally valuing a social norm seems odd. Valuing money instrumentally, for
example, makes sense because money can get us the things we really (i.e. intrinsically)
value, like a car or the ability to retire by age 65. In contrast, a social norm itself cannot
help us achieve other things, though following it can. If we uphold a social norm in order
to get something else, then what we are instrumentally valuing is not the social norm, but
the action. For instance, there is a social norm to help one’s friends. I, a talented
carpenter, may build a handicap accessible ramp into my home so my friend Sylvia can
more easily come over. I may do this for instrumental reasons—so I can see Sylvia more
often, to assuage my guilt, to get her to do a favor for me in return—yet the norm is not
what I instrumentally value. I instrumentally value the action, as it is the action that
produces the outcome that l intrinsically value.

The idea of intrinsically valuing a norm also seems strange. I am not sure what it
means to value the norm to help one’s friends for the sake of the norm to help one’s
friends. To be charitable, perhaps what Mullin means by intrinsically valuing a norm is
morally valuing it. What we are valuing in this case is clearer: the moral message of the
norm (e. g. whether helping friends is the “right” way to act). This type of valuing of
norms maps onto our lived experience, as, in everyday life, we make moral claims about
the worth of various norms. Moreover, the degree of value we place on a norm affects our
actions. If I morally value the social norm of helping ﬁiends, then I am more likely
uphold it (i.e. to actually help ﬁiends) than someone who does not morally value this

norm. The distinction between morally valuing versus not morally valuing a social norm

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seems to be more useful for understanding trust than the distinction between intrinsically
versus instrumentally valuing a social norm.

Turning to McLeod’s work, we can get a better understanding of the role
normative moral values play in trust and how they help us distinguish between trust and
reliance. McLeod’s presents a different explanation than Mullin for why breaking certain
social customs does not result in distrust, but perhaps a lack of reliance. She states, “Trust
and mere reliance are distinct because we expect trusted others, unlike those on whom we
merely rely, to be motivated by a moral commitment” (McLeod 474). When we trust,
according to McLeod, we expect people to act in a morally acceptable way, a way that
matches up to our moral beliefs. While we may agree that there are standard ways to act
dictated by social customs, most of us do not have a moral investment in these types of
norms. We do not morally uphold standing in elevators facing the doors. Consequently,
we do not feel like our trust has been betrayed by people who stand the “wrong” or
“nonstandard” way in elevators. Instead, we are more likely to feel that these people
cannot be relied upon to follow social customs.

In contrast to the elevator example, numerous social norms are morally grounded.
For example, there is a social norm that people in committed romantic relationships will
be monogamous. If we uphold this norm and ﬁnd out that our partner has had sex with
someone else, we would probably feel betrayed. The moral dimension to McLeod’s
approach to helps us understand why the emotions of betrayal are typically so much
deeper than the emotions of disappointment due to lack of reliability. In the case of
disappointment, we are upset or ﬁ'ustrated because our expectation was not fulﬁlled. For

instance, my secretary forgets to bring me my morning coffee and I am consequently

57

grumpy because my morning ritual has been broken and I am without my necessary
caffeine ﬁx. With betrayal, in addition to the feelings we have due to our expectation not
being met, we learn that the person we trusted does not have the same moral
commitment(s) that we do in this particular domain. Especially in close relationships,
such a discovery can be heart wrenching, as our relationships are often grounded in
shared values and admiration for another’s moral integrity. Furthermore, knowing that
trusted people do not share our moral commitments is troubling because it suggests that
they may not care about us as much as we care about them. If my partner does not
morally value monogarny and she cheats on me, I may worry that she does not love me
that much; otherwise, she would uphold a commitment to monogarny. Even if the person
we trusted claims to share our moral commitment(s) in a particular realm despite her
actions to the contrary, we are still upset that she hurt us by failing to maintain her moral
integrity.

One critique of the moral integrity approach (as well as the goodwill approach) is
that it cannot explain why we can feel our trust has been betrayed even when a person
acts with moral integrity (or goodwill). For example, high school student Naomi conﬁdes
in her ﬁiend Tom that she is extremely depressed and even suicidal. Tom is very
concerned about Naomi and informs her parents immediately. They set up an urgent
doctor’s appointment for Naomi, which tips her off that Tom has spilled her secret since
he is the only person she told. While there is clearly controversy regarding when it is
ethical to break someone’s conﬁdence, some would claim that Tom acts morally here and
eVen more would agree that Tom’s reasons for action are morally motivated. Even if one

believes Tom acts morally, Naomi nonetheless feels betrayed. McLeod might respond

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that her approach can accommodate this situation, as it is a case in which the truster
(Naomi) and the trusted (Tom) have different understandings of what it means to have
moral integrity in this particular domain. Yet, Naomi could believe that Tom has “an
enduring commitment to acting in a morally respectful way” toward her and that his
actions follow from that commitment—in short, that he has and acts from moral
integrity—and still feel betrayed by his behavior (McLeod 468). In other words, Naomi
can feel betrayed even if she thinks Torn acted morally. The main reason Naomi feels
betrayed is that there is a morally charged social norm that friends keep each others’
secrets—a norm that she thinks (consciously or nonconsciously) that she and Tom both
uphold. Tom violated this social norm, which leads to broken trust despite the fact that
Naomi may believe that Tom acted with moral integrity. This example suggests that we
expect more than just moral integrity from people we trust; we also expect them to act
according to shared social norms. Acting with moral integrity is not sufﬁcient for trust,
though it is necessary. The same generally holds true for the relationship between trust
and adhering to social norms: acting according to social norms is necessary for trust, but

not sufﬁcient.

Trust as Following Morally Shared Ideologies
So far I have highlighted the major strengths and weaknesses with Mullin’s and
McLeod’s conceptions of trust. My conception of interpersonal trust is basically a
combination of the strengths of their accounts. I borrow Mullin’s idea that trust involves
following social norms, though I broaden it to include ideologies, and I draw from

McLeod’s claim that trust has a moral dimension. My conception of trust is as follows:

59

when we trust, we expect people to act according to morally Shared ideologies in the
relevant domain and we assume they are competent to do 30. Since I explained why a
moral dimension and adherence to social norms are each necessary, though not sufﬁcient,
components of trust in the previous section, I will not reiterate those arguments here.
Rather, I want to focus on how incorporating ideologies into my conception leads it to
deviate from Mullin’s and McLeod’s approaches.

But, ﬁrst, I point out a commonality among my conception of trust and Mullin’s
and McLeod’s: the role of competence in trust. Most trust theorists,9 including McLeod
and Mullin, agree that incompetence can interfere with trust. According to McLeod, one
common reason for an attitude of distrust is that “we are pessimistic, rather than
optimistic, about the other person’s competence” (477). In other words, if we are not
conﬁdent in another’s competence, we are likely to distrust her rather than trust her.
Likewise, Mullin asserts that “when we trust, we assume certain forms of general
competence. These involve competence (l) to recognize the social norm supposed by the
truster and understand what it requires and (2) to act in accordance with one’s own
norms” (2005b, 322). Since my conception of trust is Similar to Mullin’s in that we both
think trust involves the expectation that people will act according to norms (and
ideologies in my account), these two forms of competence affect my conception as well.
More broadly, incompetence can prevent trust in my account of both interpersonal and

group trust.

 

9 For example, Trudy Govier enumerates three aspects of trust and one of them is competence (1992, 18).
Karen Jones directly incorporates competence into her deﬁnition of trust, stating, “trust is optimism about
the goodwill and competence of another” (7).

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Believing that someone is competent is necessary for trust. Since we usually trust
people in particular domains, what matters is whether we think their incompetence affects
what we trust them with. For example, Miguel is able to trust Latesha to water his plants
while he is away on vacation because he knows she is competent at the task. He does not,
however, trust her to borrow his car because she does not have her license and is an
incompetent driver. That she is an incompetent driver does not interfere with his trust of
her watering his plants because this incompetence will not affect her ability to water his
plants. If, however, Miguel discovers that Latesha has some speciﬁc incompetency that
will affect her ability to water his plants, such as she has a tendency to severely overwater
plants, then this incompetency will rightly interfere with his trust of her to complete this
task. Certain general incompetencies will also interfere with his trust of her. For example,
if Latesha is chronically forgetful, then this may prevent her from remembering to water
Miguel’s plants everyday. Assuming Miguel is aware of Latesha’s forgetfulness, it will
factor into his willingness and ability to trust her. Our group membership can also
inﬂuence our perceived competence, a point I return to in the next section.

Another commonality between my conception and Mullin’s and McLeod’s is the
idea that trust involves taking a risk.10 For example, Mullin states, “when trust is fully
explicit, the truster is aware that there is an element of risk involved in the trust behavior”
(Mullin 2005b, 325). When we trust, we make ourselves vulnerable by allowing for the
possibility of broken trust and the negative moral emotions it engenders. These negative

moral emotions are painful to experience and they can damage our relationships,

 

'0 Other feminist trust theorists also point out that trust entails risk For example, Govier highlights the risk
of distrust: “When we distrust, we fear that others may act in ways that are immoral or harmful to us; we
are vulnerable to them and take the risk seriously” (17).

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especially our relationship with the object of trust. Furthermore, broken trust can lead to
potentially hurtful and dangerous situations for us, and for others. In the case of
contraception, if men betray women’s trust to contracept, then the women could end up
unintentionally pregnant (and/or with a STD). Likewise, if women betray men’s trust to
contracept, then men could become a father against their wishes. As I explain in detail in
chapter 6, there are numerous harms associated with unintended pregnancy and
parenthood, more for women, but also many for men. Given these potential harms and
the unpleasant moral emotions that broken contraceptive trust can produce, many people
are cautious about trusting others, especially unknown others, with contraception.

I turn now to how my conception of trust differs from Mullin’s and McLeod’s.
One signiﬁcant difference is the role ideologies play in my conception. It is important to
be clear about what I mean by the term ‘ideology.’ Although Antoine Louis Claude
Destutt de Tracy originally coined this term to mean a “science of ideas,” I am focusing
on the more common meaning of this term in contemporary political thought as
introduced by Karl Marx and Friedrich Engels. Louis Althusser summarizes Marx’s
deﬁnition of ideology as “the system of ideas and representations which dominate the
mind of a man or a social group” (159). Indeed, I am using this term to refer to a broad
and diverse body of cultural beliefs, stories, myths, images, tropes, expectations, norms,
and so on that shape our behavior. Ideologies, according to Michel Foucault, emerge
from “power-knowledge relations” (278). He argues that “power produces
knowledge. . .power and knowledge directly imply one another; there is no power relation
without the correlative constitution of a ﬁeld of knowledge, nor any knowledge that does

not presuppose and constitute at the same time power relations” (261). In other words,

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social forces create knowledge and knowledge reinforces these social forces. For
example, the social force of patriarchy produces the knowledge that women are not as
smart as men and this knowledge perpetuates patriarchy through its disciplinary
instantiations, such as paternalistic laws regarding women’s body (e. g. limitations on
abortion), normalizing forces that prohibit women’s employment in certain jobs, and
heterosexual norms that a man should be the head of household.

Ideologies exist and interact in deep, complex, and sometimes contradictory ways.
They are not discrete or atomistic. Rather, they depend upon a social context and are
often intertwined with other ideologies. Indeed, they are culturally speciﬁc, absorbed
through socialization, and perpetuated by our use of them. We are typically not fully
conscious of them, though we constantly depend on them to make sense of our world and
guide our actions. In this way, they have a moral dimension, as we rely on them to
determine and justify moral beliefs and actions. Part of the reason we are not fully
conscious of them is that they are so deeply embedded in our cultural consciousness and
social structures that they have been normalized. We often do not recognize them as
ideologies. Rather, we generally take them for granted as “just the way things are,” which
is why it can be so difﬁcult to challenge and uproot dominant ideologies. Through
socialization, we are disciplined to become “subjected and practised bodies, ‘docile’
bodies”; that is, bodies who uphold ideology (Foucault 264). Two examples of socialized
docile bodies are “women’s cramped postures and attenuated strides and men’s restraint
of emotional self-expression (except for anger),” which are materializations of patriarchal
beliefs about women’s weakness and inferiority and men’s strength and stoicism (Frye

1983, 14). While others sometimes explicitly tell us to behave in accordance with cultural

63

 

expectations (e. g. “good girls cross their legs” and “boys don’t cry”), many of these
ideological and behavioral norms are tacitly conveyed. Girls learn there are
noncompliance consequences for sitting with their legs open—e. g. they are viewed loose
and unladylike—and, likewise, boys recognize crying is socially stigmatized—e. g. boys
who cry are considered weak, sissy, and feminine. Through these experiences, children
nonconsciously internalize these ideologies and not only modify their behavior, but they
also self-monitor and self-discipline their behavior.

The way I am discussing these ideologies is similar to concepts employed by
other theorists. For example, Hilde Lindemann Nelson presents a narrower concept than
ideologies, perhaps a subset of ideologies, that centers on narratives. She refers to the
dominant narratives as “master narratives” and deﬁnes them as:

the stories found lying about in our culture that serve as summaries of

socially shared understandings. Master narratives are often archetypal,

consisting of stock plots and readily recognizable character types, and we

use them not only to make sense of our experience but also to justify what

we do. As the repositories of common norms, master narratives exercise a

certain authority over our moral imaginations and play a role in informing

our moral intuitions. (Nelson 2001, 6)

Diana Meyers discusses an even more restricted concept than both ideologies and
narratives. She focuses on dominant gender (or patriarchal or sexist) beliefs and
expectations for women in the US and describes these “ﬁgurations of womanhood” as
“the dominant system of tropes, mythic tales, and pictorial images that encode the various
meanings of womanhood and norms applying to women in the United States today”
(Meyers 2002, 25). Recognizing the role these ﬁgurations, and ideologies more generally,

play in understanding our world, Meyers identiﬁes them as “culturally certiﬁed concepts

and interpretive schemas” (Meyers 2002, 24). For my purposes, I am not too concerned

64

1ft?“ ‘4.

about carefully distinguishing these terms, as they are all ways of conveying dominant
and systemic social understandings.

Returning to my conception of trust, if trust requires believing we share moral
ideologies with the object of trust, then how do we know what ideologies others uphold?
The truth is that we often do not know, even with people we may know fairly well. When
we do not know, we (consciously and nonconsciously) tend to assume that others believe
the dominant ideologies. Since dominant ideologies are generally well-known and well-
supported, they serve as our default option when we are unsure of what others believe.
Yet, we also recognize that beliefs and ideologies are often culturally and group speciﬁc.
In determining what ideologies others support (a process that is not fully conscious), we
usually take into account their personal characteristics, including their group
memberships. For example, Jessica opposes premarital sex. If she knows Caleb is a deep
and active believer in Evangelical Christianity, then she may presume that he also rejects
premarital sex. She consequently may trust him not to pressure her to have sex when they
are alone together. However, if she does not know about his religious convictions, then
she probably does not trust him with respect to this behavior because she would likely
assume that he follows the dominant ideology that premarital sex is acceptable, even
expected. In sum, which ideologies we expect others to follow depends on the cultural
context and the social positions of the subject and object of trust. Regardless of whether
the ideologies are dominant or not, it is imperative that the subject of trust believe that
she and the object of trust have a shared commitment to the same moral ideology(ies).

The example of Jessica and Caleb shows that getting to know others, which

includes learning about their moral commitments, improves our ability to make good

65

decisions about trusting them. When we have a deeper sense of who people are and what
they value, we are able to determine with greater accuracy if we share the same moral
commitments. Our ability to gauge whether we share moral commitments is lessened
when we do not know people well since, as mentioned above, we typically assume they
support the dominant ideology or a nondominant ideology prevalent in their community
or group. Basing trust on unsubstantiated hypotheses about people’s values results in a
weaker trust relationship because we are less conﬁdent that we and the object of trust
truly share the same moral commitments. Moreover, the probability of broken trust
increases since it is more likely that we are wrong about the object of trust’s moral
commitments.

Regardless of whether we know someone well or not, ideologies will always be
central in relationships of trust since trust is the expectation that people act according to
shared moral ideologies. Yet, ideologies play another role in trust, a role that grows
stronger the less we know someone. Ideologies aid us in determining what ideologies
others’ uphold. For example, two dominant cultural stereotypes in the US. are that “real”
U.S.ersll are white and that people of Arab descent are terrorists. Tony, an airport
security guard, does not trust people who are, or who he thinks to be, of Arab descent
because he does not think they share his belief in protecting the US. Though Tony is not
fully conscious of how these cultural stereotypes affect his relations of trust, they are
reﬂected in his actions: more thorough screening of people he believes to be Arab than
for people who he considers white. When Tony’s next door neighbor, Fatimah, comes to

the airport, he treats her like a white person even though he knows for certain she is of

 

11 I use the term “U.S.ers” rather than “Americans” to refer to people who identify as members of the

United States as a way of being more precise and less exclusionary because people living in countries in
North, Central, and South America other than the USA. also consider themselves Americans.

66

 

Arab descent. The reason he makes an exception for her is that he knows her personally
and consequently he is able to judge whether she shares his moral commitment to protect
the US. on her individual characteristics (for example, he knows she is in the Army and
served in the Gulf War) rather than on her social group membership. For people he does
not know personally, Tony relies on cultural stereotypes to assess their trustworthiness. I
will discuss these ideas in more detail in the next section in explicating my conception of
“group” trust. What I want to stress before turning to trust on the group level is that

ideologies affect trust on the interpersonal level as well, as seen in the case of Tony.

Group Trust

So far, I have been discussing trust on the interpersonal level. But there is another
level on which trust occurs that deserves recognition and that was hinted at in the
mainstream articles about contraception. The language used in these articles reveals that
many journalists, scientists, and pharmaceutical company employees are skeptical that
women will trust men as a group. I will provide more evidence for this claim in the next
chapter, but ﬁrst I want to explore this other type of trust, which I call “group trust.”
Whereas interpersonal trust examines trust on the individual level—does person A trust
person B?—group trust takes a broader perspective and examines whether someone trusts
a particular group of people—doeseperson C trust group D? Group trust does not and is
not meant to encompass the perspectives of all people. Like interpersonal trust, the
trusting agent in group trust is an individual. So, when we talk about group trust, we are
still looking at an individual’s view. The big difference between interpersonal trust and

group trust is who the object of trust is: in interpersonal trust the object is an individual,

67

 

while in group trust the object is a group. As I will show in this section, having a different
object of trust changes the nature of group trust in some signiﬁcant ways from
interpersonal trust.

Group trust is not limited to discussions in articles and surveys about which
groups people trust. It also has practical implications, as group trust is reﬂected in laws,
policies, and social norms. For example, some states do not allow gays and lesbians to
adopt children. Although politicians rarely use the language of trust to support these laws,
one of the underlying reasons they pass such laws is that they uphold, or believe their
constituents uphold, the ideology that gays and lesbians cannot be trusted to provide the
“right” (read: heterosexual) type of environment for children. There is a dominant moral
ideology that children should be raised in a two parent, heterosexual household. Many
politicians and their constituents consequently do not trust gays and lesbians to raise
[children because they do not follow this moral ideology. This group distrust is manifested
in laws prohibiting gays and lesbians from adopting.

As this example shows, because group trust concerns entire groups of people
rather than speciﬁc known individuals, it relies more heavily on dominant ideologies.
Dominant ideologies affect our determinations of a group’s trustworthiness by shaping
whether we think the group will act according to the relevant ideology in a particular
domain and whether the group is competent overall and in speciﬁc domains. Because
people engaged in interpersonal trust can generally identify and often know the object of
trust, they are less likely to have to rely on ideologies to determine trustworthiness.
Instead, they can base their assessment of trustworthiness on the speciﬁc characteristics

of the person and the particular circumstances surrounding trust. In contrast, group trust

68

involves groups of people—and thus generalizations about these groups—and
consequently such particularities about individual people or circumstances are less likely
to be recognized. Assessing the trustworthiness of a group makes us more susceptible to
stereotypes, meaning we are more likely to reduce groups to cultural tropes rather than
acknowledging the diversity within groups. The more innocuous reason for this is that we
are forced to make generalizations about the individuals who comprise the group in order
so they all neatly “ﬁt” within the group. For example, one may generalize that all women
have the potential to become pregnant, even some women do not (e. g. women who are
postmenopausal, infertile, MTF transgender, etc.). The less innocuous reason is that it is
easier to fall prey to stereotypes in an oppressive (e. g. sexist, racist, classist, and ableist)
world because they are so deeply and systemically embedded into our worldviews. For
instance, one may generalize that people on welfare are lazy rather than acknowledge the
systemic forces that lead people to go on welfare or highlight the achievements of people
on welfare.

That group trust relies so heavily on dominant ideologies is clearly problematic. I
agree with Lorraine Code that “epistemologically speaking, the use of stereotypes is
always a crude and irresponsible way of not bothering to know, yet posing as though one
does” (170n3). By extension, relying on ideologies to determine a group’s
trustworthiness suffers the same ﬂaws. Ideologies typically reﬂect the perspective of the
dominant group(s) and so it is not surprising that they usually positively reﬂect the
dominant group and negatively portray the oppressed groups. Yet, although many
ideologies are troubling, we do rely on them in group trusting. Like Code, I believe that

“something very like stereotypes is in fact needed if knowledge, or language [or group

69

1 _: —I.I\AI#-' . ‘3‘”

trustworthiness], are to be possible at all,” but that we should strive for these stereotypes
to be ﬂexible, not dogmatic (162). We cannot change the fact that, descriptively
speaking, group trust depends on ideologies. What we can change, however, are these
ideologies themselves, though this is no easy feat. Additionally, we can change the way
we approach these ideologies by recognizing that they are do not include everyone from a
particular group and they do not convey some “essence” of what it means to be part of a
speciﬁc group. I will return to some of these practical suggestions in the next chapter.
Even though I may not trust a certain group on the group level, I can still trust
individuals who are members of that group on an interpersonal level. Say, for example,
that I do not trust the group Jews with anything related to money because of the cultural
stereotype that they are greedy and stingy. This distrust is not fully conscious, nor are the
ways this distrust inﬂuences my decisions. My group distrust of Jews will probably affect
my decision of where to invest my money, which charities I donate to, which restaurants
I frequent, which companies I work for, etc. because all of these actions take place on the
group level rather than the individual level. For instance, I may refuse to donate to Jewish
charities and charities headed by Jews because I fear that the Jews working for these
charities will keep some or most of the donated money for themselves rather than using it
to advance the mission of the charity. My decision to avoid donating to certain charities is
based on my generalized and universal view of Jews; that is, my belief that all Jews are
greedy and stingy. However, I can make exceptions to this belief for Jews whom I know
personally. A ﬁiend recommends her accountant, Rebecca, to me. Not knowing Rebecca
is Jewish, I use her services and come to highly respect her and her work. After some

time, I discover that she is Jewish, yet she does not ﬁt the cultural trope that Jews are

70

greedy and stingy. Instead of changing my deeply seated belief about Jews, it is easier for
me to tell myself that Rebecca is just the exception to the norm. By doing this, I am able
to continue trusting Rebecca on an interpersonal level while simultaneously distrusting
Jews on a group level regarding money.12 What this example shows is that knong
someone personally allows us to make decisions about trust based on her individual
characteristics rather than on general assumptions we may have about people based on
their group membership. In this way, interpersonal trust is more accurate and avoids the
aforementioned problems of group trust.

Another important difference between interpersonal trust and group trust is that
when group trust is broken, there is not the same sense of betrayal as there is when
interpersonal trust is broken. To understand why this is the case, I return to the example
of some politicians (and their constituents) who think there should be a law preventing
gays and lesbians from adopting children. Imagine that such a law fails to pass and that
gays and lesbians are granted the legal right to adopt children. If gays and lesbians start
adopting children, we would not say that these politicians feel betrayed by their actions
even though they are acting in an untrustworthy manner according to the dominant
ideologies the politicians maintain. One reason it does not make sense to label the
politicians’ feelings as betrayal is that betrayal seems to presume a relationship between
truster and trusted.

On a certain level, it is difﬁcult to conceptualize a relationship between an

individual and a group, though such relationships clearly exist. For example, a teacher

 

'2 According to Sartre, we can do more than make exceptions for members of groups we distrust in a
particular domain; we can also make exceptions and befriend members of groups we hate. He states: “The
sadistic attraction that the anti-Semite feels toward the Jew is so strong that it is not unusual to see one of
these sworn enemies of Israel surround himself with Jewish ﬁiends. To be sure, he says that they are
‘exceptional Jews,’ insists that ‘these aren’t like the rest’” (47).

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1 Erasing-.127”

has a relationship with each of her classes and a child has a relationship with his
immediate family. However, in both these cases, the group is bounded and well-deﬁned;
the teacher and the child can usually identify the members of the group. Furthermore, the
teacher and the child have some sort of interpersonal relationship with all of the members
of the group. The politicians cannot identify all the gays and lesbians in their state (let
alone their district), which precludes their having an interpersonal relationship with all of
them. Perhaps being able to identify all the members of a group and to have an
interpersonal relationship is not necessary for an individual to have a relationship with a
group. For instance, a politician may have a relationship with her constituents even
though she cannot individually identify all of them. Maybe what is most important for a
relationship between an individual and a group is that there is two-way communication.
A politician can communicate to her constituents through public speeches, interviews,
and laws she supports. Her constituents can respond to her at public meetings, by
contacting her ofﬁce, through public support surveys, and, ultimately, by voting.

Since many relationships, especially close ones (e. g. partners, best ﬁiends) are
grounded in shared values and respect (even admiration) for the other’s moral integrity,
part of the sting of betrayal is learning that the person we trusted does not share our moral
commitment(s) in a particular domain. Betrayal is also such an intense feeling because it
suggests that the trusted person does not care about us, or at least not as much as we care
about her. Without a relationship based on common values and care, when someone
breaks our trust, our feelings are unlikely to be as strong as betrayal. That said, I think
feelings of betrayal or disappointment can result from broken group trust. For example, a V

politician could feel betrayed by her constituents if they vote her out of ofﬁce or a person

72

 

who considers herself Navajo could feel betrayed by the Navajo community if they refuse
to recognize her as Navajo. Yet, in both these examples the individuals seem to have a
relationship with the group and even two-way communication. When both of these two
components are not present, the likelihood that broken group trust produces feelings of
betrayal is greatly diminished.

Broken group trust, however, still leads to moral emotions, but emotions that do
not depend upon a relationship for their existence, like anger13 or disgust”. For instance,
the politicians who oppose permitting gays and lesbians to adopt probably are angry
and/or disgusted with gays and lesbians who choose to have children (via pregnancy,
adoption, or any method) because they are violating the ideology the politicians uphold.
Likewise, I may feel both anger and disgust at Jews in general when I learn that a Jewish
company has bought out my favorite local store.

Some may object to my conception of group trust because they think it deviates
from interpersonal trust in too many signiﬁcant ways: group trust has a group rather than
an individual as the object of trust, it relies more heavily on ideologies, and it does not
usually produce feelings of betrayal when broken. The concern here is that I am
stretching the deﬁnition of trust to include something that cannot rightly be considered
trust. Yet, the last two aforementioned differences result from the ﬁrst difference; that is,
the fact that the object of group trust is a group causes group trust to depend more on

ideologies and not lead to betrayal. Group trust will of course differ from interpersonal

 

13 According to Frye, “Anger is always righteous” (1983, 84). For more on anger, see her chapter “A Note
on Anger” in The Politics of Reality.

14 William Miller, for example, states disgust “marks out moral matters for which we can have no
compromise” (1997, 194). Dan M. Kahan also believes disgust has a moral component, claiming that
disgust is “brazenly and uncompromisingly judgmental” (1998, 1624). Martha Nussbaum’s book, Hiding
ﬁom Humanity: Disgust, Shame, and the Law discusses both these views on disgust and many others.

73

trust precisely because the object of trust is a group, not an individual. But some may still
reject group trust as a type of trust on the grounds that one of the main ways to
distinguish trust from reliance is that breaking trust causes feelings of betrayal, whereas
unreliability merely leads to disappointment. I agree that the potential to produce betrayal
is an important component to interpersonal trust and helps us differentiate between
interpersonal trust and reliance.

If betrayal is not common to broken group trust, then what will assist us in
distinguishing group trust from group reliance? First off, I do not think there is a clear
line of demarcation between trust and reliance, even on the interpersonal level. But more
importantly, the moral component of trust is what enables us to distinguish it from
reliance. Broken trust produces moral emotions, like betrayal, anger, and disgust, whereas
broken reliance leads to emotions that are not (or perhaps are less) moral, like confusion,
frustration, and disappointment. The examples of the politicians opposing gay and lesbian
adoption and me believing Jews are greedy and stingy show how broken group trust
causes moral emotions. Let me give an example of broken reliance. Say I rely upon the
Mexican community in my town to put on a parade for Day of the Dead. If there is no
parade this year, I would probably be confused, frustrated, and disappointed. I doubt that
I would use moral emotions to describe my feelings in this case because there is not (or
there is less of) a normative and moral aspect to expecting a parade than expecting people
to act in a particular way when raising children, for instance.

I recognize that this response will not satisfy those who believe that feelings of
betrayal are a necessary component of a good account of trust, be it on the individual or

group level. Perhaps referring to group trust as group expectation or something without

74

the word “trust” would mitigate this objection. But because I want my account of group
trust to map onto the everyday language we use, I will not replace the word “trust” with a
less contentious word. As the articles on male contraception shows, we do talk about
trusting a particular group of people. I want my account of group trust to reﬂect the
common language we use so that we can make sense of the difference between trusting

individuals and trusting groups.

CONTRACEPTIVE IDEOLOGIES

Now that we have an understanding of what group trust means, I will explore
some of the dominant ideologies at play in contraception. Recognizing the dominant
ideologies helps us to understand the discrepancy in contraceptive trust for men on the
individual and group level, a task I return to in the next chapter. The extensive
philosophical and feminist work on reproduction and childcare has shown how various
ideologies shape our understandings, experiences, and actions within these realms.
Because contraception ﬁts under the umbrella of reproduction and childcare, the
dominant ideologies at play in contraception are similar to those at play in other
reproductive and childcare matters. Yet, how these ideologies inﬂuence contraceptive
issues may not be readily apparent. Part of the reason for this is that contraception
receives little attention in political, academic, and media realms. When contraception is
addressed, the way we talk about it—speciﬁcally our focus on how it augments women’s
autonomy—tends to mask the underlying ideologies. Both of these ideas were discussed
in chapter 1, so I will not reiterate those arguments here. Instead, I will point out how

certain reproductive and childcare ideologies also shape contraceptive matters.

75

 

Although ideologies are socially situated and often entangled with other
ideologies, it is sometimes useful to be able to discuss them individually. I may refer to
particular ideologies by name to avoid cumbersome language, but this does not mean that
I think those ideologies are separable from other ideologies and from a social context. In
fact, my discussion will reveal the opposite conclusion: that ideologies depend on a social
context and sometimes on one another. In this section, I focus on two contraceptive
expectations. First, I examine the dominant ideology that contraception is a personal
matter that should not be discussed by exploring how our legal and education systems
make contraception private and taboo. Second, I extend the dominant ideology that
pregnant women and mothers should be self-sacriﬁcing to contraception to reveal that
some degree of self-sacriﬁce, or at least of assuming burdens and accepting losses, is
expected of those who contracept.

Before turning to these ideologies, it is important to note that although often
considered in the abstract, reproductive and childcare ideologies, and hence contraceptive
ideologies, are highly gendered: women are typically associated with the private realm
and women are usually the ones expected to live up to the ideal of self-sacriﬁce. That
women are the ones held responsible for reproduction and childcare plays a signiﬁcant
role in why these speciﬁc social norms are the way they are. If men were the ones
traditionally responsible for reproduction and childcare, society would have created very

different social ideologies for these realms—ideologies that would be more “masculine.”

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Privacy and Taboo

Although there are policies and laws regarding reproduction and childcare in the
U.S., as well as public debates about these policies and laws, these matters are generally
thought to belong to the private realm. Not surprisingly, little public money goes to
support for reproduction and childcare. In contrast, France, like many European
countries, publicly assists in these matters: prenatal care is easily accessible and covered
under their system of universal health care, pregnant women can take paid maternity
leave months before giving birth, nurses make home visits to help parents and babies, and
childcare is heavily subsidized by the government (Shapiro). Moreover, France also treats
contraception as a public matter by including contraception in its universal health care
systenr, providing free contraception in schools, distributing contraceptive information in
various venues, and publically funding contraception campaigns (Boonstra). In 2000,
France decided to add emergency contraception to its list of contraceptives offered in
high schools, a move that was met with wide national support. The reaction in the U.S.,
however, was generally one of shock and outrage. Examining the US. cultural belief that
contraception is private and taboo will help us understand why U.S.ers responded so
differently from the French.

Like reproduction and childcare, contraception has historically and legally been
relegated to the private realm in the US. In 1873, Congress passed the Comstock law and
was the only Western country (at least at that time) to criminalize birth control. This anti-
obscenity law speciﬁcally named contraception as a type of obscene material and
prohibited its distribution through the public postal service and interstate commerce. This

law not only made contraception illegal, but it also pushed it out of the public realm and

77

 

 

into the private realm. It was not until 1936—63 years later—that the Comstock law was
over overturned by the court case (1.5. v. One Package, which ruled that doctors can
receive contraceptive information and methods through the mail unless illegal by state
law. Due to this ruling, the American Medical Association (AMA) ﬁnally ofﬁcially
acknowledged contraception as a legitimate aspect of medicine (PBS). Previously,
contraception was not considered a medical issue; it was merely a private matter. Yet,

contraception was still not viewed as a public matter even after the AMA recognized it.

. 4.. .....__.. . -_.._n

As seen by a series of court decisions, reproductive rights, and speciﬁcally the right to
contracept, were upheld by the right to privacy. For example, the 1965 US. Supreme
Court case Griswold v. Connecticut ruled that the state could not prohibit the use of
contraception due to couples’ right to privacy. (At that time, eight states outlawed the sale
of contraceptives and Connecticut and Massachusetts still had laws against disseminating
information about contraception (PBS).) In this same vein, the Supreme Court decision of
Eisenstadt v. Baird in 1972 stuck down a Massachusetts law that prohibited selling
contraceptives to unmarried women (PBS). While these court cases show that
contraceptive use has become more acceptable, not to mention legal, they also reveal that
contraception is still ﬁrmly entrenched in the private realm. Our legal right to contracept
is grounded in our right to privacy.

Outside the legal realm, contraception has remained a private matter in part
because it is taboo. For example, abstinence-only education teaches children that
contracepting is not something people should talk about or do. The social denial and
rejection of children’s sexuality also feeds into abstinence-only education, which is

reﬂected in the main message of its educational programs: sex outside marriage is not

78

only morally wrong, but it will lead to horrible outcomes. According to Sexuality,
Commitment & Family, an abstinence-only guide for teens, the serious psychological and
social consequences of premarital sex include:

loss of reputation, limitations in dating/marriage choices, negative effects

on sexual adjustment—Premarital sex, especially with more than one

person has been linked to the development of difﬁculty in sexual

adjustment (Guilt has been found to be a pervasive problem in this

regard.) development of emotional illness, loss of self esteem [and]

confusion regarding personal value (e. g. ‘Am I loved because I am a

sex object?) (cited in Doan and Williams 116)

Abstinence-only education also teaches children that STDs are a likely outcome of sexual
activity, usually going into graphic detail about the symptoms of STDs as a scare tactic to
prevent teens from engaging in sex (ibid.).

Since the goal of abstinence-only education is to convince teenagers to delay sex
until marriage, it is not surprising that it includes little to no information about
contraception (Doan and Williams). Generally, the information it does provide on
contraception is inaccurate. For example, the Choosing the Best Life curriculum informs
students that research shows that only 5 to 21 percent of couples who use condoms do so
correctly and, furthermore, that even when used correctly, condoms do little to protect
against STDs (Cook). Although condoms, or at least their failings, are mentioned in
abstinence-only education, contraception more broadly is not presented as a method to
avoid pregnancy or abortion (Doan and Williams 120). Instead, abstinence-only literature
focuses on the failure rates of contraception without any discussion of the advantages of
methods, or how to access and correctly use such methods. Moreover, abstinence-only

education links terrible consequences with contraceptive use, as seen this in passage from

the abstinence-only Sex Respect workbook:

79

The adults who thought that they were helping, found out that birth control

was only an illusion of help. They discovered that the chemical forms of

birth control damage the inside of a young girl’s body in ways that can

affect her fertility later on, too. They found that birth control shots, pills

and implants affected a girl’s moods and often made her gain weight.

They found that many teens that [sic] used birth control had a 10 to 20%

chance of getting pregnant anyway. They found that many more sexually

transmitted diseases were being spread among teens. The abortion rates

were much higher among people who used birth control that failed. The

emotional and psychological effects of teen sex only got worse. (Mast

2001, 42).

The above passage perpetuates the myth of the uselessness of contraception and
intentionally taps into girls’ and women’s fears of infertility, unwanted pregnancy,
abortion, and STDs.

Furthermore, “the preponderance of negative associations with birth control is
likely to dissuade young people from using birth control when they do become sexually
active” (Doan and Williams 121). Teenagers who receive abstinence-only education are
much less likely to use contraception not only because of their negative perception of
contraception, but also due to their lack of knowledge of where to get it and how to use it.
Moreover, since abstinence-only education teaches that premarital sex is wrong,
teenagers may try to hide evidence of sexual activity (e. g. contraceptives) from others. Or
they may be less likely to prepare for sex by using contraception because they do not
want to intentionally go against the ideology that they should delay sex until marriage.
Given the ubiquity of abstinence education—according to Landry et al., 57 percent of
public schools teach abstinence as the only or the preferred option to prevent pregnancy
and STDs, while only 10 percent teach abstinence as one of many options (33 percent of

schools have no sexual education policy)—and that children who receive abstinence-only

education engage in sex at the same rates as children who receive “real sex” education

80

 

 

(Kohler et a1), there are a lot of teenagers who are not contracepting. The low
contraceptive use among teens is the primary reason why the US. has the highest teen
pregnancy rate of all “developed” countries. The reasons teenagers do not use
contraceptive “include negative societal attitudes toward teenage sexual relationships,
restricted access to and high costs of reproductive health services, ambivalence toward

contraceptive methods and lack of motivation to delay motherhood or to avoid

JI‘I‘ "V V

unintended pregnancy” (AGI 2001). All but the last of these four reasons are related to

the taboo of sex and the privatization of contraception.

 

In addition to abstinence education, there are many other factors that contribute to
the dominant ideology that contraception should not be talked about or used. Let me
brieﬂy mention one factor that affects all people and not just one group (i.e. children and
teenagers) like the case of abstinence education. I turn now to the way sex is discussed
and portrayed in the media. The media uses sex to sell products (e. g. material goods,
magazines, TV shows, medical and health products) and since contraception is not part of
a sexy image, it is excluded. Media images show people tearing off each other’s clothes
without any discussion whatsoever. As Anna Stubbleﬁeld argues, “these images
propagate a paradigm of sexuality and romance in which women are ‘swept off their feet’
rather than actively planning for sexual intercourse” (96). These images also teach men
not to actively plan for sex, but instead spontaneously engage in sexual activity. In short,
the media reinforces the idea that discussion of contraception, and even contraception
itself (which is conspicuously absent in movie and TV sex scenes), should not precede or

be included in sexual activity.

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Self-Sacriﬁce

One of the prominent gender ideologies at play in pregnancy and childrearing is
that women should be self-sacriﬁcing (see, for example, Kukla and Mullin 2005a). This
expectation of self—sacriﬁce stems from the oppressive socialization15 of girls into
caretakers; that is, into altruistic women who prioritize others’ needs over their own.
Women who challenge this unjustiﬁable norm of self-sacriﬁce face social penalties, such
as fewer romantic relationships, having their children feel betrayed (an example Mullin
discusses), and being labeled selﬁsh and coldhearted. In contrast, women who uphold
self-sacriﬁce are socially rewarded. Bobbi McCaughey, the famous mother of septuplets
born in 1997, is a perfect example of how society praises self—sacriﬁcing women.
McCaughey jeopardized her own health (as well as the health of her fetuses—though this
is rarely mentioned by the media) in order to birth the septuplets. Furthermore, after they
were born, she devoted herself full time to caring for them. What makes McCaughey
such a great example of a woman who lives up to the self-sacriﬁcing ideal is not only the
number of children she has, but also her eagerness and devotion to being self-sacriﬁcing.
That is, she seems happy being self-sacriﬁcing. McCaughey was rewarded for her
pronatalist, self-sacriﬁcing behavior with intense media coverage (that still continues
today—in fact, Ladies' Home Journal puts them on the cover every year for the
septuplets’ birthday), a phone call from President Clinton, and numerous substantial gifts
(Charles and Shivas).

This coercive socialization instills in women the false belief that being self-

sacriﬁcing is an essential component of what it means to be a woman. By internalizing

 

15 I discussed Paul Benson’s concept of oppressive socialization in the previous and used self-sacriﬁce as
an example.

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this belief, women come to assert that “a real woman is a mother, or one who acts like a
mother, or more speciﬁcally, like the self-sacriﬁcing, nurturant, and care-taking mothers
women are supposed to be” (Raymond 8-9). Furthermore, many women believe that their
self-worth lies in their sacriﬁces for others, especially men and their children. Catharine
MacKinnon makes a similar point in discussing care, claiming that “Women value care
because men have valued us according to the care we give them” (3 9). The same holds
true for sacriﬁces: women value sacriﬁces because men value women who make
sacriﬁces for them. Since many women internalize the ideologies that women who do not
sacriﬁce are “bad” (they are selﬁsh, uncaring, and unwomanly) and that self-sacriﬁce is a
necessary component of women’s self-worth, their autonomy is impaired because they
are unreceptive to reasons for rejecting self-sacriﬁce. Indeed, they will often not consider
reasons that prioritize them or that suggest that self-sacriﬁce is not a necessary part of
being a woman. Especially when we compare women and men on self-sacriﬁce, it
becomes clear that most women value self-sacriﬁce for more than it being “objectively”
the right way to act: they value it because they have internalized it and cannot imagine
another way of being. For instance, the criterion most frequently cited by women of all
classes as the mark of a good mother was putting her children ﬁrst, whereas the social
understanding of a good father is one who provides ﬁnancially (McCormack 666). This
empirical ﬁnding shows the ubiquity of the ideology of self-sacriﬁce among women and,

furthermore, that this ideology is usually not thought to apply to men.

83

Pregnancy and Childcare

There is a social norm that women should willingly, and perhaps happily,
sacriﬁce themselves for their fetuses and children. Indeed, women are expected to
sacriﬁce even if there is only the potential for a slight improvement or advantage for their
fetuses or children. The implicit idea here is that women are to blame if their children do
not turn out “right” since they are the ones capable of making sacriﬁces given that they
are the ones who experience pregnancy and they are typically the primary caretakers of
children. Put differently, good mothers produce good children through their sacriﬁces, so
if the children turn out “bad,” then the mothers must have been “bad,” meaning they must
not have sacriﬁced enough. As Rebecca Kukla argues in Mass Hysteria, pregnant women
are judged according to how much effort they make, which includes their sacriﬁces, to
ensure good birth outcomes, with those making the most effort viewed as the best
potential mothers. She claims that “contemporary pregnant women are expected to be
avid consumers of medical information, to actively participate in their own prenatal care,
and to aggressively pursue good birth outcomes, while these outcomes are cast as
testimony to individual maternal character” (Kukla l9). Pregnant women are expected to
monitor and discipline their own behavior not only to ensure they are doing everything
they can do for their fetuses, but also to afﬁnn that everything they are doing is being
done correctly. “According to this ideology,” explains Mullin in Reconceiving Pregnancy
and Childcare, “for pregnant women, no sacriﬁce that could beneﬁt their future children
should be considered too great, and they are expected to engage in extremely rigorous
practices of self-surveillance and self-control” (Mullin 2005a, 97). Pregnant women are

expected to careﬁrlly keep track of every aspect of their lives and faithfully report it to

84

their health care providers, who, along with others (partners, ﬁiends, co-workers, etc.),
judge women on how successfully they are living up to the maternal destiny ideal.

In particular, due to their “permeable” wombs, pregnant women are expected to
limit and give up any “toxins” that could harm the fetus, such as alcohol, drugs, and
certain foods (e. g. ﬁsh, fatty foods), even though there may not be any empirical evidence
that these substances cause fetal damage. For example, light (alcohol) drinking during
pregnancy has not been shown to lead to Fetal Alcohol Syndrome, yet health care
providers caution women not to drink an ounce of alcohol while pregnant. Furthermore,
the government warns women not to drink through labeling on all alcoholic beverages
and even Public Service Announcements on posters in restaurants and bars. Women who
do drink while pregnant are chastised for putting their “desires” above the “needs” of
their fetuses. Likewise, women who continue to use cocaine during pregnancy are chided
for being selﬁsh instead of giving up cocaine for the sake of their fetuses. These women
are held morally culpable for producing “crack” babies, even though there is no deﬁnitive
evidence that cocaine use leads to birth defects (Charles and Shivas). Pregnancy
guidebooks guilt women into restricting their diet by implying that if a woman eats what
she wants she does not have the fetus’s best interests in mind. Women are supposed to
sacriﬁce all sorts of food for the health of their fetuses, yet there is no scientiﬁc
consensus that an occasional piece of chocolate cake, for instance, is deleterious for fetal
development.

In addition to making all these sacriﬁces, pregnant women are not supposed to
complain about them. In other words, one of the things wOmen sacriﬁce is their ability to

lament, and sometimes even just discuss their situation, even when nonpregnant people

85

with the same experiences are permitted to express their thoughts and concerns. For
example, “when symptoms are considered to be those of a normal pregnancy, women are
again supposed to cope, presumably on the understanding that they should have
anticipated the impairments they experience, even if identical nonpregnancy—related
symptoms would be thought to require rest” (Mullin 65). Even in situations that are not
considered “normal” pregnancies, such as mandated bed rest for the third trimester,
women are expected to agree without complaint because they are supposed to be happy to
sacriﬁce whatever they can for their fetuses. It is interesting to note that bed rest has no
empirically proven medical value, yet women are still supposed to amiably accept it
because they are expected to do whatever they can even if the potential for improvement
is slim (Bogdan-Lovis). In both cases, “normal” and “abnormal” pregnancies, the reason
women’s silence—their lack of complaint and discussion—is important is that in order to
be self-sacriﬁcing, they must ignore their own needs. If, however, they discuss their
situations or, worse yet, complain about them, they are clearly paying attention to their
own needs, which prevents them from being fully self-sacriﬁcing. In sum, a good self-
sacriﬁcer is a silent self-sacriﬁcer.

The same social norm of the silent self-sacriﬁcer is also at play in mothering.
While I will not go into nearly as much detail on how mothers are expected to be self-
sacriﬁcing, it is worth enumerating some of the similarities with pregnant women as well
as some of the additional expectation for mothers. Like pregnant women, mothers are
expected to sacriﬁce themselves for the betterment of their children, even if there is no
empirical proof that certain sacriﬁces will help or if the potential improvement is minor.

Additionally, mothers are judged by society and others by how their children turn out: it

86

often is assumed that “bad” children result from “selﬁsh” mothers. In our “overachiever”
society, women, especially white, rrriddleclass, educated women, are supposed to ensure
that their children become superstars by making sure that their children attend the “right”
preschool, start learning a second language by age 3, etc. An additional way mothers are
expected to be self-sacriﬁcing is that they are supposed put others’ needs ahead of their
own: the needs of all their children, their male partners, and their public and private work.
Regardless of the number of children they have, mothers are expected to balance and
adequately meet the needs of all their children; women are blamed if one child feels less
loved or it goes unnoticed that a child is failing a class. Moreover, especially when their
children are young, women are expected to constantly be with them; Kukla refers to this
as the proximity norm. Women who work in the public realm (often due to economic
need) face social blame for “abandoning” their children.

It is important to note that although pregnant women and mothers make sacriﬁces
for the sake of their fetuses and children, their fetuses and children are not the only ones
beneﬁting ﬁ'om their sacriﬁces. Men are also beneﬁting, yet this is often not socially
acknowledged. Men, as a group and as individuals, beneﬁt from women assuming the
majority of contraceptive responsibility because it absolves them of much of the
responsibility and blame. Women shouldering most reproductive and childcare work not
only gives men leisure time, but also allows men the freedom not to worry about these
responsibilities. Additionally, because they know that women are the ones held socially
responsible for pregnancy and childcare, men generally do not have to concern
themselves with what these responsibilities entail, nor do they have to stress about

successfully fulﬁlling these responsibilities and the consequences they will face if they do

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not. Since men are generally not considered responsible for pregnancy and childcare
work, they are rarely blamed for poor outcomes. Instead, women are typically pinned
with full blame, and it is believed that if women had only been more self-sacriﬁcing then
they would have achieved better outcomes. This myopic view fails to recognize the ways
that men are already involved in reproduction and childcare as well as the ways men
should be in involved. Furthermore, not acknowledging that men beneﬁt from women’s

sacriﬁces conceals the patriarchal nature of this arrangement.

Contraception and Self-Sacriﬁce

Given that contraception falls under the reproductive and childcare umbrella, a
similar version of the norm of the quiet self-sacriﬁcer is also at play in contraception.
However, why there is a social expectation of self-sacriﬁce for contraception may not
initially be apparent. Some may argue the opposite: that contraception is a form of self-
empowerrnent, not self-sacriﬁce, because it allows women to control their reproduction. I
agree that contraception is empowering because it enhances women’s autonomy.
Furthermore, I think that most women are happy to put up with many of the
inconveniences and burdens of contraception because it allows them to achieve their
ultimate goal of being heterosexually active and avoiding pregnancy.

However, I maintain that contraception involves self-sacriﬁce, or at minimum, a
willingness to accept myriad burdens, because it is, in many cases, a coerced
responsibility resulting from oppressive socialization, as I argued in the last chapter.
Although women signiﬁcantly beneﬁt by contracepting, they are still expected to assume

various contraceptive burdens for the sake of their male partners. While women may be

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motivated to contracept mainly because they do not want to become pregnant, this
decision is also inﬂuenced by the dominant ideology that links femininity with
contraceptive responsibility. Women may nonconsciously feel pressure to contracept due
to noncompliance penalties and to their internalization of the belief that an essential part
of being a woman is taking care of reproductive and childcare matters, including
contraception. Other internalized norms, such as that women should tend to their male
partners’ needs, may also nonconsciously push women to assume contraceptive
responsibility.

Additionally, contraception involves self-sacriﬁce, or at least the willingness to
take on burdens for others, because it is sometimes viewed as a tool that protects the life
of potential children. Contraception serves the interests of potential children by
preventing their birth to women who are assumed to be less sacriﬁcing because they were
not interested in having children (at least at that time). While we may not consciously
think of contraception in this way, we nonetheless talk about the necessity of
contraception to protect potential children, especially children born to women deemed
unworthy of motherhood (e. g. women who are poor, of color, lesbian, disabled, and/or
unmarried). For example, some politicians have suggested mandating long-acting
contraception (in particular Norplant) for women on welfare as a way of preventing the
birth of potential children who will, it is believed, be harmed by the environment in
which they will gow up (see Roberts 1997).

Some may object to applying the language of sacriﬁce to contraception because
women’s sacriﬁce is usually associated with getting pregrant and having children—

exactly what contraception is intended to prevent. In a way, women who contracept are

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going against the traditional understanding of women’s sacriﬁce as bearing and raising
children. Thus, some may view these women as selﬁsh, rather than selﬂess. Yet, as I
hope to show, the responsibility of contraception, like that of pregrancy and childcare,
involves considering what is in the best interest for one’s children or future children and
making sacriﬁces, or at least taking on burdens, toward that end. In both the case of
contraception and the cases of pregrancy and childcare, women are expected to make
sacriﬁces and assume burdens for the beneﬁt of others and, furthermore, they generally
want to make these sacriﬁces and assume these burdens. Because most women want what
is best for their children and potential children, they are typically happy, or at minimum
willing, to make sacriﬁces and assume burdens. Women often fulﬁll their own desires by
serving the interests of others (whether these desires are authentic or adaptive is another
matter). For example, a woman may meet her desire to be a good mother by giving up
playing in her soccer league so that she can spend more time with her children. While this
decision results in a personal loss for her, this woman chooses to take this loss in order to
achieve her goal of being a good mother. The decision to contracept can also result in
personal loss for women, such as the burdens discussed in the previous chapter and, as I
will explain, the sacriﬁce of not becoming a parent even if one wants to. Like the woman
who gives up soccer, many women choose to contracept despite the losses in order to
achieve their ultimate goal(s). But just because a person chooses to go down a certain
path does not mean that what she knowingly gives up is any less sigriﬁcant. Though she
may choose to become a mother or to contracept for whatever reason (e. g. because it is
what she wants, or because is her best worst option, or because she is coerced), she is

nonetheless expected to accept the sacriﬁces and burdens of that choice, even if they are

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unfair.l6 As exempliﬁed the case of the pregrant women with unpleasant symptoms who
are expected to “cope,” people are often unsympathetic to others who experience a bad
outcome due to a choice they made that they knew had the potential for a bad outcome.
Mothers who are overwhelmed by the sacriﬁces they are expected to make for their
children and women who contracept and experience negative side effects are sometimes

99 ‘6

met with sayings like “you should have known better, you made your bed, now you
have to lie in it,” and “suck it up and deal.” These responses can be, at least partially,
attributable to the norm of silence that often goes hand-in-hand with expectations of
sacriﬁce.

Some may still ﬁnd the language of sacriﬁce too strong when referring to the
burdens and losses women experience in contracepting. While I understand the concern
of using this language, I will still do so for two reasons. First, I want to maintain
consistency between broader discussions of reproduction and my discussion of
contraception. In this vein, 1 want to illuminate how topics under the umbrella of
reproduction—pregrancy, childrearing, contraception—share and are inﬂuenced by
similar gender ideologies, including sacriﬁce.17 Second, sacriﬁce is a stronger word than
burden. The word “burden” refers to a large load, something one is forced to carry. The

word “sacriﬁce” derives from “sacred,” which refers to something holy, and thus carries

the connotation that one is giving up or taking on something highly valued, sigriﬁcant,

 

'6 Some may claim that this statement applies to all choices and, at a certain level, it does. In choosing any
given path there are always things we must leave behind and losses we must accept. However, in the case
of motherhood and contraception, women are expected to make sacriﬁces for the sake of others, something
that is not universal to all choices. Furthermore, the associated burdens of motherhood and contraception
are more signiﬁcant than many other choices we make, say, choosing to eat a ham sandwich rather than a
turkey sandwich for lunch.

‘7 The same could also be said for other reproductive topics, especially infertility. However, I will not
discuss infertility in this project. For more on infertility and sacriﬁce, see M. Kirejczyk.

91

 

and respected, that is, something holy. The line between a burden and a sacriﬁce is not
always clear-cut. One may not want to classify many of the contraceptive situations
women face as involving sacriﬁces, such as high cost of contraceptives and certain
adverse side effects; one may instead consider them burdens. Yet, there are particular
situations that do seem more in line with sacriﬁce. Considerable bodily invasion is one
such example since our culture prizes (and legally upholds) bodily integity and privacy.
Also, the choice not to have a child is viewed a large sacriﬁce by many, since they see
having a child as a sacred gift. Although not everyone will agee, I will continue to use
the language of sacriﬁce to describe contraception because I think there are cases in
which contracepting involves more than burdens; it entails sacriﬁces.

I turn now to idea that contracepting is a type of sacriﬁce some must make in
order to protect potential children. John Arras and Jeffrey Blustein present this line of
thinking in “Reproductive Responsibility and Long-Acting Contraceptives” when they
discuss what it means to responsibly reproduce: “If one can reasonably be expected to
predict that, should a person decide to reproduce, the resulting child’s existence would
fall below a certain threshold of acceptable well-being, the person can be blamed for
reproducing irresponsibly” (827). There is clearly disageement about what counts as
being below this threshold. Arras and Blustein enumerate a range of ideas of what is
considered being below this threshold from least controversial to most controversial:
child abuse and neglect, children with medical conditions, anything that parents do to
“lower a child’s potential” (e. g. drinking alcohol during pregnancy), and “parents who do
not optimize their child’s potential for a good life” (e. g. genetic enhancement).

Regardless of our own view on what counts as below this threshold, the main idea behind

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this threshold is that people should not reproduce if their potential children would be
harmed in life. The potential parents are viewed as the ones responsible for causing this
harm and, moreover, as the only ones who can prevent this harm. In order to be
responsible reproducers, people who believe their potential children will fall below the
threshold should take action to ensure that they do not reproduce either by using
contraception or by abstaining ﬁom sex.18 Even if these individuals would like to be
parents, they should not reproduce because of the potential harm to their potential
children.

Taking the perspective of potential children, Lisa Cassidy extends this argument
even further, arguing not only that those people who may harm their potential children
should not parent, but also that “those people who anticipate being averagely competent
parents should not parent” (46). She concludes that only people who will make excellent
parents should have children because “parenting is just too important to do in a way that
is just good enough” (47). Although Cassidy intentionally avoids defining what it means
to be a good parent besides referring to Sara Ruddick’s three criteria of preservation,
nurturance, and inclusion, her parenting ideal is in line with that of the self-sacriﬁcer. She
in fact recogrizes this and, in presenting an objection to her argument, states that her
position leads to the “self-sacriﬁcing non-mother who has sacriﬁced having children for
the children’s sake” (Cassidy 53). While she objects to the gendered nature of sacriﬁce—
that only women should be the ones expected to make sacriﬁces—she does not ﬁnd
people sacriﬁcing their desire to have children problematic because she believes that

morality should take others into consideration and that the potential children’s interests

 

18 Here, as throughout this project, when referring to sexual activities, I am limiting my discussion to
heterosexual activities.

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outweigh the potential parents’ desires. Recogrizing the effects our actions have on
others and, in particular, not harming others to achieve our ends is not a controversial
goal. Yet, not everyone would draw the same conclusion that Cassidy does: that people
should sacriﬁce their desire to be parents if they would not be excellent parents. Many
would argue that this sacriﬁce is too geat. While Cassidy rightfully points out that “the
belief that refraining from parenting is an undue sacriﬁce is a belief imbued with our
culture’s pronatalist values,” this does not minimize the feeling that people have that not
having children is an unbearable sacriﬁce (Cassidy 53). Many people, and especially
those who observantly follow certain religions, believe that children are sacred—that they
are gifts from god—and that having children is a necessary aspect of living a good (and
even holy or moral) life. For them and for many others who may not be religious, not
having children is a sigriﬁcant sacriﬁce even if it is thought to be in the best interest of
potential children.

This last point is what is most important to the argument I am making in this
section: that the self-sacriﬁcing parent ideology extends to potential parents. People are
expected to make all kinds of sacriﬁces and take on numerous burdens to prevent certain
types of existences for potential children, ranging ﬁom harmful and life-threatening
existences to Cassidy’s “good enough,” average existence. In short, people are not only
supposed to keep their potential children’s interests in mind when making various types
of decisions that could affect these potential children, but they are also supposed to act in
a way that will maximize their potential children’s interests. If people believe they will
make inadequate or even average parents, then they have a responsibility to ensure that

they do not reproduce. There are just two ways to avoid pregrancy: abstinence or

94

contraception. Both alternatives require sacriﬁce. Being abstinent means not engaging in
sexual, physical intimacy with one’s partner(s), which is much more than a burden
according to some, as it means denying our sexual and bodily expression. Using
contraception entails myriad burdens and/or sacriﬁces depending on the type of
contraception used, such as discomfort, minimized sexual pleasure, ﬁnancial cost,
maintenance, bodily invasion, interruption of sexual intimacy, and adverse side effects.
Even though contraceptive use involves many burdens and sacriﬁces, there is still the
social belief that people should do whatever they can, including sacriﬁcing, in order to
prevent pregnancies of children who would live below a certain threshold. This line of
thought is what we mean when we say that certain people (e. g. drug addicts, teenagers,
the terminally ill, etc.) should not have children because of the quality of life the potential
children will have. Speciﬁcally, we often claim that it is not fair to potential children to
bring them into the world under certain conditions. What underlies this claim is a belief
that all people deserve a certain minimum quality of life and that choosing to give birth to
people who we know will not meet this minimum is irresponsible, and perhaps even
unjust, on our part.

Let me brieﬂy state and reply to two possible objections to the argument that
people should not reproduce if their potential children will have a quality of life below a
certain threshold. First, those who believe that any life is better than no life will argue
that these potential children are harmed more through the prevention of their lives than
they would be by living. This comparison is problematic not only because it is comparing
such vastly different things, but also because I am not sure how one quantiﬁes the quality

of nonexistence in order to compare it to the quality of life. Additionally, I do not think

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we could argue that nonexistent beings are harmed unless we imagine that there exists a
place where all the nonexistent beings hang out and wait for existence and that this place
is such a bad place that any sort of life would be better in comparison. Second, while
people may believe that parents who knowingly have children whose lives will fall below
the threshold (however one deﬁnes it) are being irresponsible, this does not mean that
they think these children should be prevented ﬁom living. It is true that some people will
argue that the best way to protect potential children ﬁom living a life below this threshold
is to prevent their birth. However, this argument does not entail that these potential
children be denied life. In fact, this argument makes no claim about how these potential
children should be treated once they become embryos, fetuses, and infants. The only
normative claim this position afﬁrms is that responsible people should ensure that their
potential children have a quality of life at or above the threshold of acceptable well-
being. To act otherwise, is to irresponsibly reproduce. There is no normative claim about
what action, if any, we should take toward people who reproduce irresponsibly or toward
children whose lives fall below this threshold.

Although there is no normative view about what action we should take toward
those who irresponsibly reproduce, there is a social belief that people who unintentionally
reproduce are blameworthy because it is thought that they could have prevented
reproduction if only they had been willing to make more sacriﬁces. (However, this blame
is most common with women considered unworthy of motherhood, such as poor women
and women of color.) Just as in pregrancy and childcare, people are expected to sacriﬁce
for potential children, and if something goes wrong (i.e. unintended pregrancy), it is

assumed that it is the potential parents’ fault for not making every possible sacriﬁce and

96

assuming every conceivable burden. For example, if they had been willing to use more
than one form of contraception or a more effective form of contraception, then they
would not have gotten pregnant. Or, if they had been willing to be abstinent, they would
not have reproduced. This expectation of abstinence especially affects women, as due to
the ideology that women are either virgins or whores, women who are sexually active are
“bad,” whereas women who abstain are “good.” According to this dichotomy, women
who become unintentionally pregnant deserve this fate because they are already “bad” by
being sexually active. Additionally, as I will discuss in the next chapter, it is thought to
be easier for women to abstain because they are believed to have a weaker libido than
men.

Although I have sometimes discussed contraception in a gender neutral way, it is
important to note that just as the self-sacriﬁcing norms apply almost exclusively to
women for pregnancy and children, the same is true for contraception. That is, the social
norm that people should assume burdens and sacriﬁce for the sake of their potential
children is generally expected only of women. While part of the reason for this may be
that women are the ones who get pregnant and that the majority of contraceptives are for
women, there are also sexist reasons behind why women are assumed to be the ones
responsible for contraception, which I discussed in chapter 2. As the case of childcare
shows, the expectation of self-sacriﬁce is applied mainly to women even though
childcare, unlike pregnancy, is not something that is limited to women. In other words,
men could just as easily participate in childcare as women, so it would seem like a
general social norm about how to raise one’s children should equally apply to women and

men. However, there are gendered social norms for childcare: women are expected to be

97

 

self-sacriﬁcing, whereas men are not. In fact, what these three cases—childcare,
pregnancy, and contraception—reveal is that there are gendered expectations of how
women should act towards others. The general pattern is that women are expected to be
self-sacriﬁcing. That is, they are expected to put others’ needs before their own. This is
also the case for male partners. Women are supposed to prioritize their partrners’ needs
over their own just as they are expected to prioritize their children and potential
children’s needs over their own. There is not a corresponding social norm of sacriﬁce for
men. In fact, quite the opposite: men are expected to independent, self-interested, and to
prioritize their own needs.

Yet, some claim that the social norm for men is not so self-focused; they argue
that men are also expected to be self-sacriﬁcing by being the breadwinner. Indeed, some
posit that men are expected to be self-sacriﬁcing for the sake of their female partrners and
children by working long hours in the public realm in order to support them
economically. While there is no doubt that many men work long hours to economically
support their families and that supporting their families is part of their motivation for
working, I do not think self—sacriﬁce is the correct way to describe their actions and/or
commitment. Self-sacriﬁce necessitates placing the needs of another or others ﬁrst; that
is, doing what is best for another or others even though it entails some sort of burden or
sacriﬁce of oneself. I do not think that the sole reason most men work in the public realm
is for the sake of their families, as working in the public realm provides many beneﬁts for
men. For example, working in the public realm typically goes hand-in-hand with various
“public” rights, such as‘govemmental rights (the right to vote, to drive, etc.) and mobility

within the public realm and between the public and privates realms. Moreover, having a

98

job, especially a “white” collar or well-paying job, is a sign of prestige, power, and
success. Given the expectations and social pressures on men to be active, strong, and
dominant, having a prestigious, powerful, and successful job increases their
“masculirnity.” Men who are successful in the public realm are socially rewarded because
not only do they adhere to the social norms of masculinity, but they also excel at them.
Additionally, there is an expectation that men should economically provide for and
protect their families. Men who are the breadwinners meet this ideal, thus afﬁrming their
masculirnity and ensuring social acceptance. Men who are not the breadwinners—their
female partners make more than them—or who do not work in the public realm are
typically seen as weak and unable to fulﬁll their manly duties. In other words, they are
viewed as feminine, and being labeled feminine (for example, being called a sissy, pussy,
or girl) is one of the worst insults men can receive. Most men try to avoid association
with anything femirnine as a way of asserting their masculinity. Meeting the social
demands of masculinity is extremely important to most men.

Since having a job in the public realm and economically providing for one’s
family are crucial social norms of masculinity, I think that the majority of men are
motivated to work in the public realm because their self-worth and the perception they
give to others are so closely tied into their adherence to these social norms. If these
reasons do play a role in men’s decisions to work in the public realm, then their decisions
are motivated by self-interest, not self-sacriﬁce. In sum, working in the public realm not
only gants men various rights and freedoms, but it also enables them to successfully
’ meet various social norms of masculinity. If any other reason other than helping one’s

family motivates men to work in the public realm—and I really doubt that this is the only

99

reason—then I do not think we can consider their work in the public realm to be self-
sacriﬁcing. Furthermore, men’s work in the public realm could only be considered self-
sacriﬁcing if this work is disadvantageous for them.‘9 For some men, the perceived
disadvantages are actually advantages; for example, working long hours means time
away from the responsibilities of a house and family. While working long hours is
disadvantageous for some men, given the numerous beneﬁts men receive from working
in the public realm and the fact that they are motivated to work in the public realm
precisely because of these beneﬁts, we cannot classify their work situation as overall
disadvantageous or as self-sacriﬁcing.

It is important to understand that this speciﬁc social norm of self-sacriﬁce does
not apply to men—it only applies to women—as I turn to explore whether women and
men are considered trustworthy with contraception in the next chapter. The differing
gender expectations of women and men toward their children and partners plays a

signiﬁcant role in whether or not they are trusted with contraception.

 

'9 Clearly, there are cases of men working jobs that are disadvantageous to them, such as coal miners or
meat packers. In such cases, men typically make geat and many sacriﬁces for the sake of their families.

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Chapter 4: The Role of Gender Ideologies in Contraceptive Trust

In the previous chapter, I distinguished between interpersonal trust and goup
trust. I argued that we (people in general) are usually more likely to trust on the
interpersonal level than the goup level. Since trusting involves taking a risk, we are
typically more reluctant to trust unidentiﬁable, amorphous goups than identiﬁable
individuals because we perceive the risks associated with goup trust, especially the
possibility of broken trust, to be geater. Furthermore, I argued that interpersonal trust
tends to be more accurate than goup trust because the object of trust is known and hence
trustworthiness is generally based on personal characteristics rather than ideologies. For
this same reason, we are generally more conﬁdent about our relationships of
interpersonal trust than goup trust. That is, since in interpersonal trust we typically know
the object of trust personally (at least to some degee), we feel more secure in cm
judgnents about her competence and her moral commitments.

In this chapter, I apply this distinction between interpersonal trust and goup trust
to the case of contraception to explain why there a social perception that both women and
men are untrustworthy with contraception, yet individuals tend to trust their partrners to
contracept. Differentiating between these two levels of trust illuminates the seemingly
contradictory views, laws, and policies that relate to contraception and trust. On the
interpersonal level, people are likely to trust their partrner to contracept because they can
assess trustworthiness on known characteristics instead of ideologies. In contrast, on the
goup level, the media, politicians, policymakers, and researchers and developers often

semi-consciously defer to dominant gender ideologies, which typically lead them to

101

 

conclude that neither women nor men are trustworthy with contraception. Exposing some
of dominant gender ideologies that contribute to women’s and men’s perceived
untrustworthiness to contracept on the goup level is important not only because it
enables us to better understand the roots of this perception, but also because it is the ﬁrst
step in deterrning strategies to alter it.

This chapter is divided into two major sections: one on men and one on women.
In the ﬁrst section, I examine the language of trust used in mainstream mass media
articles about new male contraceptives. I conclude that most authors are discussing goup
trust rather than interpersonal trust, thougln none of them explicitly say so. I argue that
men are not trusted as a goup due to dominant ideologies of masculinity. In the second
section, I claim that, prima facie, women would seem to be trustworthy with
contraception because of their association with the private realm and the social
expectation that they be self-sacriﬁcing. However, the cultural perception of women as
irrational inhibits goup trust and leads to various laws and policies that control women’s
reproduction. Part of the reason women are still held responsible for contraception even
though they are not trusted with it is that this arrangement beneﬁts men. In the end, I
conclude that neither women nor men are going to be trustworthy as goups until our
dominant gender ideologies change. Though a challenging goal, the importance of
eradicating these gender ideologies extends beyond contraceptive trust: their elimination

would create a more just and egalitarian society.

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MEN AND CONTRACEPTIVE TRUST

I began the previous chapter by laying out an apparent tension: women seem to
botln trust and distrust men with contraception. The distinction between interpersonal trust
and goup trust can help us make sense of this tension. Whereas the language of
interpersonal trust focuses on individuals—for example, do women trust their partner to
contracept?———the language of goup trust presents a goup rather than an individual as the
object of trust—for example, do women trust men to contracept? References to women’s
partners suggest that women have a relationship with a particular man and therefore
would be a case of interpersonal trust. Discussions of goup trust use terms like “men” or
“a man,” which imply trusting all men or some abstract, universal man and not someone
with whom women have an intimate relationship.

Conversations about goup trust sometimes obscure who the subject of trust is by
asking if women will trust male contraception rather than actual men. For example, in an
article about an “instant pill,” a pill men take before sex that reduces their fertility for
only a matter of hours, experts claim that “it [the instant pill] is more likely to be trusted
by women as they would not be relying on the man remembering to take his pill
everyday” (Macrae). The second half of the previous sentence shows that these experts
are really concerned about whether women will trust men to use contraception and not
whether women believe that contraception will work properly. Here is another example:
“the ﬁeld of male contraceptive development has been plagued by questions of whether
men will be willing to use systemic methods, and whether women will trust their
contraceptive protection to a male method that they cannot verify is being used” (Darroch

91 ). Although the autlnor asks whether women will trust male contraception, the end of

103

the sentence, “is being used,” implies an agent that is using male contraception, men. So,
the concern is whether women will ﬁnd men trustworthy to use contraception, not
whether the contraceptive method itself is trustworthy.

This distinction between interpersonal trust and goup trust is signiﬁcant because
whether women trust or distrust men with contraception seems to largely depend on
whether the scope of trust is individual men or the social goup men. An empirical study
by Glasier et al., which is cited by a few of the mainstream articles, asked women of
various cultures if they trust their partner, not men in general, to use contraception. Their
study shows that almost all women (98%) would trust their partner to contracept; that is,
on the interpersonal level, the vast majority women trust individual men (i.e., their
partner).20 Yet, on the social goup level, women seem less likely to trust men. Here are
some examples of discussions of goup trust in mainstream news articles:

“One major question is whether men will stick to the routine and use the

contraceptive prescription safely. This is an issue for women who wonder

whether men can be trusted to take pills.” (Addison 3)

“I asked some ﬁiends if they would trust men, if male contraception

became available, to bear the birth control responsibility. Not one of them

said yes.” (Christman)

“The other grey area, says Baker [Peter Baker, director of Men’s Health

Forum], is whether or not women actually trust that men have had the

injection just because they say they have. It’s for this reason he thinks the

method should solely be used by men in stable relationships.” (Scott 1)

“For a start, there are practical concerns. Never mind whether a man can
actually be trusted to take a pill on a regular basis or not.” (Sarler 12)

All these passages reﬂect doubt that women will trust men in general or some universal,

unknown man to cOntracept. In sum, women are much more likely to trust their partners

 

20 Clearly this one study should not be taken as irrefutable proof that women trust their partners to
contracept More empirical studies need to be conducted.

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than they are to trust men as a goup to contracept. The researchers in the Glasier et al.
study also recognize this pattern, stating, “On the whole many women have rather cynical
views of men in general which do not reﬂect their views of individual men—especially

their partrner” (649).

Ideologies of Masculinity

In order to understand this disconnect between women’s distrust for men as a
goup and theirtrust for their male partners, I turn to three dominant ideologies of
masculinity that inhibit their contraceptive trustworthiness as a goup. Two of them
suggest that men are incompetent. First, there is a cultural belief that men have an
uncontrollable sex drive, which interferes with their ability to contracept. Second, there is
a commonly held idea that men are incompetent with domestic tasks, which impairs their
ability to correctly use contraception. The third does not involve competence; rather, it
deals with valuing the dominant ideologies at play in contraception and speciﬁcally the
ideology of self-sacriﬁce. According to my conception of trust, when we trust, we expect
people to act so as to uphold our shared our moral ideologies. Due to the social
perception that men are self-interested, many women do not trust men as a goup to act in

a self-sacriﬁcing manner.

Men’s Libido Is Uncontrollable
As exempliﬁed by women’s sexual objectiﬁcation (see Bartky) and the
medicalization of women’s bodies (for a historical perspective, see Ehrenreich and

English), women are often seen as just their bodies, as objects, and not as embodied

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AHA: 13-nu
o _.

agents. Moreover, women are typically thought not to have control over their bodies,
especially their bodily ﬁmctions, such as menstruation and pregnancy. Rebecca Kukla
states, “Female bodies, and especially pregnant and newly maternal bodies, leak, drip,
squirt, expand, contract, crave, divide, sag, dilate, and expel” (3). In contrast, men are
generally considered and treated as agents, not objects, and are thus thought to have
control over their bodies. When it comes to libido, however, these perceptions about
bodily control are reversed: women are viewed as being able to control of their libido,
whereas men are not. Empirical research conducted by Emily Kane and Mimi Schippers
conﬁrms the dominance of this belief:

Most Americans appear to believe that men’s sexual drives are stronger

than women’s, and at least half perceive those differences as natural,

which is potentially important given the role that beliefs about sexual

drives have played in justifying men’s sexual aggession and in depicting

women as generally passive. (662) '

Indeed, claiming men cannot control their libido men means that men cannot be held
responsible with anything regarding sex, including sexual harassment, rape, and
contraception.

Reasons given to support the difference between men’s and women’s libidos,
especially from people who believe these differences are natural, often echo of biological
determinism: the belief that our biology determines our desires, characteristics, and
actions. According to biological determinism, because women have so few eggs
(approximately 500 total compared to the millions of sperm men produce daily), women
need to be selective in who they choose to have sex with. They should limit sexual

encounters to men who they think would make the best fathers; that is, men who would

produce the best genetic offspring and who would be able to provide amply for offspring.

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Moreover, since women will be responsible for childrearing—investing signiﬁcant time,
energy, and resources into raising their children—they should be careful to pick men who
will make this investment worthwhile. Women’s passive sexual “nature”—their libido is
believed to be weak and so they can easily control sexual urges—is thought to aid them
in making good choices about mates. In contrast, men have no reason to be selective. In
fact, because they have so many sperm and because they are not responsible for
childrearing, they have no constraints on whom to have sex with. If we afﬁrm a
“biological” urge to procreate, then men are “naturally” inclined to have sex with as
many women as they can.

The “spread the seed” versus “board the eggs” mentality is often used to explain,
and justify, men and women’s different sexual “natures.” We see it used in everything
from heterosexual courtship practices (see heterosexual dating guides such as Men are
From Mars, Women are ﬁom Venus), to arguments about why heterosexual men are
more likely to cheat on their partrners than heterosexual women (see Greenﬁeldboyce for
scientiﬁc research on the “monogamy” gene), to rape. It is assumed that our sexual nature
is uncontrollable because it is natural, that is, biological. Human brains are biologically
hardwired for us to act a certain way so as to ensure procreation and thus survival of the
species. Whereas women long for a monogamous relationship to protect their
investment—their children—men have trouble settling down and when they do, they
often cheat because of their biological urge to procreate with as many women as possible.
According to this View people cannot be held fully responsible for their sexual behavior
because it is beyond their control; it is their nature. It is interesting to look at what it

means to hold women and men responsible for their sexual behavior. The extreme of the

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women’s sexual nature is permanent virginity—being so selective that they choose not to
have sex with anyone—and the extreme of men’s sexual nature is rape—having sex with
as many women as possible, which means forcing nonconsenting women to have sex.

It may seem contradictory that men are typically regarded as in control of their
bodies save for their libidos. Yet, this tension is rarely acknowledged. That men are
perceived as unable to control their libido is generally not seen as problematic because
this arrangement is thought to be biologically necessary (that is, an evolutionary
mechanism for ensuring the reproduction of the species). Since men’s uncontrollable
libido is typically viewed as natural, men cannot be blamed for it. Instead, it is men’s
uncontrollable libido that is to blame, as it inhibits their rationality, thereby preventing
them from acting according to the social values and ideologies they uphold. For example,
the teenage boy in Meat Loafs song “Paradise by the Dashboard Light” is so “crazed” by
his desire to have sexthat he makes promises in the heat of the moment that he later
regets. Although men’s libido is viewed as a barrier to rationality—a form of
incompetence—that interferes with their ability to act the way they want to act, it is not
thought to affect their overall competence. Instead, it is thought only to affect their
competence in one realm: the sexual realm. Since this incompetence is limited to only the
sexual realm, men’s freedoms in other realms are not restricted. For instance, (white,
property-owning) men have historically had the right to run for political ofﬁce despite
their “uncontrollable” libido because their libido is typically not thought to affect their
political decision-making ability.

Women, not men, are typically blamed for men’s uncontrollable libido. Indeed,

women are often faulted for arousing men’s libido with their sex appeal. Because

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women’s libido is thought to be either nonexistent or easily controlled and because they
are assumed to know that men’s libido is the opposite, they are culpable for arousing
men’s libido. We see this mentality when people talk about women who are “asking to be
raped” because of the clothing they are wearing. The idea here is that most men cannot
control their libido and if they see a woman who is dressed in a sexy way, they have no
control over their desire to have sex with her and thus may rape her. Women are seen as

responsible for causing their rape because of the clotlnes they wear (or the way they

 

dance, the things they say, etc.) and they are told to dress a certain way (or dance a 11
certain way, refrain from saying certain things, etc.) in order to prevent rape. In short,
women are supposed to know that men cannot rein in their libido and consequently they
should dress and act in a way that prevents them from turning men on.

As the above example shows, since women are thought to have a controllable
libido, they are generally expected to assume responsibility for sex-related matters. Men,
in contrast, cannot be trusted to act responsibly with anytlning related to sex due to their
uncontrollable libido, which renders them irrational. According to this ideology, if one
can control one’s sex drive, then one can control anything sex-related. While this
reasoning clearly has problems, which I will discuss shortly, it nonetheless applies to
contraception: because men are not thought to be able to control their libido, they should
not be held responsible for contraception. It is assumed that men’s sex drive is so
overwhelnning that once turned on, all men can think about is sex. Consequently, they are
unable to be responsible for using contraception. In other words, this argument posits that
once men are turned on, they can no longer be blamed for their actions or held

responsible for anything because their sex drive takes over, inhibiting their rationality and

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making them incompetent. Thus, men are unable to think about using contraception or, in
the case of rape, realize that a woman is saying no.

One of the problems with this line of thought is that it posits that any strong,
biologically-based desires or needs are uncontrollable. While I do not believe men’s
libido is stronger than women’s due to biological reasons, let us, for a moment, assume it

is and explore whether we treat other biologically-based desires or needs as

‘f’.?‘ 9‘

uncontrollable. One biologically-based desire or need is addiction. Alcoholics’ bodies,

 

for example, come to depend upon alcohol, thereby causing them to crave it, seek it, and a
feel like they need it. Although alcoholics have what feels like an uncontrollable need to
have alcohol, there is a social (and medical) belief that addiction is something that can be
controlled, though it may be difﬁcult.

Some may dispute the comparison of libido and addiction, claiming that they are
not analogous since libido is an innate urge, whereas addiction is a learned or social one.
Though everyone may not agee, let us, again, for the sake of argument assume that
libido is indeed a biological, innate drive, not something that is affected by environment.
Given that people who believe libido is a biological urge usually support this claim with
some form of biological determinism, I will compare men’s libido to women’s desire or
need to have children, which is also often supported by biological determinism. People
who support the idea that women have a “natural” desire or need to have children believe
that this is an innate, biological urge, so in this way it is comparable to people who
believe men’s strong libido is an innate, biological drive. There is a widespread belief
that women have what is colloquially referred to as a “biological clock”: a device,

tlnought to be hormonal, that tells them to reproduce. People seem to imagine this

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biological clock to be similar to the body’s “clock” that tells girls to start menstruation——
just like the body’s timer goes off and girls begin menstruating, so too does a timer go off
and women begin to need/desire a child. Women’s biological clock is considered
extremely powerful because, like men’s strong libido, it is thought to be an evolutionary
mechanism to ensure survival of the species.

Assuming women’s biological clock and men’s strong libido are equally powerful
given their biological nature and evolutionary origin, if one concludes that if men’s libido
is uncontrollable, then women’s biological clock should also be considered L
uncontrollable. Yet, even if women very much desire a child, but they know that their
potential child would fall below the threshold of what is considered a worthwhile
existence, according to the ideology of self-sacriﬁce, they are expected to use
contraception. Women’s need to have a child is not thought to be so geat that it causes
tlnern to dump all their birth control pills in the toilet. Nor is their biological clock is
considered so powerﬁrl that it will lead infertile women to steal children off the street in
order to become a mother. While many women may have a strong desire to have a child,
there is a social expectation that they control this desire, which implies that they are able
to control it. (However, as I will discuss later in this chapter, women are expected to go to
geat lengths to have children, including tricking men, because their drive to have
children is viewed as so powerful.) In contrast, the social understanding of men’s libido is
that it is so strong that it not only leads them to reject contraception, but it also causes
them to have sex with as many women as possible, even if it means rape. But if men’s
libido and women’s biological clock are both equally strong and women can control their

biological urge, then men should also be able to do so. Even if men’s libido and women’s

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biological clock are not equally strong, women’s ability to control their desire/need to
have children shows that it is possible to control biological, innate drives. Thus, one
should question whether men’s libido is really uncontrollable or if there is just a societal
belief that it is. Given that many men are able to control their libido, it does not make
sense to think of men’s libido as an innately uncontrollable drive. Perhaps certain men
have uncontrollable libidos, but it seems a stretch to say all men have an uncontrollable
libido. Plus, there are ways to help men control their libido; for example, certain
medications reduce libido and even diminish it completely. (It is interesting to note that
weak libido is usually considered a problem, even a medical condition, but a strong libido
is generally considered neither a problem nor a medical condition.) And if men are able
to control their libido, then they should be able to use contraception.

The claim that men cannot use contraception because of their uncontrollable
libido only works for contraception that is used in the heat of the moment. There are only
two available male contraceptives and just the condom requires use during sexual activity
(vasectomy is a permanent, one time surgical procedure). It seems farfetched that men
would not be able to think to use condOms during sexual activity because their rationality
is inhibited by their libido. Yet even if this is true, it does not mean that men could not be
responsible for other forms of contraception that do not need to be used during sexual
activity, when their libido is presumably less strong. Many of the male contraceptives
currently being researched are long acting methods that are taken on a regular basis and
do not need to be used right before or during sexual activity. The question then arises as
to whether men would be trusted to be responsible for contraceptives that are not used

before or during sexual activity. This is the key question that researchers and

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“‘ m

pharmaceutical comparnies are asking irn order to determine if there is a market for male
LARCS.

Returning to the idea that if one can control one’s sex drive, then one can control
anything sex-related, the belief that men’s libido is uncontrollable leads some to think
that men will not even be able to be responsible for contraception that is not used during
or right before sex. Part of the reason for this is that it is thought that men’s desire to
“spread their seed” is so strong that they will not diligently use contraception. That is,
men’s subconscious, and perhaps in some cases conscious, desire to procreate prevents
them ﬁ'om acting responsibly with contraception. Tied into this covert “need” to
procreate is the belief that “real” men don’t use contraception because it dimirnishes their
masculinity. The social norm that men ought to be tough can lead men to take risks and to
shy away from protecting themselves. In the case of contraception, this means that men
may risk having unprotected sex, even with people they do not know well or at all.
Additionally, men who use contraception may worry that others (e. g. their partner,
ﬁiends, health care professionals, etc.) perceive them as feminine because they take on
the caretaking, sacriﬁcing role that women usually assume. I will return to this idea that
contraception is women’s work later in this chapter. This fear of femirnization is also
behind why men may be reluctant to use contraception: they worry that anything that
affects their hormone levels will make them less manly. Many men believe that
testosterone is a crucial factor in what makes them men. Though certain levels of
testosterone in the body do result in what scientists, health care professionals, and
laypeople usually classify as masculine characteristics, such as more body hair, more

muscle tone, deeper voice, aggessive behavior, and stronger sex drive, the category

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‘men’ is not just a biological one; it is also a social one. And there are many ideologies

about what it means to belong to the category ‘men,’ one of which is that men have an

uncontrollable libido. Most men want and feel pressured to adhere to these dominant

conceptions of masculinity so that they are considered “real” men. Hence, even if they

krnow that their libido is controllable, they may pretend it is not so they are not accused of

being “femirnine,” that is, of having such a weak libido that it is controllable. l
However, men in monogamous relationships may not feel as pressured to abide

by the ideology of uncontrollable libido with their long-term partner as they do with

 

others, such as ﬁiends and women they are causally dating. Some men may feel like they
can just “be themselves” with their partrner rather than (consciously and nonconsciously)
worrying about living up to certain ideals of masculinity. Since men are probably more
honest about their sexual drive with their partner than with others, their partner is better
equipped to make an assessment of men’s trustworthiness with contraception. Women
can base their determination of trust on their partner’s speciﬁc and known characteristics
instead of gender ideologies and even the facade their partner may project in order to
publicly uphold norms of masculinity. On the interpersonal level, women can recognize
(though this may be senni-conscious) whether their partner’s libido interferes with his
ability to contracept. If a woman does not think her partner’s libido affects his ability to
contracept, then assuming there are no other factors that inhibit his contraceptive
competence, she probably trusts him with contraception. Even if a woman believes her
partner has a strong libido and that once he is sexually aroused he is unable to concentrate
on anything but sex, she may still be able to trust him to use types of contraception that

are not related to the timing of sexual activity, such as an implant or a daily pill. Given

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that only two percent of women do not trust their partrner with contraception, is seems
that most women do not think their partrner’s libido prevents him from successfully
contracepting (Glasier et al., 2000).

On the goup level, in contrast, women are probably more likely to defer to
dominant ideologies about men’s libido and hence ﬁnd men as a group untrustworthy to
contracept. Likewise, journalists, contraceptive researchers and developers, and others
are likely to assume that women will not trust men to contracept at least in part because
they are also inﬂuenced by the dominant ideology of men’s uncontrollable libido. Many
journalists, scientiﬁc researchers, and pharmaceutical company workers further
strengthen this ideology by pointing to men’s libido as a reason why so few male
contraceptives exist and/or are needed. Since many scientiﬁc researchers and
pharmaceutical company workers, as well as some journalists, are mainly concerned with
goups rather than individuals, they may not realize that most women trust men on an
interpersonal level. Instead, they probably base their beliefs and actions (e. g. whether to
ﬁmd research on male contraceptives or how to explain the lower rates of male
sterilization to female sterilization in an article) on goup trust, though they are unlikely
to consciously recognize this is what they are doing or that there is a difference in

women’s trust of men on the goup and interpersonal levels.

Men are Incompetent with Domestic Tasks
As I explained in the previous chapter, contraception (as well as reproduction
more broadly) has historically been relegated to the private realm. Women have also been

historically relegated to and associated with the private realm. Reproductive work and

115

domestic tasks more generally have come to be classiﬁed as “women’s work.” This
private/public dichotomy feeds into the dominant cultural perception that men are
incompetent with domestic tasks. And this incompetence prevents many women from
trusting men on the goup level with domestic work, including reproductive work like
contracepting.

Movies like Mr. Mom, Three Men and a Baby, and Cheaper by the Dozen—which
all involve men trying to take care of children and other domestic tasks—are comedies
precisely because of the cultural perception of men’s domestic incompetence. These
movies include scenes in which men do not know how to change a diaper, do laundry, or
keep siblings from injuring each other—all things that the women characters are able to
do easily. In contrast, movies like North Country, The Contender, and Gracie, in which
women try to break into the men’s world of mining, politics, and soccer respectively, are
not comedies, but serious dramas. There are at least a few reasons for the different genres
of the two sets of movies. First, the women characters want to enter men’s world,
whereas the men fall into the private realm for reasons beyond their control. Second,
women entering the public realm is a threat to patriarchy because they are thought to be
trying to usurp men’s power. Men doing “women’s work” is not threatening; in fact, in
some ways movies about men working in the private realm reinforce patriarchy by
portraying men doing women’s work as silly and unnatural. Third, women’s work is
thought to be ﬁivolous and easy, which is why it is funny to watch a man put on a diaper
backwards. Men’s work, however, is considered serious, important, and difﬁcult, which

is why allowing a girl to take a soccer penalty kick is both risky and scary.

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In both sets of movies the characters are able to prove that they can succeed in the
new realm. In the movies about men entering the private realm, the men usually return to
the public realm, whereas the women do not return full time to the private realm
(typically the women are balancing both reahns simultaneously). This difference shows
that work in the private realm is not worth taking on full time and permanently. While
men are indeed capable of mastering tasks in the private realm, they choose to return to

the public realm, which sends the message that men belong in the public realm and

 

women in the private realm. i;
This gendered division of labor, which is presented as natural in these movies and
by the media generally, leads us to believe not only that men are incompetent with
domestic tasks, but also that this incompetence is normal. Men are not supposed to be
good at domestic tasks because it is not in their nature. Women, in contrast, are thought
to be naturally, that is, biologically, better at serving in a domestic role. Part of the reason,
for this, as I explained in the previous chapter and will return to later in this chapter in the
second section, is that women are considered better self-sacriﬁcers and many domestic
roles, especially those surrounding reproduction and childcare, require self-sacriﬁce.
Another reason for this is based on ideas about biological determinism. Since women
give birth and breastfeed, they are the “natural” choice for caring for children. And
because it is assumed that women must stay in or close to the house in order to care for
children and because of the social belief that women are irrational, it makes sense that
they should tend to the private realm. Since men are physically stronger, do not get
pregnant or breastfeed, and are thought to be tougher and more rational than women, they

are viewed as better candidates for the public realm. In short, according to this view,

117

women are biologically better suited to work in the private realm and men are
biologically better suited to work in the public realm. Men are biologically disadvantaged
when it comes to work in the private realm, and so it should not be surprising that they
are considered incompetent with domestic tasks. While this does not mean that men
cannot learn how to do private work well, it does mean that many of them start off as
domestic bumblers, which is exactly what the movies about men doing domestic work
show.

Additionally, there is the assumption (also seen in these movies) that even if men
dedicate signiﬁcant time to learning domestic tasks, they will never do as good of a job as
women “naturally” do. Since women today still do the majority of the domestic work,
though men’s share of it has increased over time, they have the knowledge and
experience to succeed in these tasks. It is this lifelong knowledge and experience—little
girls learn domestic tasks from an early age botln by observing and by direct instruction
ﬁ'om their mothers—that accounts for any superior skills women have in the private
realm, not their biology. Because little boys are typically not taught how to cook or
change diapers, it is not surprising that they fumble with them at ﬁrst. Given that men do
not spend nearly as much time doing private work as women, it is also not surprising that
their skills are not as honed as women’s. In sum, it is this lack of knowledge and
experience that makes many men incompetent with domestic work. Plus, since there is
the expectation that men are incompetent with private work, there is little social incentive
for them to strive towards success, nor is there much social blame if they do not excel, as
there is for women. A man who has a repertoire of three dinners, boxed macaroni and

cheese, ﬁ'anks and beans, and hamburgers, might be thought of as a kitchen wiz. In

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“RA-h..—

rar -

contrast, a woman who has the same repertoire is considered domestically deﬁcient. This
comparison shows that the expectations of men are much lower because of their
perceived incompetence. A recent commercial for Tyson chicken epitomizes these
differing expectations: the mother in the commercial is praised for making a good and
healthy dinner (consisting of Tyson chicken, of course) for the sake of her family (see
Haskins for the video clip). The father makes frozen waffles for dinner when the motlner
is not around, but he is not really blamed for this, though he does look somewhat
sheepish when this fact is mentioned. The message seems to something like, poor dad, he
does not krnow how to cook anything more complicated than frozen wafﬂes for dinner.
Being incompetent with domestic tasks is obviously a form of incompetence that affects
one’s trustworthiness with domestic tasks. Due to the dominant ideology that men are
incompetent with domestic work, women are not likely to trust men on the goup level to
do this work.21

While some men are competent with (and actually enjoy) domestic work, on the
goup level they are usually not trusted because they are viewed as abnormal and this
abnormality is seen as a kind of incompetence. Indeed, men who enjoy working in the
private realm are thought to be “odd,” usually considered gay or perverted and typically
the subject of jokes, as in the movies I mention above. Men who take too much interest in
women’s work, like cooking, fashion, and home .décor, are often accused of being gay
since “real” (masculine) men stick to interests in the public realm. (It is interesting to note
that the many of the famous chefs, fashion designers, and interior decorators are straight

men. Perhaps this shows how little trust we have for women and how strong patriarchy is

 

2' This ideology is not the only reason women may be hesitant to trust or rely upon men with domestic
tasks. Another reason stems from the power differential between women and men. Women may worry
about asking men to do domestic tasks because they fear they will get angry or will refuse.

119

 

that we would rather employ men to do women’s work at the top levels than to allow
women to do it.) A man who likes women’s tasks is not a “ﬁrll” man, but only a
feminized version of a man; consequently he must be gay because of the stereotype that
gay men are not “real” men, but are instead efferrninate men. Men who enjoy women’s
work, but are not thought to be gay are often labeled perverts. Parents and coworkers are
sometimes suspicious of men who work with young children, such as preschool and

elementary school teachers, because they fear they will molest the children. This fear

 

stems from the convergence of at least two dominant narratives: ﬁrst, that men have an L
uncontrollable libido; second, that men who want to do women’s work have something
wrong with them. Together, these narratives result in the cultural stereotype that men
who work with children do so for the unnatural reason of wanting to have sexual relations
with children. In sum, men being competent at and enjoying domestic work is seen as a
type of incompetence that can prevent goup trust.

In contrast, on the interpersonal level, such competence aids in trust. A woman
who believes her partrner is competent with domestic tasks is much more likely to trust
him with them than if she did not tlnink he was competent. Furtlnerrnore, she is less likely
to view his competence as odd or abnormal. Since she knows him personally, she
probably does not think that domestic competence diminishes his masculirnity. That is,
she is unlikely to classify him as “gay” or effeminate because he does “women’s” work.
Instead, she probably positively views his competence and may think he is “more of a
man” for it. His ability (and willingness) to take on domestic tasks may lead her to
respect him even more. In short, it is her interpersonal relationship—the fact that a

woman krnows the personal characteristics of her partner—that explains why a woman

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may laud and trust her partrner with domestic work, while labeling men in general as
“weird” if they do, and especially if they enjoy, such work. On the interpersonal level,
women generally look beyond the cultural trope that men are incompetent with domestic
chores and base trust on individual traits. This opens up for the possibility for women to

trust their partrners ‘with speciﬁc domestic tasks, including contraception.

Men Are Self-Interested

In the last two subsections, I described how ideologies contribute to the
perception that men as a goup are incompetent, which often leads women to view men as
untrustworthy. Here, I move away from the topic of competence, but, continue to reveal
how ideologies can inhibit trust. Recall that when we trust, we generally expect people to
act according to the dominant moral ideologies within a speciﬁc domain. Due to the
social belief that men are self-interested, they are not trusted as a goup to follow the
expectation of self-sacriﬁce at play in contraception.

As discussed in the previous chapter, the ideology of self-sacriﬁce typically only
applies to women as a goup. Both women and men expect women to be altruistic and
self-sacriﬁcing in most aspects of their lives, especially in their relationships with men
and children. The expectation for men is practically the opposite: men are expected to
. independent, self-interested, and to prioritize their own needs. Consequently, it is
unlikely that men believe they should act in a self-sacriﬁcing manner. In other words, it is
doubtful that most men normatively value self-sacriﬁce as a quality that they themselves
should strive toward. In contrast, most women semi-consciously believe that self-

sacriﬁce is a moral characteristic that they should seek to embody. Because self-sacriﬁce

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is an important ideology at play in contraceptive trust, women are at least superﬁcially
trusted to contracept since they value this ideology (I return to this claim in the second
half of this chapter). Men as a goup are not thought to be trustworthy with contraception
because they are not thought to value self-sacriﬁce. Put differently, if women doubt that
men share the moral ideology of self—sacriﬁce, tlnen they will probably not trust men with
contraception.

Some may object that it is not important whether men value the norm of self-
sacriﬁce. What really matters in this case is whether men value the end of preventing
pregnancy. Proponents of this objection may claim that if men value pregnancy
prevention, then they should be trusted to contracept because the desire to prevent
pregnancy will shape their actions, leading them to contracept. There is empirical
evidence that shows that men are concerned about pregnancy prevention and are
interested in using male contraceptives. For example, a survey of 9,000 men in 9 nine
countries in 2005 revealed that 55% of men were willing to use male hormonal
contraceptives, while only 21% were unwilling (Nuzzo). Another study showed one third
of men would use male contraception as their main form of contraception (Macrae). And,
according to Garesia Randle, various “studies show men are ready for a change [in
contraceptive options] contrary to popular belief.” Furthermore, men are already
responsible for contraception in many cases, as nearly a third of heterosexual couples
worldwide use a male-dependent form of contraception (Ringheim 79). Looking within
the United States, James Knight and Joan Callahan claim that

there does appear to be a gowing interest on the part of men in sharing
responsibility for family planning and a gowing desire among men to

achieve control over their own fertility. Given that more than 25 percent of
the couples employing contraception in the United States rely upon the

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condom and that over half a million vasectomies are performed each year,

it seems that a large segnent of the male population is willing to share or

assume the responsibility for fertility control. (304)

These examples show that both in the US. and abroad, not only are men willing to take
responsibility for contraception, but in many cases they already do.

Despite this empirical evidence, however, the master narrative that men do not
value the end of preventing pregnancy as much as women do persists. This cultural trope
is usually presented as fact without much or any empirical backing in the literature, even
the academic literature, as seen in these two examples: “men are, in general, less
interested in controlling their fertility than are women” and “For men, the subject of
pregnancy may cause concerns, but their level of concern tends to be lower than
women’s” (Knight and Callahan l 1; Hatcher 21). One explanation for tlnis phenomenon
is that reproductive prowess is an important component of masculirnity. Despite
signiﬁcant evidence to the contrary, “The idea that men want more children than women
has been a very donninant representation of men, particularly non-white men”
(Oudshoom 120).

Another explanation, and one that is quite ubiquitous, is that men are not the ones
who get pregnant. Since men are not at risk for pregnancy and thus do not have to deal
with all the problems and challenges of pregnancy (e. g. the decision whether to carry to
term or abort, the bodily changes, the stigna of being a single mother, etc.), they are less
concerned about pregnancy and hence less willing to make the sacriﬁces (i.e. use
contraception or abstain) to avoid it. On the goup level, most women are not willing to
depend upon men with contraception because they do not believe men sufficiently value

pregnancy prevention and they do not want to suffer the consequences (that is, get

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pregnant) due to men’s perceived lack of commitment to pregnancy prevention. As Segal
quips, “If he doesn’t get it right, it is the woman who pays the price” (114). While some
women are willing to rely on men to use condoms because they know they are being used
and can check to make sure they are being used correctly, “it is questionable how many
women would be willing to rely on men’s use of a systemic, undetectable method [such
as a male pill or gel], except in the context of a long-term, committed relationship”
(Darroch 91 ).

The case of a long-term, committed relationship is an exception because the
woman krnows her male partner well and so she does not have to defer to cultural tropes
to determine if her male partner sufﬁciently values the end of pregnancy prevention.
Instead, the woman can judge her partner’s commitment to this end based on his
individual characteristics and not based on social perceptions about men generally.
Looking at individual characteristics rather than general social beliefs will enable women
to recognize if their partrners do not ﬁt the dominant narrative that men are less interested
in preventing pregnancy. If their partners do not adhere to this social norm but instead
sufﬁciently value avoiding pregnancy, then women can trust them to contracept.

Carol C. Korenbrot nicely summarizes these two reasons why men are thought
not to value pregnancy prevention as much as women: “men are not as easily motivated
to take responsibility for contraception as women both because tlnerisks of pregnancy
are more remote and because masculirnity is socioculturally connected to maintaining full
reproductive potential” (52). In short, because men are not thought to be invested in and

concerned about preventing pregnancy to the same degee women are, they are less likely

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to value self-sacriﬁce in their own reproductive behavior. Hence, many women view men
as untrustworthy to contracept.

What can explain the discrepancy between the social perception that men are less
or not interested in using contraception and the fact that men say they are interested and
many men in fact use contraception? There seem to be many possible answers to this
question, so I will brieﬂy enumerate a handful of them. One way to understand this
tension is to distinguish between the goup level and the individual level. On the goup
level, many people, including policymakers, academics, women, and researchers, may
perceive men as uninterested in contraception due to their semi-conscious acceptance of
dominant ideologies. Yet, on the individual level, they recognize that some men express
interest in contracepting. Another explanation could be that social perceptions and
realities do not always match up. Sometimes one’s perceptions about how life is differ
dramatically from how life actually is. The reason for this may be due to an incorrect
master narrative; the master narrative that men are not interested in contraception is
wrong. Or, the actual realities are changing and the corresponding narratives and norms
have yet to catch up: men are becoming interested in participating in contraception, but
the narratives and norms do not yet reﬂect tlnis. There are many reasons men could be
beconning more interested in using contraception. An optimistic reason could be that our
society is becoming more egalitarian and men want to assume shared responsibility for
contraception. A cynical reason could be that increasingly stringent paternity and child
support laws are causing many men to want to protect themselves from women who may
deceive them into having a child. A historical explanation, like the one I provided in

chapter 1, points to the fact that it is only recently that contraception has become

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women’s responsibility. Perhaps the reason men are interested using contraception is that
they still feel that it is their responsibility. While the new expectation is that women
should be the ones responsible for contraception, maybe some remnants of the older
expectation are still at play. A more insidious explanation is that men do not want to let
on that they are willing to use contraception because then they would be forced to assume
contraceptive responsibility. Indeed, as previously discussed, men beneﬁt signiﬁcantly
from not being the ones responsible for contraception. There are many other possible
explanations. Doing empirical research to determine what explains this discrepancy
would be useful, as it would provide us with a deeper understanding of the current, and
historical, contraceptive narratives, norms, and realities.

Wlnile I agee that women who believe (consciously and/or nonconsciously) that
men value the end of pregnancy prevention are more likely to trust men on the goup
level, this belief alone is not sufﬁcient for trust. Valuing a particular goal often gives the
facade of trustworthiness since the truster and trustee uphold the same end. Yet, valuing a
particular end, in this case avoiding pregnancy, does not make one trustworthy.
According to my conception of trust, one must value a moral ideology, not just an end.

For example, partners Tim and Demarco share the goal of having a healthy
relationship. However, Demarco may not trust Tim to follow through on this goal
because Tim does not value the social expectation of monogamy. Though Tim may be
committed to a healthy relationship, since he does not normatively value the social norm
of monogamy —an important component for many healthy relationships—Demarco does
not trust him in this domain. This example shows that valuing a particular end does not

make one trustworthy to achieve that end. Tim valuing a healthy relationship does not

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automatically result in Demarco trusting him to be sexually faithﬁrl. Demarco needs to
feel that he and Tim share the moral commitment to monogamy, one of the expectations
at play in most romantic relationships, before he can trust Tim in this realm. Having the
goal of being a healthy partner does not compare to the deep commitment that
normatively valuing the norms and ideologies involved in a being a healthy partner does.
This profound commitment makes trust possible, whereas having a goal does not. Having
a goal only shows that there is something one desires; it does not convey the degee of
one’s commitment to engendering this goal.

Even if one normatively values a particular goal, this does not make one
trustworthy in that realm. Mia may normatively value being a good mother, yet she not
trusted as a mother by most people unless she afﬁrms the dominant ideologies
surrounding motherhood. As a single, working woman, many of her acquaintances do not
trust Mia to be a good mother due to the dominant belief that married homemakers
provide the best environment and care for their children. While valuing a goal perhaps
gets us one step closer to be trustworthy, it is not enough because we also need to value
the “right” ideologies for achieving this goal. The “right” ideologies will often be the
dominant ideologies, though what is most important for trust is that the ideologies are
shared between the subject and object of trust. Some of Mia’s friends will trust her to be a
good mother because they maintain a nondominant ideology about what it means to be a
good mother, an ideology that they and Mia have in common.

Returrning to the case of contraception, even if women (consciously and
nonconsciously) believe men normatively value preventing pregnancy, they will not trust

men to contracept if they do not think they share the same contraceptive ideologies. That

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is, if women suspect (agairn, consciously and nonconsciously) men affirm the “wrong”
ideologies, then they will probably not trust them with contraception. Wanting to prevent
pregnancy may not be a strong enough desire for some men to act in accordance with
contraceptive ideologies, especially an expectation as demanding, personally
disadvantageous, and contrary to masculine gender roles as that of self-sacriﬁce. In order
for women to trust men to contracept, men must value the norm of self-sacriﬁce for their
own actions. There are at least two reasons that play into why many women may assume
that most men do not value self-sacriﬁce. First, as mentioned above, men are usually
socialized to be self-interested. Most women are aware of this on a semi-conscious level
and thus are often skeptical that men will be self-sacriﬁcing because it so strongly goes
against how they were socialized.

Second, the power differential between women and men makes many women
doubt that men, as members of the privileged goup, will make sacriﬁces at all, let alone
for something (i.e. contraception) that is generally perceived to only help women, not
men. On some level, though perhaps not fully consciously, women recognize that
privilege allows dominant goups to shove unwanted tasks and responsibilities onto
oppressed goups; for example, women shouldering the majority of childcare work and
people of color taking on most of the lower paid and dangerous jobs. That privileged
goups often push responsibilities onto oppressed goups contributes to women’s
suspicion that men will not assume the sacriﬁces involved in contracepting. Given these
power dynamics, women, as members of an oppressed goup, are hesitant to trust men, a
privileged goup, with something that directly and so signiﬁcantly affects them. Instead,

they often cling to whatever perceived and real power and control they can. For example,

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some women will conform to dominant beauty norms because they think it gives them
power over men, such as the ability to have men to buy them drinks at a bar. In the case
of contraception, this means that women generally do not want to relinquish
contraceptive responsibility to men. Women are concerned about sharing contraceptive
responsibility with a more privileged goup, a goup that could limit or deny their
reproductive rights. According to Dixon-Mueller, many women, “although committed to
furthering research on male methods so that men can share the responsibility for birth
control and sexually transmitted disease prevention more equitably, are reluctant to
depend on their male partners and want to maintain this control for themselves” (49). In
other words, even if they believe there should be more male contraceptives and that men
and women should share contraceptive responsibility, women are worried about the
consequences of a privileged goup actively participating in contracepting because such
an arrangement could lead men to usurp women’s (albeit limited) control over

contraception.

WOMEN AND CONTRACEPTIVE TRUST
The relationship between men’s contraceptive trustworthiness and their
contraceptive responsibility is more straightforward the relationship between
contraceptive trustworthiness and responsibility for women. While many women trust
their speciﬁc partner to contracept on the interpersonal level, on the goup level, men are
generally not trusted due to various dominant ideologies of masculinity. Not surprisingly,
there is little social expectation that men will contracept. In the case of women’s

trustworthiness, although many men trust their speciﬁc partrner to contracept on the

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interpersonal level, women are typically not trusted on the goup level. However, despite
their presumed untrustworthiness on the goup level, women are socially expected to
assume contraceptive responsibility. In this section, I seek to uncover the patriarchal
social forces and ideologies that contribute to women’s contraceptive untrustworthiness
and contraceptive responsibility.

As discussed in the previous chapter, there is an expectation that mothers,
including potential mothers, should be self-sacriﬁcing toward their children and that
women should be self-sacriﬁcing toward their male partners. Most women value this
norm, in part because through oppressive socialization they internalize it and come to
believe that their worth lies in the sacriﬁces they make for others. Hence, women would
seem to be trustworthy to contracept. And, on the surface, women are trusted.
Responsibility usually stems ftom trust, and women are the ones held responsible for
contraception. On a social level, they are expected to contracept and, in fact, they do most
of the contracepting: they alone contracept in two thirds of all cases and they participate
in contracepting over ninety percent of the time.

Yet, at the same time, women do not appear to be trusted with contraception
because of the numerous restrictions on their reproductive autonomy. A necessary
component of autonomy is being trusted by otlners and the government to make our own
decisions. When we are not trusted, politicians pass laws to restrict our behavior and
social forces like surveillance and normalization limit our behavior. There are myriad
laws and forms of surveillance and normalization surrounding contraception. Although
the most restrictive laws, such as laws prohibiting the dissemination of contraceptives

through the mail or interstate commerce (e. g. the Comstock Law) and laws forbidding the

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sale of contraceptives to unmarried couples or single women, were overturned by the
mid-19703, there are still many limitations on contraception. Though I have mentioned
some of these in previous chapters, I list a handﬁrl of such restrictions here to emphasize
how, together, they systematically minimize women’s autonomy and ability to
contracept. For example, only two of the eleven female contraceptives—the female
condom and the sponge—are available without medical involvement; most insurance
companies do not cover contraception, a de facto way of restricting access to
contraceptives (Segal 86); half the states that mandate insurance companies cover
contraception have moral or religious “opt-out” clauses (Knudson 115); abstinence-only
education ignores or misinforrns children about contraception (Doan and Williams);
pharmacists can refuse to ﬁll prescriptions for contraceptives based on their religious or
moral convictions, which can be an insurmountable obstacle for some women, especially
those in rural areas; and President Bush proposed a new regulation that would redeﬁne
abortion to include many common contraceptives (AGI 2008c). Given these and many
other restrictions, contraception seems to be a responsibility that the government and
medical establishment do not trust women with.

‘ What accounts for this tension: that women are apparently both trusted and
distrusted to contracept? Despite the fact that women as a goup are held responsible for
contraception, they are not trusted because they are perceived to be incompetent due to
cultural tropes that they are irrational and that they have a strong desire to become
mothers. Women are expected to be responsible for contraception so that men do not

have to shoulder this responsibility and its associated burdens. Even though they are not

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trusted, women are permitted certain reproductive freedoms, namely a formal right to

contraception, in order to successﬁrlly assume contraceptive responsibility.

Incompetence Due to Irrationality

In “The Man of Reason,” Genevieve Lloyd seeks to understand why masculinity
is associated with rationality while femininity is excluded ﬁom it. Drawing on the history
of philosophy as far back as Ancient Greek philosophy, Lloyd traces how the
reason/emotion dichotomy came to map onto the man/woman dichotomy. Women’s
association witln emotions and irrationality persists today. This dominant ideology
contributes to why women as a goup are often thought to have a limited ability to make
good decisions and to act in accordance to their own values. In the case of contraception
(and reproduction more generally), the worry is that women will not be able to act in a
self-sacriﬁcing way because of their presumed irrational and emotional nature. An
example of blaming women’s “irrationality” for “bad” decisions is seen in the way the
media portrays women who drink during pregnancy: such women are stupid and are not
capable of making a good decision on behalf of their fetus. The media, politicians,
policymakers, and most men do not usually tlnink that women are maliciously making
decisions that go against the expectation of self-sacriﬁce. Rather, they semi-consciously
believe that women’s irrational nature makes it difﬁcult for women to judge how best to
act in a self-sacriﬁcing way. In other words, women’s irrationality is perceived to be like
an overarching force that has the potential to affect any decision women make. While the
media, politicians, policymakers, and most men are not concerned when women’s

supposed emotional nature affects women’s choice in kitchen wallpaper style, they are

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worried when there is more at sake with a decision, especially if the decision involves
others (e. g. children, men, the public). Given that protecting children and fetuses is a
strong social value and that many do not trust women to adhere to the norms and values
they (women) believe in because of their presumed irrational nature, they do not trust
women as a goup with contraception. According to this view, women need to be
protected ﬁ'om their own bad decision-making, which is why laws regulating women’s
reproduction and policies that insinuate that men should be the head of household are
justiﬁable. In sum, the ideology that women are irrational leads some (e. g. media,
politicians, policymakers, and some men) to distrust women with contraception because
they consciously and nonconsciously believe women are incompetent at making good
decisions and at acting according to their values.

The existence of unintended pregnancies—almost half of all pregnancies—feeds
the belief that women are incompetent at being responsible for contraception (Finer and
Henshaw). Part of the reason for this is due to the ideology of the “American Dream”: it
is assumed that if one works hard enough and makes enough sacriﬁces, one will achieve
one’s dream. This ideology translates to contraception: that if one works hard enough to
prevent pregnancy and makes all the necessary sacriﬁces, one will achieve one’s goal of
avoiding pregnancy. Yet, no matter how much effort one puts forth and how much one
sacriﬁces, contraception is never one hundred percent effective and there is always a
chance of pregnancy. In fact, “Even a contraceptive method with an annual failure rate of
one percent that is used from age 30 to age 45 will leave one woman in seven with an
unintended pregnancy” (Potts 288). The existence of such failures leads some men, as

well as some in the media, politics, and policymaking, to question women’s competence

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in being self-sacriﬁcing. Although women may morally value the social norm of self-
sacriﬁce, they are thought to be incompetent in executing it since there are unintended
pregnancies. That there is a failure at achieving the goal of avoiding pregnancy makes
women as a goup seem untrustworthy.

On the individual level, men (including men who are part of the media, politics,
or policymaking) are more likely to trust women, namely their partners, to contracept.
Instead of relying on dominant ideologies, men can look at speciﬁc characteristics of
their partrners to determine their competence and trustworthiness with contraception.
Presumably, many men consider their partners rational and trustworthy to contracept.
Yet, as I will discuss more in chapter 6, some men, especially those who uphold
traditional gender roles, believe women are inherently irrational and thus untrustworthy
with contraception. Even though some men will not trust women on the individual level,
the probability of trust seems geater on the individual level than the goup level. Given
that most women assume contraceptive responsibility in monogamous relationships, it
seems likely that many men do trust their partrners to contracept. This claim is
strengtlnened by the fact that there are male contraceptives available, so men do have the
option of contracepting themselves. So, if many men really did not trust their partner and
were worried about unintended pregnancy (and perhaps STDs), tlnen it seems likely that
more men would choose to contracept. Perhaps some men decide not to contracept even
though they do not trust their partner because they do not want to take on the burdens of
contracepting or they semi-consciously believe that reproductive matters are women’s

3 work. While there probably are some men that depend upon their partner to contracept

134

 

even tlnough they do not trust her, I believe (perhaps overly optimistically) that in healthy

relationships, many men do trust their partner with contraception.

Another Barrier for Trust: Women’s Desire for Children

Women’s perceived irrationality is not the only barrier for trustworthiness.
Interestingly enough, another barrier is an extension of the ideology that women should
be self-sacriﬁcing: the idea that women should be accepting of—and moreover, excited
about—children, whenever they should enter into their lives. Because women are thought
to want (and even need) children, they are also thought to be welcoming of pregnancy,
regardless of when and how it occurs. In fact, the social expectation may be stronger than
just that women are always thrilled to discover that they are pregnant: women actively
seek out children, perhaps so much that they are willing to deceive their male partners
about their contraception use. For example, in the movie The Wedding Singer, Julia is
engaged, but her ﬁancé will not set a wedding date. Her mother suggests that she get
pregnant as a way of pushing her ﬁancé to move forward on the marriage. The mother’s
advice exempliﬁes the societal belief that women actively try to “trap” men into marriage
by getting pregnant even though they tell their male partners that they are using
contraception. While unwed motherhood is more common and more socially acceptable
today, the societal belief that women will trick men about their contraceptive use in order
to leverage something else (e. g. marriage, money, power, etc.) remains. The fear that
women will deceive men about their contraception use runs deep: in the mainstream mass
media articles I looked at, it was one of the leading reasons given for why men would be

interested in male contraceptives. According to these articles, many men are interested in

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male contraceptives because they would “protect” them from untrustworthy women.
“Since a man could unwillingly and unknowingly impregnate a woman whom he trusted
was using reliable contraception, he may prefer to rely on himself” (Ringheim 85).
Indeed, male contraceptives “could shield men from the baby entrapment of duplicitous
partrners” and protect them from the economic costs of having a child, which some assert
as a main reason men want to control their fertility (Christman; Ringheim 86).

The social belief that women desire children so badly that they are willing to
deceive their partrners about their contraception use leads some men to semi-consciously
tlnink that women as a goup are untrustwortlny to contracept. Like the social perception
of women as irrational, this perception presents women as incompetent in this reahn, tlnus
making them untrustworthy. This cultural understanding portrays women as incompetent
because it conﬂicts with the contraceptive ideology of self-sacriﬁce: according to this
cultural understanding, women will deceive men in order to get pregnant, yet according
to the ideology of self-sacriﬁce, women should make whatever sacriﬁces necessary to
avoid pregnancy. Women’s perceived desire to do whatever possible in order to get
pregnant interferes with men’s trust of them to do whatever possible to avoid pregnancy.
However, as I discussed earlier in this chapter, it is also assumed that women should be
able to control their urge to have children. So there is some tension here: women are
thought to be able to control their libido and their “biological need” for children, though
it is also believed that they will go to geat lengths, such as deceiving men, in order to

have children.22

 

22 Women’s strong desire for children is thought to contribute to the p0pularity of reproductive
technologies.

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While some men may be concerned that their partners will surreptitiously get
pregnant, this worry seems less likely on the interpersonal level than the goup level. On
the interpersonal level men can judge their partner’s trustworthiness to contracept without
deception based on her personal characteristics rather than ideologies about women’s
desperate and “wild” desire to have children. Many couples (hopefully) discuss their
contraceptive arrangements and their fertility preferences (e.g. if they want biological
children, how many children they want, etc.). These sorts of open conversations help
build trust between partrners. In sum, it is likely that most men trust their partrner to
contracept on the interpersonal level more than they trust women to contracept on the

goup level.

Why Women Are Still Responsible for Contraception

The conclusion that women are not trusted to contracept is both odd and
problematic for the same reason: women are held responsible for contraception. Typically
when we trust people, we hold them responsible. Thus, it does not make sense that
women are held responsible for contraception even though they are typically not
considered trustworthy with it. While morality and legality do not always go hand in
hand (as illustrated by controversial issues such as abortion, euthanasia, and the death
penalty), ideally our legal system attempts to codify what is moral. Indeed, our legal
system codiﬁes various social norms and ideologies (e. g. do not kill, do not steal, respect
private property, etc.) that politicians and presumably citizens believe are necessary for a
moral and harmonious existence. Social contract theorists like Hobbes, Locke, and

Rousseau tlnink people have no reason to trust one another to act morally in the state of

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nature; consequently, a social contract is necessary in order to ensure moral behavior.
Social contract theorists assume all individuals value the laws of this country. While
clearly not everyone values all laws, these tlneorists assume they should. For the sake of
argument, let us go along with this assumption since our legal system does not make
exceptions for people who disagee with the laws. Because it is assumed everyone values
the laws, our government and other citizens trust individuals to follow them (which plays
into why our legal system assumes innocence rather than guilt). Consequently, if
someone breaks the law she is held legally responsible.

The main exception23 to this is if a person is considered incompetent and this
incompetence is thought to affect her trustworthiness. For example, people who do not
have the mental ability to understand the laws, such as children and some mentally ill
people,24 are usually not held responsible for their crimes because their incompetence
prevents tlnern from being trusted to know and follow laws. Recall that Mullin outlines
two types of competence in order to be trustworthy: ﬁrst, that people are able recognize
the social norm that they are supposed to follow and understand what it entails; second,
that people are capable of acting according to the norms they uphold (2005b, 322).
Because those involved in legal matters (e. g. lawyers, judges, psychologists, etc.) believe
that children and some mentally ill people are incompetent in one of these two ways—
either they'do not recognize the laws and/or understand how to follow tlnern or they are
unable to act according to the laws even tlnough they know them—they do not usually

hold tlnem legally responsible for breaking the law (or if they do hold them responsible,

 

23 There are other cases where people are not held responsible. For example, diplomats often have
immunity.

24 While there are various forms of mental illness, ﬁ'om minor to severe, here I am taking only about the
most severe forms of mental illness.

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the consequences are different). Children and some mentally ill people are not held
responsible because their incompetence is thought to be an inherent, and thus
uncontrollable and unavoidable, part of who they are. That is, it is assumed that by virtue
of being a child or having a certain mental illness, one will not have the competence to
understand and follow the laws. Since this incompetence is a “natur ” and inevitable part
of being a child or mentally ill, our legal system does not hold these individuals
responsible in the same way it does for competent individuals because it is not their fault
that they lack this competence.

Returning to the case of women and contraception, it seems not only strange, but
' also unfair that our legal system, the medical establishment, and individuals consider
women untrustworthy with contraception and yet still hold them responsible for it. Why
is this? It reinforces patriarchy and beneﬁts men. The current arrangement reﬂects men’s
semi-conscious desire not to be held responsible for contraception and to have to deal
with the burdens of contracepting. However, men still want to have control over
reproductive matters, though they may not be aware of this desire. By covertly and
overtly insisting that women are irrational and therefore incapable of making good
decisions, men, who are viewed as rational and thus capable of making good decisions,
retain control over reproductive matters. They exercise this control through policies,
laws, surveillance, and normalization that target women’s bodies. Women are granted the
(limited) freedom to contracept in order to relieve men of this responsibility.

Our patriarchal social forces and ideologies regarding the public/private
dichotomy, gender roles, and sexist assumptions about women’s bodies discipline women

to assume contraceptive responsibility. Since reproduction is thought to be part of the

139

private realm and women are typically associated with the private realm, it is assumed
that women should be the ones responsible for reproduction. Due to the gender ideology
that women are naturally better caretakers—that they are innately loving, giving, self-
sacriﬁcing, and maternalistic—they are generally thought to be better equipped to be
responsible for reproduction and childcare. Women’s bodies are also thought to be better
suited to contraception because they are often viewed as objects and thus are considered
easier to control (I return to this point in chapter 6).

Claiming that women ought to be the ones responsible for contraception due to
these reasons while simultaneously asserting that women are not trustworthy aligns
femininity with contraceptive responsibility, while enabling men to keep their top-down
political, social, economic, and interpersonal dominance over reproduction. Men beneﬁt
from this arrangement because they maintain power while at the same time avoiding
contraceptive responsibility and all that it entails. Women assuming contraceptive
responsibility increases men’s freedoms: the freedom to have sex worry-free, the freedom
to avoid bodily invasion by contraceptive medication and procedures, and the freedom of
increased access to women. Catharine MacKinnon argues that abortion was legalized
because the “availability of abortion enhances the availability of intercourse” (188).
Contraception was legalized for the same reason—it increases men’s sexual access to
women. Women’s ability to control their fertility is thought to increase their sexual
activity because they are able to have sex like men, that is, sex without worrying about
the consequences of pregnancy. For example, women can no longer use the “excuse” of

potential pregnancy to avoid sex since there are so many female contraceptives.

140

Saddling women with contraceptive responsibility also beneﬁts men because
women, not men, are usually the targets of blame for contraceptive matters. For instance,
women are often stignatized for being sexually active—for falling on the “whore” side
of the virgin/whore dichotomy—especially if they belong to one of the goups I discuss
below. Additionally, if an unintended pregnancy results, women are blamed for not
successfully contracepting. Since women are generally responsible for contraception,
they are often pinpointed as the cause of “bad” outcomes, such as an unintended
pregnancy. In contrast, men are often let off the hook occurs. For example, men today are
not usually pressured into marriage due to an unintended pregnancy (the boyfriend of
Bristol Palin, Sarah Palin’s daughter, is a notable public exception).

Blaming women is especially unfair because the barriers to successﬁnlly
contracepting are typically ignored. For example, Anna Stubbleﬁeld claims that some
women risk not using contraception even though they know it increases the probability of
pregnancy because of the cultural belief that women who use contraception are sexually
promiscuous. She concludes that “Social norms such as those in the case of contraceptive
risk-taking that assign blame to women for unwanted pregnancies while simultaneously
coercing them to engage in premarital sexual intercourse without using contraceptives are
oppressive” (Stubbleﬁeld 85). These competing social norms lead to a no-win situation
for women: if they contracept then they are viewed as sluts, but if they do not contracept,
then they run the risk of pregnancy. I will return to Stubbleﬁeld’s work and some of these
barriers to contracepting in the chapter 6.

It is important to note that certain goups of women—young, poor, unmarried,

and minority—are considered less trustworthy and more blameworthy than others. While

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it is true that these goups of women are more likely to have unintended pregnancies
(Finer and Henshaw), rather than understand why this is the case, the media, politicians,
policymakers, and others blame tlnern for not upholding the self-sacriﬁcing norm either
by using contraception or abstairning ﬁom sex (see Roberts 1997 on the treatment of poor
black women). Yet, many of these women cannot afford contraception and the Bush
government continues to make it more difﬁcult for women to get access to reproductive
services. For example, on the national level, Title X, which provides public funding for
family planning services, is underﬁrnded and often under attack (Reproductive Rights). A
state-speciﬁc example: in 2006, Missouri House Republicans voted to ban county health
clinics from providing family planning services, including contraception (Temple). The
stereotype that women belonging to these goups are sexually promiscuous leads some
politicians to argue that if these women stopped having sex their problems would also
cease. This argument assigns full blame to these women—insisting that the women are
morally irresponsible for not being able to control their libido—while overlooking the
way others (i.e. men and society) contribute. In reference to the Missouri ban on family
services, Rep. Susan Phillips (R-Kansas City) said in an interview, “If you hand out
contraception to single women, we're saying promiscuity is OK as a state, and I am not in
support of that” (Shakespearsister blog).

In sum, implying that women are irrational is an easy way for politicians,
policymakers, members of the media, male partnners, and fathers to justify their control
over women as well as to pin blame on them when something goes wrong. On both a
conscious and nonconscious level, men do not want to acknowledge that women are

rational because it would mean that women should be trusted with contraception. Thus,

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women would no longer “need” men to control them and the reproductive realm in the
way that men currently do. The idea that women are irrational is a key part of the
patriarchal control over women not only in reproductive and childcare realms, but in all
other facets of life as well (e. g. public life, political realm, education, etc.). The ideology
of women irrationality is often subtly, thought sometimes explicitly, behind justiﬁcations
of laws and social policies (in various realms) that convey distrust for women. The only
way to move toward trusting women, then, is to deconstruct the cultural trope that women

are irrational. I turn to this goal in the next section.

Changing Our Contraceptive Social Norms

My analysis leads to a quagnire: neither women nor men are trusted as a goup
with contraception. What can be done to rectify this situation? There are at least two
possibilities: change the contraceptive ideologies or change the gender ideologies. While
changing one set of ideologies and not the other could make women, men, or botln goups
trustworthy, both need to be changed because they are both morally troubling. Yet, such
change will not be easy, nor will it be quick. I offer some brief suggestions here, but will
go more detail on these suggestions and others in chapter 7.

One suggestion is changing the contraceptive ideologies of self-sacriﬁce. I have
already spent time (in the last chapter) explaining how the contraceptive expectation of
self-sacriﬁce is problematic because it gloriﬁes and upholds the social norm of women as
self-sacriﬁcing, but I will brieﬂy add a few tlnoughts here. One reason I ﬁnd this norm so
troubling is that it is directed at a particular social goup—women+in order to beneﬁt

another social goup—men. Another reason is that the degee of sacriﬁce is so extreme:

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“on a cultural level women are expected to donate themselves in the form of time, energy,
and body” for others (Raymond 9). As discussed with pregnancy and childcare, no there
is no such thing as too big a sacriﬁce, nor is there a chance or type of improvement that is
too little to merit self-sacriﬁce. I recognize that some amount of sacriﬁce is necessary
with contraception. However, as it currently stands, this expectation is botln oppressive
and unrealistic. It assumes that women should warmly welcome full reproductive
responsibility and uphold this responsibility ﬂawlessly. This ideology contributes to some
men’s feelings of betrayal in the reproductive realm, as few women live up to this self-
sacriﬁcing ideal. Indeed, the expectation of women to be superwomen/super-sacriﬁcer—
miraculously able to be successfully responsible for work, children, male partrner,
household, and still maintain her femininity—means that women who allow anything to
inhibit their ability to be successfully responsible for contraception are not thought to
deserve trust. Upholding this norm prevents us from accounting for the role of others:
men, partners, families, and ﬁiends; of society: ideologies, societal norms, and
oppression; and of factors about contraception: such as price, side effects, efﬁcacy, and
availability of options.

Another suggestion also involves changing a contraceptive expectation: the
cultural belief that contraception should not be discussed. This belief is problematic
because it relegates contraception to the private realm, which results in silencing women
and placing women’s reproductive issues outside the realm of public justice. The taboo
on discussing contraception prevents children from learning how to properly use
contraception and often leads to the belief that both sex and contraception are “bad.” This

expectation of silence should be changed and can be changed without harming women’s

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autonomy to use contraception. Many people, especially liberal theorists, assert the need
for the privatization of reproduction (including contraception) so as to ensure people’s
reproductive autonomy. However, privatization and silencing are not the same, though
many people are silenced by being pushed into the private realm. Furthermore,
privatization does not guarantee reproductive freedom. According to MacKinnon,

Private is what men call the damage they want to be permitted to do as far

as their arms extend to whomever they do not want permitted to ﬁght

back. Epistemically, in gender terms, it means that male force is invisible.

When aggession occurs, what is seen is consent. (191)

By privatizing contraception, our government makes it easier for men to control women’s
reproduction, while proclaiming that women autonomously make reproductive decisions.
Moreover, this arrangement forces women to be responsible for contraception without
any public support. Our goverrnrnent must move contraception (as well as reproduction
and childcare) out of the private realm so that women can have reproductive autonomy
backed by public rights. Brining contraception into the public realm will establish the
unfair burdening of women with contraception as matter of social justice.

The government can make contraception a public matter through creating and
funding public progams and goals. For example, public educators can normalize
contraception by teaching children sex education that promotes its use. Government and
nonproﬁt workers can lobby the media to include contraception in movies and television
shows to normalize it and encourage partners to discuss it. Currently, contraceptive use is
not included in media images:

First, the prevalent images in the media of nonmarital sexual activity,

which impart the message that such activity is both common and

acceptable and thereby counter the norm against it, do not include images
of contraceptive use. Second, these images propagate a paradign of

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sexuality and romance in which women are ‘swept off their feet’ rather
than actively planning sexual intercourse. (Stubbleﬁeld 96)

Given the far-reaching arms of the media, movies and television progarns that include
contraception use and/or discussion of contraception would be viewed by millions of
people.

Yet, changing contraceptive ideologies is not enough for women to be viewed as
trustworthy. The reason women are distrusted is that they are seen as incompetent and
changing the expectation of self-sacriﬁce and/or the taboo of contraception will not make
women seem more competent. What will make them seem more trustworthy is viewing
them as competent. Believing that women are irrational leads people to tlnink that they are
incompetent. Thus, in order to see women as competent our government and its citizens
need to assert their rationality. There are probably additional ideologies, as well as other
factors, that contribute to the belief that women are incompetent. However, I do not have
the space to discuss them all, so instead I have used the umbrella concept that women are
irrational, which covers a lot of other ideologies that portray women as incompetent:
women are emotional, unreasonable, ﬂaky, irresponsible, stupid, and incapable of being
profound or making good decisions. Eliminating the cultural stereotype that women are
irrational will lessen or eradicate these other problematic tropes. Furthermore, eliminating
this stereotype is necessary in order for women to be considered trustworthy not just with
contraception, but in all realms of life.

Another beneﬁt of increasing the social perception of women’s trustworthiness is
that this will enhance their autonomy. Believing that someone is incompetent justiﬁes
paternalism. Philosophers distinguish between weak and strong paternalism: weak

paternalism involves acting patemalistically toward incompetent people (e. g. children,

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mentally retarded individuals), whereas strong paternalism is acting patemalistically
toward competent individuals. Most philosophers think that restricting the autonomy of
competent people is morally unacceptable because these individuals are capable of
making good decisions for themselves, whereas incompetent people are not. According to
the trope that women are irrational, the government and men (i.e. women’s partners,
fathers, etc.) are justiﬁed in limiting women’s autonomy because it is merely a form of
weak paternalism. However, if women are viewed as rational, then the govemment’s and
men’s actions that result from distrust (e. g. laws, surveillance) are unjust because they are
cases of strong paternalism.

In order to move towards viewing women as rational, our legal system needs to
stop treating them patemalistically. On a practical level, this means removing laws that
regulate women’s reproduction. In addition to ganting women the negative ﬁ'eedom to
make choices about their bodies, our legal system must provide them with the positive
freedoms that enable them to make good choices (e. g. education, access to clirnics, cheap
or free contraceptives). Our government must strive toward gender equality in all realms,
and not just reproduction, as a way of systematically afﬁrrrning women’s rationality since
what happens in one realm affects other realms. Moreover, our government and private
organizations should develop male contraceptives, especially long-term reversible
options, as a way of achieving shared contraceptive responsibility. The lack ofoptions for
men makes it difﬁcult for them to assume responsibility for contraception and this pushes
contraceptive responsibility on women. Additionally, as I already mentioned, our
government should make contraception a public matter. This would allow politicians,

policymakers, and everyday citizens to recognize the challenges women face in

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contracepting, as well as the role men and the government play in contraception, which
would (hopefully) minimize the blame directed at women. In sum, viewing women as
rational and moving contraception a public matter would allow women to freely exercise
their reproductive autonomy and would limit unfair blame directed at them. Additionally,
afﬁrming women’s rationality would increase women’s overall autonomy by making
them seem more trustworthy with matters outside of reproduction and childcare.

In conclusion, changing these contraceptive and gendered social norms is a long
and difficult process, but one that is worthy of our most valiant efforts. Changing these
beliefs will not only allow for women and men to be trusted on the goup level with
contraception, but it will also mean that we rely on a less problematic social norm in

order to determine trustworthiness.

I48

Chapter 5. Paternal Responsibility and the Principle of Nonmaleficence

In the previous chapter, I explored some of the gender ideologies that contribute
to men’s perceived untrustwortlniness regarding contraception. In our current
contraceptive arrangement, this distrust usually absolves men as a goup of contraceptive
responsibility. Women, in contrast, are not only typically held responsible for
contraception, but they also do the vast majority of contracepting. As I have shown in the
previous chapters, the current contraceptive arrangement is unjust and oppressive for
women. My goal in the second half of this project is to propose a more just contraceptive
arrangement, one in which women and men share contraceptive responsibility.
Speciﬁcally, I hone in on men’s moral duty to contracept. Although I think this moral
duty applies to botln women and men, 1 limit my argument in this chapter and the next
one to men’s moral duty because it is typically ignored. Women’s moral duty to their
fetuses and children, in contrast, receives lots of attention. In examining the neglected
topic of men and contraception, I seek to ﬁll a void in philosophical conversations about
contraceptive responsibility.

In order to claim that men have a moral duty to contracept, I draw on the principle
of nonmaleﬁcence, which states that we should act in ways that do not cause harm to
otlners. One reason I turn to this principle is that is it ﬁequently appealed to in discussions
about women and reproductive responsibility. As I will explicate later in this chapter,
there is a social fear that women will harm their fetuses and children. In arguing that
women should act in a certain way so they do not cause harm, many politicians,

policymakers, academics, and health care professionals rely upon the principle of

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nonmaleﬁcence. Yet, this principle is rarely mentioned in discussions of men and
reproductive responsibility. Even though the number of discussions about men’s
reproductive responsibility pales in comparison to those about women, it is striking that
the centerpiece of most discussions about women—their potential to cause fetal harm—is
virtually absent from most discussions about men. The small number of discussions about
men’s reproductive responsibility, as well as the fact that these discussions rarely
mention fetal harm, reﬂects dominant gender ideologies about who ought to be
responsible for reproduction and who is capable of and causally responsible for harming
fetuses and children. In this chapter, I apply the principle of nonmaleﬁcence to the case
of men’s reproductive responsibility to argue that men have a moral duty to contracept if
their actions could harm their fetuses and children.

This chapter consists of three sections. In the ﬁrst section, I present the
circumstances under which it is fair to expect people to act according to the principle of
nonmaleﬁcence. In the second section, I highlight the contrasting social views about
women’s and men’s potential and likelihood to cause fetal harm, despite scientiﬁc
evidence that both women’s and men’s actions can lead to fetal harm. There is a cultural
understanding that women are very likely to cause fetal and child harm, reﬂected in
limitations on women’s participation in clirnical trials and certain jobs, public service
announcements telling women not to drink alcohol while pregnant, and extensive media
coverage of “crack babies” and other babies thought to be “damaged” by women’s
behavior. Conversely, there is little public discussion of men and fetal and child harm,

which implies that men do not (or cannot) cause such harm.

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In the tlnird section, I use the principle of nonmaleﬁcence to argue that men have a
moral duty to contracept if their behavior—past, current, or future—could harm the
potential fetuses and children who result from their unprotected sexual behavior. This
argument rests on the claim that moral responsibility often stems from causal
responsibility. Since men have the potential to cause harm to fetuses and children, they
should be morally responsible for preventing such harm. There are three ways for men to
avoid harming fetuses and children. One way is to not partake in activities that can cause
fetal and child harm. I recommend that men who are actively trying to father a child
follow this method. If they are unable to avoid activities that risk harming a fetus, then
they should contracept in order to prevent harm. The other two ways involve striving to
avoid fathering a fetus either by abstaining from sex or by contracepting. Men who are
not interested in fatlnering a child should abide by one of these two suggestions so as to
obviate health-related risks to fetuses as well as economic and social harms that may
befall children after birth.

Two caveats before moving on. First, I am limiting my normative discussion to
moral responsibility. I am not endorsing state enforcement to ensure certain types of
behavior nor am I condoning punishment for those who deviate ﬁ'om “acceptable”
behavior. I am merely outlining what people should do if they want to act in a way that is
responsible toward (and respectful of) their potential fetuses and children.25 Second, there

are numerous harms parents can inﬂict upon their children. Obviously, I cannot address

 

5 While my drscussron in this chapter and the next one focus on the moral duties mdnvrduals have, this
does not mean the government does not have moral duties regarding contraception. I make
recommendations for government involvement with contraception in chapter 7.

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them all here. I consequently conﬁne my discussion to health-related,26 economic, and

social harms, broadly construed.

Harm and the Principle of N onmaleﬁcence

Before turning to what it means for men to abide by the principle of
nonmaleﬁcence with reproductive responsibility, I ﬁrst lay out the circumstances under
which it is fair to expect individuals to act according to this principle. In order to prevent
harm to others, individuals sometimes have to take on harms themselves. For example, as
discussed in chapters 3 and 4, women are typically expected to make myriad sacriﬁces in
order to avoid harming their fetuses and children. Yet, many of these sacriﬁces are unfair
because the degee of sacriﬁce is much geater than the degee of potential harm. In other
words, women are often expected to make huge sacriﬁces to prevent very minimal
potential harms. Such signiﬁcant sacriﬁces are usually harmful to women (I pointed out
some of these ways in previous chapters), which is why they cannot be justiﬁed if they
are undertaken to avoid a slight potential harm to fetuses and children. This example
shows that in order to determine if an action to prevent harms in others is justiﬁed, it is
necessary to compare the harms engendered in trying to prevent harm to others with the
harms experienced by others if we do not prevent harm.

In general, most politicians, policymakers, academics, and laypeople do not think
it is wrong for individuals to take on some harm to themselves if it means they will
prevent geater harm to others. This utilitarian logic is especially common in debates

about various public health issues, such as quarantining individuals with a highly

 

26 More speciﬁcally, I limit the type of health-related harms I discuss to those caused by parental behavior
(e.g. parental smoking leading to low birth weight).

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contagious and serious diseases, like tuberculosis. Most health care professionals would
claim that, based on the principle of nonmaleﬁcence, individuals with tuberculosis have a
duty to prevent harming others (i.e. spreading the disease). Dr. Julie Gerberding, Director
of the Centers for Disease Control and Prevention says health officials “usually rely on a
covenant of trust to assume that a person with tuberculosis just isn’t going to go into a
situation where they would transmit disease to someone else.” The media and laypeople
seem agee that people have a duty not to spread dangerous diseases, as seen by the
public outcry in May and June of 2007 when a man with a drug-resistant form of
tuberculosis ﬂew to Europe for his honeymoon (No autlnor, “Man knew he had TB before
ﬂying to Europe”).

Although being quarantined harms individuals with tuberculosis (e. g. they
temporarily lose their freedom of mobility and some aspects of their autonomy), the
harms they could cause to others (e. g. severe sickness and deatln of many) far outweigh
the harms they face in being quarantined. Part of the reason many health care
professionals and others do not think it is unfair for individuals with tuberculosis to
assume some harms is that these individuals are causally responsible for harming others.
Generally, people are not expected to take on harms to themselves to prevent harms to
others that they have not caused. For example, many in the global North do not think they
have a moral duty to prevent harms (e. g. poverty, disease, lack of education) to those in
the global South because they do not consider themselves causally responsible for those
harms.27 Consequently, they do not donate money or time (such donations could be

construed as harms to themselves) to those in the global South. Or, if they do give, they

 

27 See Thomas Pogge for a compelling argument explaining how people in the global North are causally
responsible for the situation of people in the global South.

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do so based on altruism or some other reason, not because of a moral duty they feel they
have due to the principle of nonmaleﬁcence. Clearly, there are cases where people are
expected to take on personal risks in order to prevent harms to others even though they
are not causally responsible for tlnese harms, such as health care professionals and
ﬁreﬁghters risking their health and lives to aid others.

In the case of contraception, men are causally responsible for the existence of
fetuses, a causal relationship that is generally shared with women (rape is a notable
exception). Additionally, men’s actions can cause health, social, and economic problems
for fetuses and children that result from unprotected sexual activity. The harms men
could cause by not contracepting are much geater than the harms they could face by
using contraception. Furthermore, men beneﬁt from contracepting: they prevent harms to

themselves. I will return to these arguments later in the chapter.

Contrasting Social Views about Women’s and Men’s Potential to Cause Harm
As discussed in previous chapters, women are usually expected to make various
sacriﬁces for their fetuses and children and “problems” or “imperfections” are often
blamed on women. That is, women are typically identiﬁed as the cause of harm. And
while it is no doubt true that women can harm their fetuses and children, placing the
majority, and sometimes all, of the blame on them overlooks both the societal factors at
play as well as the ways men cause harm to their fetuses and children. As Cynthia
Darniels argues, “Debates over fetal risk are not so much about the prevention of fetal
harm as they are about the social production of truth about the nature of men’s and 1

women’s relation to reproduction” (579). The focus on women in discussions of fetal

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harm reinforces the belief that women’s bodies are permeable: that they easily spread
harms to others, especially an innocent fetus (for both historical and current examples,
see Kukla). Furthermore, the long history of medicine treating women’s bodies as weak,
inferior, and inherently diseased contributes to the worry that women’s bodies will
“infect” fetuses. In contrast, men’s bodies as seen as stable, bound, and healthy; tlnerefore
they are not a risk to fetuses. Because men’s bodies are thought to be stronger than
women’s, men are thought to be invulnerable to harm from toxics, or if they are harmed,
they are assumed to become infertile and thus incapable of harming others (Darniels 1997,
583)

These sexist understandings of women’s and men’s bodies essentially fail to
acknowledge any signiﬁcant role for men in reproduction, further perpetuating the
assumption that reproduction really only involves only one person: the woman. Clearly,
human reproduction requires two people, yet “the man’s involvement seems insigniﬁcant,
amounting to notlning more than the ejaculation of a small quantity of seminal ﬂuid. And
even this has been codiﬁed in conventional wisdom as primarily a sexual act, rather than
a reproductive one” (Sheldon 1999, 130). Men’s role in reproduction is reduced to a one
time event, whereas women’s role in reproduction consists not only of pregnancy, but
also anytime she is not pregnant (during childbearing age). The potential for women to
become pregnant—the idea that women are constantly in a state of pre-pregnancy—was
the main reason why the FDA issued new guidelines in 1977 that recommended
prohibiting women of childbearing age from the early phases of clirnical trials, except for
life-threatening diseases (Sarto). That the harm to potential fetuses of potentially

pregnant women was accepted as a legitimate reason for women’s exclusion from

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biomedical research for sixteen years shows how deep the fear runs that women will
(perhaps unintentionally) harm their fetuses.

Although the FDA changed its policy in 1993 to include women in clinical trials
in order to study sex/ gender differences in treatments, clinical researchers continue to
view women’s bodies as dangerous to potential fetuses. A study by Cain et al. found that
only 8.5% of all trials had no restrictions for women’s participation; the rest mandated
contraceptive use or sterility (862). Yet, “contraception was unnecessary in one third of
the protocols studied (24-hour to 2-day drug use) because timing to menstrual cycles
would prevent potential exposure during pregnancy” (863). How is it that these trials
were allowed to mandate contraception for women when it was unnecessary? Many
scientists and members of the FDA do not (consciously and nonconsciously) trust women
to make good reproductive decisions. The protectionist mentality is so strong that 41.7%
of the trials Cain et al. examined received FDA approval to mandate contraceptive use for
women without providing any reasons (862). Furthermore, almost all the trials demanded
a negative pregnancy test and 99.3% of trials requiring contraceptive use mandated
signature certiﬁcation or documentation that women are using an “acceptable” form of
contraception—often a hormonal form—in order to participate. This “proof” was
required even if the woman was celibate, lesbian, had a sterile partner, or was in a
. situation not conducive to reproduction (e. g. being in an intensive care unit) (864).

None of these sorts of restrictions are placed on men in clinical trials because men
are rarely thought to transmit harm to fetuses. What is particularly egregious is that “even
when studies were restricted to men because of known teratogenicity of the drug studied,

the reproductive control required was for female partners of subjects No mention of

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abstention, vasectomy, or sterility as a requirement to prevent fetal exposure by male
subjects was included” (Cain et al 864; emphasis added). The targeting of women’s
bodies (the female partrners of subjects) in this situation rather than men’s bodies (the
actual research participants) shows that while researchers recognize that men can harm
fetuses, they refuse to hold men responsible for such harm. Instead, the responsibility for
preventing harm is transferred to women, as is the implication of causal responsibility.

Placing the onus on women to prevent fetal harm makes women seem causally

 

responsible and hence blameworthy for any harm that does occur since it insinuates that
they are the only ones with the power to stop such harm.

The cultural belief that only women cause fetal harm is not limited to clinical
trials, but is also seen in public life. For example, warnings on alcohol bottles caution
only against pregnant women drinking. There is no similar warning for men seeking to
become fathers, though “paternal alcohol use has been found to cause low birth weight
and an increased risk of birth defects” (Darniels 1997, 597). Nor are there any warnings
about all the other harms that occur due to alcohol consumption, harms that often cause
more overall damage and affect more people, such as drunk driving and crime. Although
illegal in the United States tlnanks to the 1991 unanimous Supreme Court decision
International Union versus Johnson Controls Inc., the UK still permits employers to
exclude women from certain occupations if there is potential harm to potential fetuses.
Here again, women, rather than others, namely their mostly male employers, are held
responsible for fetal harm: “the removal of the women, rather than the chemical is thus
the solution to avoiding the risk” (Sheldon 1999, 144). No workplace chemical has been

outlawed because of its effects on women’s reproduction, yet there is a double standard:

157

the pesticide dibromodiclnloropropane (BDCP) was barnned because of its harmful effects
on male reproduction (ibid.).

As these examples show, the message that women can (and do) cause harm to
fetuses is ubiquitous. More insidiously, tlnese examples reveal that men are not usually
viewed as causally responsible for fetal harms. Women, in contrast, are viewed as in need
of constant protection because “maternally mediated fetal risks are assumed to be certain
and known”; that is, women are “scientiﬁcally-proven” causal agents of fetal harms
(Daniels 1997, 602). Additionally, due to the ideologies of fernirninity discussed in the
last chapter, women are not trusted to be self-sacriﬁcing and prioritize the needs of their
fetuses or potential fetuses, despite the fact that they are generally held responsible for
contraception. Men are typically not seen as causally responsible for fetal harm because
of various dominant cultural beliefs, including: they are not thought to be able to prevent
such harm, there is denial that men’s bodies can cause harm, and men are usually not _
associated with reproduction. By upholding and perpetuating gendered beliefs, the media
contributes to why men are not viewed as causally responsible for fetal harm. Cynthia
Daniels, a political scientist, analyzed newspaper coverage of fetal harm over a ten year
period and, not surprisingly, found a huge discrepancy in the number of articles about
women (over 200) versus men (only 17) (ibid. 601). Darniels argues that ﬁve factors
contribute to the minimal coverage of men’s responsibility for fetal harm. First, whereas
men are conspicuously absent from articles on matemal-fetal harm, not only are women
always included in articles on paternal-fetal harm, but they are also mentioned as a
possible source of harm. Second, as stated above, the risks women pose to fetuses are

assumed to be “certain and known” (ibid. 602). Third, the knowledge of men’s risks to

158

fetuses is presented as “qualiﬁed and limited” (ibid.). Fourth, men’s responsibility is
diminished by reference to “involuntary” workplace and environmental exposure, even
when the toxin in question is an illegal or legal drug. Lastly, “the language and images of
harmed children and ‘crack babies’ are absent from stories on men” (ibid. 603).

Because the perceived harms women can “inﬂict” on fetuses (e.g. FAS, low birth
weight due to smoking, “crack babies,” etc.) are ubiquitous, I will not enumerate them all
here. What is interesting to note is that there is scientiﬁc evidence that many of the
actions believed to be most risky are not as dangerous to fetuses as the way they are
publically presented. For example, a study linked the prevalence of Fetal Alcohol
Syndrome (FAS) to poor nutrition, a result of low socioeconomic class: women who
consumed at least three drinks a day but ate balanced diets experienced a rate of Fetal
Alcohol Syndrome (F AS) of only 4.5 percent, while women who drarnk the same amount
and were malnourished had an FAS rate of 71 percent” (Daniels 1997, 587). While this
study uncovers that FAS is mainly just a risk for poor women, women of all classes are
targeted by the medical establishment and the public to abstain from alcohol while
pregnant for the sake of their fetuses. It is not surprising that this study has not gotten
much media attention, as it goes against the dominant norm that women should make
extreme sacriﬁces to prevent their permeable bodies from causing fetal harm, even if the
possibility for such harm is close to zero. Two other examples I mentioned in the
previous chapter are that there is no deﬁnite evidence that cocaine causes fetal damage
and that bedrest prevents problems in high risk pregnancies.

In presenting these examples, I do not mean to suggest that women’s actions

cannot lead to fetal harm. Rather, my point is that the risks of certain actions have been

159

overstated or that there is no evidence to conﬁrm such harm. What I ﬁnd troubling is that
the laws, media, medical establishment, and the public typically hone in on and blame
women for certain actions without adequate evidence. Yet, men are rarely reproached for
their behavior even when there is scientiﬁcally conﬁrmed, unexaggerated information
that it can lead to fetal harm. For example, both alcohol use and smoking in men
increases the chance of birtln defects and low birth weight. Illegal drug use, such as
cocaine, hashish, opium, and heroin, often results in abnormal sperm (Daniels 1997, 597).
Studies documenting tlnese harms began in the 19803, and in some cases earlier, yet this
information is still not widely disseminated (Darniels 1997, 579). As Koren et al. explain,
this lack of dissemination is partially due to editors of science journals rejecting papers
that violate scientiﬁc “believability”; in this case, the claim that men can cause fetal harm

is not believable.

Why Men Should Contracept According to the Principle of Nonmaleﬁcence
Given the knowledge that men’s actions can lead to fetal harm, if we hold women

responsible for behavior that can cause fetal harm, then we should do the same for men.
According to the principle of nonmaleﬁcence, men have a moral duty to contracept if
they engage in potentially risky behavior. Before turning to this argument, however, I
want to point out that the principle of beneﬁcence, which states that we should act in
ways that promote the welfare of others, is also at play in many arguments about how
pregnant women ought to act. The principle of beneﬁcence ties into to the social
expectation that pregnant women and mothers should be self-sacriﬁcing. Given the

unique situation of pregnancy—that is, the fetus growing inside the woman’s body—a

160

case can be made for women taking positive steps to ensure the welfare of their fetuses,
such as taking folic acid. However, there are limits to what women should be expected to
do, as such expectations can often lead to extreme, and problematic, self-sacriﬁce, as
discussed in chapter 3. Since parenting is not sex speciﬁc (like pregnancy), the argument
that children are entitled to positive rights is often extended to botln biological parents
(see, for example, James Lindemann Nelson). Since men’s role during gestation is
limited, it would be much more difﬁcult to make a case that fetuses deserve positive
rights ﬁ'om their fathers28 while in utero, except in the case where men actively want to
be fathers. I consequently will limit my discussion of the rights fathers owe their fetuses
to negative rights. It is easier to claim that children deserve positive rights from their
fathers and indeed much has been written on this topic, especially regarding the economic
and social rights children should receive from their fathers (Onora O’Neill and William
Ruddick’s edited collection is an early example). Since many fetuses become children, it
would be shortsighted to neglect the rights of children. The harm men can cause to their
potential children is not limited to the act of conception. In refusing economic and social
support—both positive rights—men are also causing harm to their potential children that
could be avoided by contracepting. In the next two subsections, I explore the moral duties
of men who do not want to father a child and those of men who are actively trying to
father a child. I restrict my discussion to heterosexually active men for the sake of

simplicity.

 

28 While I think it is problematic to refer to pregnant women as mothers and their male partners as fathers, I
use such language due to the lack of better terms that are not awkward.

161

Men Who Do Not Want to Father a Child

Applying the principle of nonmaleﬁcence to a potential fetus, men who are not
interested in fatlnering a child have a moral duty to contracept. Since many common
behaviors, such as smoking, drinking, drug use, and working with certain chemicals, can
result in patemal-fetal damage, men who engage in any of these risky behaviors should
use contraception as a way of preventing fetal harm. Because men have the potential to
directly cause fetal harm, they should assume responsibility for their actions, and for the
potential consequences of their actions, by using contraception. In some ways, this
argument seems intuitive: if X causes harm to Y, then X should be responsible for
preventing harm to Y. While I do not want to suggest that causal responsibility always
leads to moral responsibility—a simple counterexample is killing in self-defense—in the
case of patemal-fetal harm causal responsibility should lead to moral responsibility. As
previously discussed, the media, the medical establishment, and even the legal system
typically hold women responsible for actions they believe to cause fetal harm, even when
there is little to no scientiﬁc evidence supporting such beliefs. Our reason for this usually
depends on the principle of nonmaleﬁcence; pregnant women have a duty not to harm
their fetuses. The same argument should apply to men; if men are engaging in behavior
that could lead to fetal harm, they should protect potential fetuses by contracepting.

Some may object that men’s and women’s circumstances between are not
analogous because the potential for patemal-fetal harm occurs pre-conception,29 whereas
maternal-fetal harm mostly occurs during pregnancy. The claim here is that it is easier for

women to prevent fetal harm. because once they know they are pregnant, they can cease

 

29 The manifestation of the harm (i.e. the disease or condition) may not be apparent until sometime during
the pregnancy or even after birth. However, the cause of the harm occurred during conception when an
abnormal or damaged sperm fused with an egg.

162

risky behaviors. The duty for men to prevent fetal harm is more onerous because by the
time they ﬁnd out a woman is pregnant, it is too late for them to prevent fetal harm.
Consequently, men have to be proactive in preventing harm, which is more demanding
than being reactive like women since it requires constant contraceptive use and/or
continual abstention ﬁom risky behaviors. This objection fails because women also have
to be concerned about pre-conception harms, as their behavior before pregnancy can
cause fetal harm. In fact, women’s responsibility to prevent harm seems more onerous
because they have to worry about harms that can occur before conception and during
pregnancy (as well as after birth if breastfeeding).

A stronger objection is that it is unfair to hold men responsible for fetal harm
because they probably do not have the knowledge that some of their behaviors can result
in fetal harm. As Daniels’s media analysis shows, there is a lot of information about the
ways in which women can harm fetuses, while information about men causing fetal harm
is scarce. Most accounts of causal responsibility afﬁrm that people should only be
morally responsible for the consequences of their actions that they can foresee, tlnose
consequences that reasonable people have reason to expect may occur (see, for example,
Gerald Dworkin). Yet, while some types of ignorance may absolve individuals from
moral responsibility, other types do not. As many philosophers writing on epistemologies
of ignorance argue, ignorance is often “actively produced for purposes of domination and
- exploitation” (Sullivan and Tuana; see their edited collection for some excellent articles
on race and epistemologies of ignorance). Especially in a world ﬁlled with oppression,

ignorance is typically not neutral or accidental. Marilyn Frye argues that ignorance “is

163

not a simple lack, absence or emptiness, and it is not a passive state. . . [it] is a complex
result of many acts and many negligences” (1983, 118).

Men’s ignorance surrounding paternal-fetal harm is also not a simple lack or an
accident, but rather is a series of actions and omissions that reinforce men’s domination.
Although there are patriarchal social forces at play that shape men’s beliefs and behavior,
men are also morally culpable for their complicity with oppressive power structures. That
many men are blinded by their privileged positioning is not a good reason to excuse them
of moral responsibility. Men who resist dominant gender ideologies may come to suspect
that women are not the only ones who can cause fetal harm; men can too. Even if men do
not challenge gender ideologies, if they critically reﬂect on well-known scientiﬁc
ﬁndings, such as that secondhand smoke is dangerous to others, they may conclude that
their actions can also be harmful to potential and actual fetuses.

Some may oppose holding men morally responsible for fetal harm because they
believe it is unreasonable to expect men to know about the possibility of paternal-fetal
harm given the dearth of media coverage about it. However, this objection carries less
weight as information about paternal-fetal harm becomes more commonplace. I found
eight mainstream newspaper articles on this topic (using Lexus-Nexus) published during
the two month period of February through April of 2008, whereas Daniels found only
seventeen articles during a ten year period of the mid-19805 to mid-19903.30 Additionally, .
of the articles I found, the main topic of most of these articles was paternal-fetal harm.
Interestingly, the majority of these articles were not published in the United States, but in

other English-speaking countries (the UK, Australia, and Canada). While I do not

 

30 The eight articles on paternal-fetal harm are by Goldberg, Jha, Laurance, MacRae, No author
(Chromosomal abnormalities), No author (Fathers who smoke ‘hit future generations’), Smith, Taylor.

164

 

endorse my research as following the rigors of social science, that I was so easily able to
ﬁnd so many (relatively speaking) articles on paternal-fetal harm does indeed seem to
indicate a signiﬁcant change from even just ten years ago. Perhaps I was able to ﬁnd so
many articles because my search was international and other countries are more likely to
publish stories on paternal-fetal harm. Even if this is the case (and it may well be as four
of the articles were published by British newspapers), given the intemet and our
globalized world, information is more quickly and easily disseminated, which means
important stories such as these will hopefully spread to the US.

While it is true that more media coverage would make it easier for men to know
that their behavior can cause fetal damage, individuals are commonly held morally
responsible for their actions despite their ignorance. In fact, women are generally held
morally responsible for fetal harm regardless of whether they know that their behavior
can lead to fetal harm. One reason commonly given to explain women’s moral
responsibility is that women ought to have known better and to have been able to
conclude, even without public knowledge, that certain actions could lead to fetal harm.
This same logic is often used in other situations. For instance, when Shu is confronted
about her habit of taking (or stealing) supplies ﬁom her company. she may claim that she
did not know her actions were wrong. Perhaps she though these supplies were for
company as well as private use. Shu’s boss, however, is likely to hold her morally (and
perhaps ﬁnancially and legally) responsible because the boss probably believes Shu
ought to have realized that her actions were wrong notwithstanding the fact that there is
no company policy that explicitly states this. In the case of fetal harm, the discrepancy in

moral responsibility (i.e. women are usually held morally responsible while men are

165

typically not) has little to do with the knowledge women and men have about their ability
to cause fetal harm. Rather, this discrepancy is a reﬂection of dominant ideologies and
power structures.

Although some may not be convinced that men should be held morally
responsible for fetal harm because men may be ignorant that their actions can cause such
harm, there are other types of harms men can cause to future beings (fetuses and children)
that they can, without question, foresee. I now turn to economic and social harms rather
than health-related bodily harms. Additionally, instead of focusing on harms to fetuses, I
take a more long-term view and examine harms to potential children that result from
men’s failures to contracept. For example, there are social harms to children by fathers
who are not interested or not involved in their lives as well as economic harms that befall
children of fathers who do not ﬁnancially contribute to their well-being.31 I do not want
to imply that children who do not know their fatlners or do not have relationships with
their fathers are necessarily socially damaged. Yet, social science research shows that
having an absent or uninvolved father increases the probability for a variety of social
problems, such as behavioral problems, academic failure, unhappiness, and mental health
problems (Amato; Boyce et al.).32 While some men who were not interested in having
children (or at least not at that time or with that particular woman) become geat fathers,

men who do not want children are probably more likely to be “bad,” or simply not

 

3] Following empirical evidence, my assumption here is that, in situations where the biological parents are
not living together, children will generally live with their mothers.

My concern in making this argument is that it will be misconstrued and used to buttress Claims that
children need to be raised in heterosexual, two parent households in order to avoid harm. I do not agee
with that claim. I think the reasons fathers (and mothers) can harm their children are complex and are
beyond the scope of this chapter. What I want to make clear is that just because absent or unirnvolved
fathers can harm their children, this does not mean that present and involved fathers do not cause harm or
provide an overall better environment for their children.

166

“good,” fathers than men who do want children. It is true that we cannot always foresee
how we will respond to a future situation. However, our interest in a certain realm
typically affects our success in that realm, as our interest motivates and comnnits us.
Following this reasoning, men who are interested in being fathers have the advantages of
motivation and commitment to parenting that will help them succeed as parents, whereas
men who are not interested in being fathers do not, at least irnitially, share these
advantages, which may make it more difficult for them to be “good” parents. In fact, their
lack of interest in being fathers may lead them to have little to no involvement in their
children’s lives.

Moreover, men who are not interested in being parents are probably less inclined
to ﬁnancially support their children. We generally prefer to spend our money on ﬁrings
and people we like, although this is often not possible because of ﬁnancial obligations
and basic needs (e. g. car payments, taxes, food, housing). Indeed, we are usually happy to
spend our money on people we care about, while we are reluctant to give money to others
we do not know, do not like (or even just feel neutral about), or do not think deserve our
generosity. If people prefer not to be parents—they do not like the role of parent and/or
they do not like their child(ren)——they may resist giving money to their child(ren). And
given the number of women who take their male partners to court to get child support, it
seems that many men do indeed resist ﬁnancially supporting their children (11,406
women were awarded child support in 2005 and ten times as many women as men sought
governmental assistance in securing child support (US. Census Bureau 2005a». Even
men who are willing to ﬁnancially support their children may be in no position to do so,

as raising children is quite an expensive undertaking. According to the US. Department

167

of Agiculture, the average cost of raising a child for eighteen years (not including
college) ranges from $143,790 to $289,380, depending on income (Lino 2007, ii). While
not all parents are economically prepared for the cost of raising a child, people who are
interested in and actively planning on becoming parents have probably reﬂected on their
economic situation and possibly started ﬁnancially preparing for a child. In contrast, for
people who are not interested in being parents, the cost of raising a child is likely not
sometlning that crosses their minds and consequently they have not ﬁnancially prepared
for a child. Fathers’ lack of ﬁnancial support can harm their children by placing them at
risk for poverty or in poverty, with all of its associated harms. Beyond economic
struggles, men’s lack of ﬁnancial support can harm children due to the increased
probability of a strained relationship between biological parents over money.

Because the dominant social norms for fatlners include the roles of breadwinner
and disciplinarian, men who do not ﬁll these roles, especially men who shirk them, are
often viewed as unmarnly (that is, weak and feminine). Furthermore, such men are
thought to be harming their children not only because they do not contribute socially
and/or economically, but also for a more subtle and sexist reason: men who do not uphold
their fatherly duties challenge both the norms of masculinity and the heteronormative,
patriarchal norms of what it means to be a family. Challenging these dominant norms is
often thought to be dangerous to children—it will teach children that it is acceptable, and
even desirable, to resist gender norms. These same concerns are raised against other types
of “nontraditional” families, such as single parent families, gay or lesbian families, and
even against heterosexual families in which the woman works outside the home. While I

am in favor of challenging gender norms within the family (as well as in general) and

168

believe that doing so is beneﬁcial to children, the dominant narrative is that families
should consist of a heterosexual couple who follow standard gender roles and that
families that deviant from this arrangement are hurtful to their children. This cultural
understanding persists even though there is empirical evidence to the contrary (see, for
example, Wainright et al.).

Although I do not think men’s lack of social and economic support is harmful to
children because it challenges gender norms, the other possible consequences of
uninvolved fathers I mention above (e. g. poverty, behavioral problems) are damaging to
children. Additionally, there is a cultural belief that men who are not socially or
economically involved in their children’s lives harm the children through this omission.
Negative terms like “absent father” and “deadbeat dad” are used by individuals,
politicians, and the media to refer to men who do not adequately fulﬁll their fatherly
duties. These terms reﬂect the social belief that fathers ouglnt to be involved in their
children’s lives. Our government, moreover, upholds the importance of father
involvement through laws and policies, such as child support. In 2005, our government
proclaimed the need for more than just ﬁnancial involvement ﬁom fathers by allocating
$150 million each year to promote healthy marriage and fatherhood tlnrough the Healthy
Marriage Irnitiative of the Deﬁcit Reduction Act. The goal of this legislation is “to
encourage healthy marriages and promote involved, committed, and responsible
fatherhood” (U .S. Department of Healtln and Human Services). Given the prevalence of
the expectation of involved fatherhood (at least ﬁnancially), it seems unlikely that men

could genuinely not be aware of the cultural belief that absent fathers harm their children.

169

Returning to the objection to my position that it is unfair to hold men responsible
for harm if they do not have the knowledge that their behaviors can result in such harm, I
have shown that men do know that certain actions—namely, their social and economic
absence—can harm their potential children. If men foresee that they would not be
involved fathers, thus potentially harming their potential children, then they have a duty
to contracept according to the principle of nonmaleﬁcence. Some may object that it is
misleading to compare bodily harms to social and economic harms because the former
occurs from a one time event before birth—the insemination of abnormal sperm—while
the latter takes place continuously over a child’s lifetime. First off, it is worth pointing
out that many of the bodily harms that occur during conception affect children throughout
their lives (e. g. various birth defects) and not just during the fetal stage. Just as bodily
harm can begin at conception, so too can social and economic harms. For example,
pregnant women who do not receive emotional or ﬁnancial support ﬁ'om their partners
have a geater chance of facing situations that can adversely affect the fetus, such as
stress and lack of prenatal care. Hence, bodily and social/economic harms are similar in
that they can endure throughout a child’s life. However, proponents of this objection are
right to point out that the majority of paternal-fetal bodily harm results from a single
occurrence while social and economic harms are due to a series of individual actions.
Yet, this difference does not diminish my argument. If anything, the recurrence of social
and economic harms strengthens my claim, as, assuming a similar degee of harm,
recurring harrrns seem more pernicious than one-time harms. In sum, since men know that
harms often befall children who have absent fathers, men who think they will not be

socially and economically involved in their children’s lives have a duty to contracept.

170

It is important to note that I am not making any suggestions about what men’s
roles should be in their children’s lives after birth, or even after conception for that
matter. My argmnent is merely that men have a duty to prevent harm to potential children
by using contraception if their actions could cause harm. Beyond this, I do not make any
normative claims about how the public and the government should respond to such men.
I do not, for example, seek to answer the questions of whether such men should be held
responsible for fetal harms if they use contraception that failed or whether the
government should mandate child support ﬁ'om unwilling fatlners. Careﬁrl responses to
such questions merit their own papers.’3 Instead, my focus is on men’s responsibility to
prevent harm to their potential children. Men whose behavior, including their future
behavior, could be harmful to their potential fetuses and children have a moral duty to
prevent such harm by contracepting.

Some may object to my argument and claim that the expectation that men
contracept is too demanding and perhaps even unfair. In comparing the harms men face
in contracepting with the harms to potential fetuses and children, they may assert that the
latter do not outweigh the former, so we cannot justify a moral duty to contracept. These
opponents may even turn to the argument I made in chapter 2 that contraceptive
responsibility is burdensome and oppressive for women in order to make a similar claim
for men. While there may be an apparent tension between my argument in chapter 2 and
my argurrnent in this chapter, I think this tension is minor. Our current contraceptive
arrangement is unfair for women because they are oppressively socialized to assume full

contraceptive responsibility, which limits their autonomy. Men are not expected to

 

33 For interesting responses to these questions, see Elizabetln Brake and Sally Sheldon (2003).

171

 

assume full contraceptive responsibility, nor are they oppressively socialized to make
certain contraceptive choices tlnat impair their reproductive and overall autonomy. What
women and men who contracept share are some of the burdens associated with
contracepting, like cost, negative side effects, etc. Yet, as I demonstrated in chapter 2, the
burdens women face in contracepting are much more signiﬁcant than those that men face.
The costs, side effects, extent of medical involvement, and degee of bodily invasion are
minimal for vasectomy, especially compared to female contraceptives, and even more

nominal for condoms. Vasectomy is approximately a third of the price of tubal ligation

.- ___.._ ._ _ .4." A- I'
{1 7. . 3:. . In !._ﬁ,_
4 ’ ' .

and is much cheaper than female LARCS over a lifetime of use. Furthermore, the side
effects of vasectomy are less in number and severity than for tubal ligation and females
LARCS. Male condoms are one of the cheapest types of contraception, require no
medical involvement or bodily invasion, and have only one health-related side effect:
allergy.

Even though the burdens men experience in contracepting are fewer and less
serious than those women experience, this fact alone is not a compelling enough reason
for why men should contracept to prevent harm to potential fetuses and children.
However, in comparing the burdens men experience in contracepting with the possible
harm to potential beings if men do not contracept, claiming that men should contracept
does not seem unreasonable. Not contracepting can cause health, social, and economic
harms for resulting fetuses and clnildren that are signiﬁcantly geater than the burdens of
contracepting. For instance, the birth defects and low birth weight that are caused by
paternal smoking seem to be geater problems than spending $30 a year on condoms and

dealing with the possibility that condoms may decrease sexual spontaneity and

172

sensitivity. I do not want to completely minimize the demands of contraceptive
responsibility, as its associated burdens can take a toll on men. My point is that tlnese
burdens are minimal in comparison to the harms men can cause to potential children and
fetuses if they do not contracept. Hence, according to the principle of nonmaleﬁcence, the
moral responsibility to contracept is fair because the harms experienced by men are much
less than the harms their potential fetuses and children can experience. Like the example
of individuals with tuberculosis that I described earlier in the chapter, the burdens and
limitations men face in contracepting are justiﬁable because they are limited—in number,
severity, and duration—and they prevent causing signiﬁcant harm to others.

Furthermore, using contraception is not just about preventing harm to others; it is
also about preventing harm to oneself, something that is outside of the principle of
nonmaleﬁcence. Using male condoms protects men (and women) against STDs.
Contracepting also prevents unintended pregnancy. In the next chapter, I will discuss in
detail the harms of unintended pregnancy for women. Here I will brieﬂy mention some of
the harms to men. While unintended pregnancy does not directly cause health-related
harms in men since they do not experience the bodily changes of pregnancy, men can
have indirect health harms due to pregnancy, like stress and insufﬁcient sleep.
Additionally, unintended pregnancy can entail economic and social harms for men. As
previously stated, raising a child is quite expensive. Channeling their money to this end
can adversely affect men’s quality of life and even deplete their ﬁnancial resources. If the
biological parents are not living together, determining the father’s ﬁnancial contribution
can be a legal, economic, and social nightmare. The role of father can also negatively

affect men’s relationships with others and in particular the mother of the child and his

173

own family. For instance, he may be pressured to stay witln or live with the mother or
there may be family tension if his parents want to be involved with their gandchild’s life
but he does not want such an active role as fatlner. In sum, using contraception is a way
for men to prevent harm to themselves.

Recognizing that men contracept not only to avoid harming potential fetuses but
also for themselves minimizes the degee of sacriﬁce men are thought to be making for
the sake of potential fetuses and children. Though many men contracept in order to
prevent harm to potential beings, the desire (or even moral duty) to protect themselves
also typically factors into why men contracept. Having two reasons rather than one to
contracept means more support for one’s decision. Yet, if one of the reasons men
contracept is to protect themselves, then we cannot afﬁrm that men are acting in a self-
sacriﬁcing way. I made a similar argument in chapter 3 when I claimed that men do not
work in the public realm merely for the sake of their families; they also do so because
they enjoy the associated rewards of prestige, power, and success. Men therefore cannot
be said to be acting in a self—sacriﬁcing way with regard to their employment because
self-sacriﬁce necessitates placing the needs of other(s) ﬁrst even though it involves some
sort of burden or sacriﬁce for oneself. Likewise, men who contracept in part to protect
themselves against STDs and/or unintended pregnancy are not being self-sacriﬁcing. The
reason this is worth noting is that when we are motivated by self-interest, even if it is
only partially, then it is more difﬁcult to assert that we are making undue sacriﬁces for
others. We cannot parse out the burdens we accept only to prevent harm to others from
the burdens we take Onto prevent self-harm. Hence, determining if burdens are unfair

according to the principle of nonmaleﬁcence is more challenging since there are two

174

intertwined reasons for making such burdens: preventing harm to others and preventing
harm to ourselves. That men contracept for themselves as well as others means that the
degee of burden they take on for others is not so geat. This point, coupled with my
previous claim that the burdens men take on in contracepting are justiﬁed in comparison
to the possible burdens to potential beings, leads me to conclude that men contracepting

is not an unjust situation given the harms they prevent to both themselves and others.

Men Who Are Actively Trying to Father a Child

Men who are autonomously and intentionally trying to fatlner34 a child have a
responsibility to prevent harm to their future child. This argument relates to the one Arras
and Blustein make that people who reproduce knowing that their potential children will
fall below a particular threshold of acceptable well-being are reproducing irresponsibly
(see chapter 3). The key idea here is that it is irresponsible and perhaps even unjust for
parents to have children who they know will be harmed. Arras and Blustein provide
various understandings of what counts as irresponsible reproduction and one is any
parental action that could “lower a child’s potential.” Implicit in this understanding is that
fetuses and children have the negative right not to be harmed. In order to act according to
the principle of nonmaleﬁcence and this understanding of responsible reproduction, men
interested in having a child must refrain ﬁom behavior that could harm fetuses and future
children. For men who want to father a child, this does not seem like a controversial
claim. Another understanding of responsible reproduction that Arras and Blustein present

is that parents should “optimize their child’s potential for a good life”——an understanding

 

34 It is interesting to note the difference between the verb “to father” and “to mother.” The former, and its
synonym “to sire” both have to do with impregnating a woman—they are limited to the onetime event of
fertilization. In contrast, the latter refers to a lifelong process of caregiving and nurturing.

175

that is in line with the principle of beneﬁcence. Even this more demanding
understanding, which gants fetuses the positive right to welfare promotion, does not
seem controversial for men who want a child. Contributing to the social acceptance of
both principles is the assumption that parents want to do what is best for their children, as
well as the expectation that parents should be self-sacriﬁcing.

Men who do not think they can abide by these principles have a moral duty to
contracept. In other words, if men know that their actions have the potential to harm their
fetuses and/or their future children, they ought to contracept even if they want to become
fathers. I do not want my argument here to be misconstrued as stating that only certain
people are worthy of and tlnus should be allowed to reproduce. I reject reproductive
paternalism: permitting the government, the medical establishment, or anyone else to
make reproductive decisions for others or punish people for “bad” reproductive choices
and outcomes. Yet, disageeing with reproductive paternalism does not rule out the moral
claim that people should not become parents if tlney know that their behavior has the
potential to harm their fetuses and future children. For example, should a man who is a
smoker have a duty to contracept to prevent the possibility of low birth weight and birth
defects in his future children? Should a man who works an hourly job for minimum wage
who is constantly in jeopardy of losing his job due to downsizing have a duty to
contracept to protect his potential children ﬁ'om economic uncertainty and possible.
poverty? Should a man who travels for work and is only home on weekends have a duty
to contracept because his potential children might feel socially abandoned?

In response to tlnese questions, let me ﬁrst state that I recognize that various

factors, including ones beyond people’s control like poverty and arguably drug addiction,

176

affect people’s ability to adhere to the principles of nonmaleﬁcence and beneﬁcence.
Because of the social circmnstances that many disadvantaged people face, they may not
be able to uphold the principles of nonmaleﬁcence and beneﬁcence in the sarrne way or to
the same degee that privileged people can. For instance, people who are poor are more
likely to struggle to provide clothes, shelter, food, material goods, and so on for their
children than people who are wealthy. It is important to acknowledge that being a good
parent involves more than a focus on harm. Even though the men in the examples above
have the potential to cause harm to their fetuses and children, they could otherwise be
excellent fathers. Sara Ruddick posits three facets of good mothering: preservation
(meeting children’s basic needs), nurturance (meeting children’s emotional and
psychological needs), and inclusion (preparing them to be part of their social world). If
men are able to mostly or fully meet these three criteria, then they are probably good
fathers (assuming we think that the qualities used to deﬁne a good mother are the same as
those to deﬁne a good father).

But even if we conclude that the men in the three examples above would
otherwise be good fathers according to Ruddick’s deﬁnition, should they still have a duty
to contracept because of their increased probability to harm their fetuses and future .
children? I am hesitant to make a universal claim that in situation X all men should
contracept because such an assertion fails acknowledge people’s different social
positioning. Indeed, my worry with having a blanket interpretation of what it means to
adhere to the principles of nonmaleﬁcence and beneﬁcence is that this interpretation will

reﬂect the values of the dominant goup. Groups who do not meet the white, middleclass,

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able-bodied, heterosexual norm would likely be prohibited or discouraged from
reproducing (through laws, denial of rights, stigna, normalization, etc.).

Instead of enumerating all the situations in which people should contracept even if
they want to have children, a better way to prevent harm to fetuses and children is to
educate the public about potential risks. Equipped with this knowledge, people can make
autonomous and informed decisions about reproduction that respects their cultural
beliefs. This suggestion does not absolve people of reproductive responsibility. People
who want to have children still have a moral duty to follow the principles of
nonmaleﬁcence and beneﬁcence. However, they are the ones who determine what it
means to uphold these principles and whether they are capable of doing so given their
individual circumstances. If people do not think they can adequately maintain these
principles, then they have a moral duty to contracept even if they want to have children.
Some may be concerned that allowing people to make subjective decisions about what
counts as following these principles will increase the probability of “bad” choices. While
there is no doubt that letting people autonomously make decisions can result in “bad”
choices, I think permitting people the autonomy to make reproductive decisions on their
own is a better alternative than a top-down method that coerces or mandates the forms of
acceptable reproductive behavior. My suggestion does not prohibit the government,
medical establishment, or organizations from educating people about how their behavior
can harm their fetuses and children and aiding people in making responsible reproductive
decisions. In fact, I encourage such involvement, as it would be a real boon to individuals

and society overall while avoiding reproductive paternalism.

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In addition to the concern that people will make “bad” reproductive choices, there
is also a worry that my position leads people to hold individuals responsible for every
small action they take that has the potential to cause fetal harm. Although my position
does not inherently entail such extreme measures, it is true that my position allows people
the freedom to endorse such measures (e. g. the social norm that women should monitor
every little thing they do to ensure that they are doing what is best for their fetuses and
children). While some may suggest that this is a problem with my position because I
support people making their own reproductive decisions, including what counts as harm
and how to act to prevent it, I contend that this as a problem with our dominant cultural
values. That is, allowing people reproductive autonomy is not the cause of extreme
decisions; the social ideologies that lead to such decisions are. In chapter 3, I argued that
the decisions we make reﬂect the ideologies we (consciously and nonconsciously)
uphold. Although reducing people’s reproductive autonomy would probably generate a
particular desired outcome (i.e. the reproductive decisions that the government and/or
other organizations endorse) and might lead to a shift in donninant ideologies, this
approach is coercive and unjust. Furthermore, it may not be as successful as bottom-up
strategies in transforming dominant ideologies (I return to why I tlnink bottom-up change
is more effective than top-down change in chapter 7).

In sum, men (and women) have a moral duty to contracept if they believe their
actions have the potential to harm their future fetuses and children. What degee of
possibility for harm is enough for people to contracept? For example, is a ten percent
chance of birth defects signiﬁcant enough] for people to have a moral duty to contracept?

I believe this decision is best left up to individuals. However, as stated above, I think

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other agents—the government, medical establishment, and organizations—should
educate people about these risks so that people can make informed decisions that reﬂect

their personal values.

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Chapter 6. Social Privilege and Unintended Pregnancy: Men’s Moral Duty to

Contracept

Over half of all pregnancies in the United States are unintended at the time of
conception, which means that annually three million women face an unplanned
pregnancy.” According to Sheldon Segal, a population scientist, half of these urnintended
pregnancies—1.5 million—occur when contraception is not being used (136). Given that
5 million women who are fertile and sexually active do not contracept and that there is an
85 percent chance of becoming pregnant if no contraception is used, one would expect an
annual number that is closer to 4.25 nnillion for unintended pregnancies that result
because contraception is not used (The Alan Guttrnacher Institute 2008b; Hatcher 2004,
foreword). Perhaps the reason for the difference in these two estimates is that not all
women are sexually active on a regular basis; they may have cycles of high sexual
activity and tlnen cycles of no sexual activity. The failure rates for contraception (i.e. the
likelihood that one would get pregnant) are based on a one year period of sexual activity.
Underreporting and difficulty gathering accurate data may also factor into a difference in
estimates. Regardless of the exact number, failure to contracept leads to millions of
unintended pregnancies each year.

But failure to contracept only accounts for half of all unintended pregnancies. The
other half occurs when people are using contraception. There are various factors that
contribute to unintended pregnancy while using contraception including incorrectly

and/or inconsistently using contraception, high failure rates for typical use of non-

 

” This number most likely does not include women have a planned, but unwanted pregnancy. That is,
women whose male partrners pressure, coerce, or force them to become pregnant. These pregnancies are
intended, but only by the male partrners, not by the women.

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LARCS, and high discontinuation rates of all types of contraceptives (Table 2; Nass and
Strauss 125-6). That so many—1.5 million annually—unplanned pregnancies occur while
people are contracepting is worrisome (Segal 2003, 136). One way to reduce these
urnintended pregnancies is to provide better contraceptive education. Another is to
encourage people to use LARCS, since they are the most effective type of contraception. I
discuss both of these strategies in chapter 7.

Another strategy, which is the focus of this chapter, is men contracepting. If men
contracepted, the rates of unplanned pregnancies for people who do not contracept would
go down since one partrner would now be contracepting. The rates of unplanned
pregnancies for people who do contracept would also shrink if the couple was only
relying on a female contraceptive, as using two forms of contraceptives is more effective
than just one. I will recommend ways to encourage men to contracept in chapter 7. Here,
I argue that, according to the principle of nonmaleﬁcence, men have a moral duty to
contracept if their actions (past, present, or future) could harm others. Instead of looking
at potential beings—future fetuses or ﬁrture children—as I did in the previous chapter, I
focus on the harms inﬂicted on people who already exist, women. As in the last chapter, I
am limiting the types of harms I examine to health-related, social, and economic harms.
The main harm I am concerned with is unintended pregnancy, for it leads to these other
types of harms. Furthermore, I am interested in unplanned pregnancy because men play a
causal role in its existence, like they do for various harms to fetuses and children.

To be clear, I am only discussing unintended pregnancies in this chapter. The

moral duty to contracept is not at play in intended pregnancies since they are presumably

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wanted and planned for by both partners."6 I am assuming that the majority of urnintended
pregnancies are not actively or consciously desired by the people involved, at least at the
time of conception. Of course, some women (e. g. women who were told they would
never become pregnant, but they always wanted biological children) are tlnrilled to
discover that they are accidentally pregnant. However, these women are in the minority.
Most women are unhappy to ﬁnd out that they are pregnant since they did not want to
have a child (at least at that time), which is the reason why they were not planning on
becoming pregnant. That 40 percent of unintended pregnancies end in abortion is
evidence that many of these pregnancies are not wanted (The Alan Guttrnacher Institute
2008a).37

While my distinction between intended (that is, wanted) and unintended (that is,
unwanted) pregnancies may be slightly simplistic and hence not accurate for all cases,
making such a distinction is very important for my argument in this chapter. I argue that
unintended pregnancies in and of themselves constitute a harm to women because of the
potential health, social, and economic harms they entail. While planned pregnancies also
typically involve similar harms, that women autonomously choose to become pregnant is
signiﬁcant. Women who are unintentionally pregnant did not autonomously choose to
become pregnant, making these harms a forced imposition rather than a foreseeable
possibility of an actively chosen decision. Philosophers and laypeople often categorize
things that are forced upon us as harms, such as rape and slavery, because they take away
our self-determination. Unintended pregnancy also ﬁts in this camp since it too

diminishes one’s agency.

 

36 However, there are other moral duties for people trying to conceive, as discussed in the previous chapter.

37 . . . . . .
We can probably assume that more umntended pregnancres would end rn abortion 1f access to abortion
services was more convenient, inexpensive, and less stigmatized.

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My language in the previous paragaph implies that someone or something is
forcing unplarmed pregnancies onto women. Who then is this agent? In some cases, there
is no identiﬁable agent to pinpoint. Even perfect compliance with contraception can
result in a pregnancy. In such a case, it is just a matter of bad luck. In other cases,
however, an agent can be identiﬁed. Some may suggest that women “force” urnintended
pregnancies on themselves by making poor contraceptive decisions (e. g. failing to
contracept, inconsistently contracepting, using a less effective contraceptive, etc.). While
women are and should be held responsible for contraception, their ability to control
contraception is sometimes limited in heterosexual relationships within a patriarchal
society. In these situations, those who are restricting women’s autonomy—namely men
and the govemment—are the agents who are forcing unintended pregnancy upon women.
Here I will focus only on men’s role in urnintended pregnancy; I will return to
govemment’s role in chapter 7.

This chapter is divided into ﬁve sections. In the ﬁrst section, I outline the harms
associated with pregnancy, motherhood, and abortion in order to demonstrate that the
harms to women that result ﬁ'om unintended pregnancy are real and serious. Referring to
a recent Michigan court case that deﬁned pregnancy as a form of “bodily harm,” I discuss
the impact pregnancy has on women’s health. If women choose to carry their pregnancies
to term, then they face numerous potential harms as mothers. There are also harms for
women who decide to terminate their pregnancies. I argue iii the second section that men
have a moral duty to prevent the harms of unintended pregnancy because they are (at
least partially) causally responsible and because they are aware of the potential harms of

unintended pregnancy. Furthermore, I claim that the harms men may face in

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contracepting—using current methods or future hormonal methods—are not
unreasonable or unfair. In the third section, I draw ﬁom the work of Catharine
MacKinnon and Andrea Dworkin to show how in a patriarchal society, men not only
control sex, but they also use sex to objectify and subordinate women. I continue this
argument in the fourth section, asserting that this power difference impedes women’s
ability to contracept. I contend that men have a moral duty to contracept both because
their failure to contracept can harm women and because their privileged social
positioning enables tlnem to more easily contracept (that is, they face fewer obstacles in
trying to use contraception). In the ﬁfth section, I examine the speciﬁc case of whether
men in monogamous (heterosexual) relationships also have a duty to contracept even if
their partrner already uses contraception. I identify two reasons why it is problematic for
couples to make contraceptive responsibility just the woman’s job: it reinforces a

gendered division of labor and it demands another type of bodily invasion from women.

Harms Associated with Pregnancy, Motherhood, and Abortion
Harms Associated with Pregnancy
One the one hand, it is undeniable that pregnancy and motherhood are wonderful

experiences for many women. On the other hand, however, even planned pregnancies
have the potential to cause various types of harm, including bodily, mental, social,
economic, interpersonal, and moral. In the global Soutln, the leading cause of death for
women in their prime is complications from pregnancy. Although only one percent of
deaths from pregnancy occur in the glObal North, mainly due to better access to basic

services (e. g. nutrition, health care), pregnancy can still result in bodily harm and medical

185

conditions (Mann 769). Following precedent from a previous judicial decision, the recent
Michigan court case of People v. Cathey concluded that pregnancy is a form of bodily
injury. Deﬁning bodily injury as “physical damage to a person’s body,” the court stated
that

by necessity, a woman’s body suffers “physical damage” when carrying a

child through delivery as the body experiences substantial changes to

accommodate the gowing child and ultimately to deliver the

child. ...'lhese types of physical marnifestations to a women’s body during

pregnancy and delivery clearly fall within the deﬁnition of “bodily

injury,” for the manifestations can and do cause damage to the body.

(People v. Cathey)

Indeed, pregnancy can entail various nontrivial, though not life threatening, discomforts,
such as weight gain, back pain, edema, and morning sickness. Furthermore, pregnancy
can lead to life threatening conditions, such as gestational diabetes and hypertension. In
addition to being painful, giving birth can also cause harms, like hemorrhaging, internal
tearing, placental abruption, and nerve damage to the pelvic structures. In addition to
physical harms, pregnancy and childbirth also have the potential to lead to mental health
problems. Since being pregnant changes women’s hormone levels, it can affect women’s
emotional well being and their overall psychological balance.

Claiming that pregnancy is inherently physically (and perhaps mentally)
damaging is controversial. It is this sort of thinking that is often behind the treatment of
pregnancy as a disease or disability. While pregnancy shares some similarities with
disease and disability (see Mullin 2005a, ch. 2), my intention is not to classify it as either

a disease or disability. Nor is my goal to support the conclusion reached in People v.

Cathey that pregnancy is necessarily a bodily harm.

186

Rather, I merely want to point out the strong likelihood that pregnancy will lead
to something we typically consider to be bodily harm. In our pronatalist culture, the
dominant cultural view of pregnancy is that it is a positive event, and so the media,
literature on pregnancy and motherhood, and even some health care professionals rarely
classify the marnifestations of pregnancy as harm. Furthermore, pregnant women rarely
describe themselves as being harmed by their pregnancies (pregnancies that result ﬁom
rape are a notable exception). However, most people would apply such a label if
nonpregnant people experienced identical symptoms, so there is a double standard here:
when pregnant women experience certain symptoms it is thought to be normal and
therefore not harmful, yet when nonpregnant people have the same symptoms most
people recognize them as harms and treat them accordingly. The reason often given to
explain this discrepancy is the following: since women know that potentially harmful
symptoms often accompany pregnancy and they still choose to get pregnant (or, at least,
stay pregnant), their symptoms are not considered harms because they were
autonomously chosen. Yet, even though women may choose to become pregnant this
does not mean that they choose to have negative health effects, nor does it mean that they
like or deserve these health effects.38 Just as women use contraception despite its adverse
side effects because it enables tlnem to achieve their goal—not getting pregnant—so too
may women choose to become pregnant even though there is the possibility of negative
health outcomes because it is a way to attain their end of having a baby. Furthermore,

since 50 percent of all pregnancies are unintended, many women are not autonomously

 

38 According to some Christian scholars, all women deserve the negative side effects of pregnancy and
labor because of Eve’s original sin. For example Cardinal Robert Bellarrnine states: “Wherefore the
punishment of the sin is that women bear the fetus in the womb with disgust and labor, that they give birth
with pain.”

187

choosing to become pregnant. While some may want to label these women irresponsible
and hence deserving of the side effects of pregnancy, I ﬁnd this claim overly punitive.
Moreover, this line of thought only conﬁrms my claim that there are some serious harms
associated with pregnancy.

Although all pregnancies have the potential to lead to serious physical and mental
harms, it seems likely that unplanned pregnancies could be more risky than planned
pregnancies. Women who are attempting to get pregnant are probably carefully
monitoring their bodies for any sign of pregnancy. In contrast, because they are not
actively trying to become pregnant, some women may not realize they are pregnant until
they are ﬁnrther along in the pregnancy (or in some rare cases, until they give birtln) in
part because it is not something they expect to happen. Moreover, a small number of
women who were not intending to become pregnant deny their pregnancies altogether
(see Lundquist). The risk to women who are unintentionally pregnant is that in delaying
or forgoing medical treatment, potential medical problems may go unrecognized and
untreated. Women who were not planning on becoming pregnant may not feel
emotionally equipped to handle the physical and mental manifestations of pregnancy as
well as the idea of becoming a mother. It is not surprising then that such women are more
likely to become depressed during pregnancy than women who are intentionally pregnant
(N ass and Strauss 1). Women who are unintentionally pregnant are also at geater risk for
other harms, including domestic abuse, as their male partrners may be unhappy to ﬁnd out

that they are pregnant (ibid.)

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Harms Associated with Motherhood

The result of carrying a pregnancy to term—becoming a mother—can also lead to
health problems, such as exhaustion, depression, and sore nipples from breastfeeding.
Further, if we employ the World Health Organization’s deﬁnition of health—“a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity”—then being a mother can adversely affect women’s mental and social well-
being (WHO Constitution, Preamble). Women comprise the vast majority of primary
caretakers for children, a demanding and undervalued role that not only can lead to stress,
but also can be socially isolating. Full time homemakers spend most of their time at home
or in other gendered spaces where children are welcome, such as malls and playgounds.
Caring for children limits women’s mobility, thereby minimizing and even precluding
their involvement in the public realm, such as town meetings, academic lectures, social
events, and public employment.

In addition to the health and social harms women can experience as a result of
motherhood, there are also economic harms. These harms are often exacerbated for
women who were not planning to have a child and thus have not made any economic
preparations for such an event. Having a child in lnigln school or college often makes it
more difﬁcult for women to complete their education, thereby dinninishing better paying
job opporturnities. For working women, balancing. employment and childcare is generally
both economically stressful and emotionally exhausting. Many working women do not
have family or ﬁiends to watch their children, so they turn to daycare, which is
expensive: the average cost for an infant is $3,803 to $13,480 a year in the US. For a

two-parent household, the cost of daycare is 10% of their household income. For single

189

parents, it is a staggering 30% of their income (Gruber). Furthermore, many US. women
cannot take the time off they would like to after giving birth because they cannot afford
to take unpaid leave. The U.S., Liberia, Papua New Guinea, and Swaziland, are the only
countries in the world that do not mandate paid leave to new mothers (Stringer 4-5).
Furthermore, the US. does not require employers to offer ﬂexible time to its employees,
exacerbating women’s struggle to balance work and children. Sadly, “The United States
is alone among developed countries, and virtually alone in the world, in its failure to
support working parents and their families tlnrough ﬂexible time and leave policies”
(Stringer 1). This lack of governmental support deleteriously affects women’s emotional,
physical, and economic well-being, and this is especially the case for women who are
poor and/or single. Indeed, the sheer cost of raising a child is overwhelming for many
people and is even worse for women working pink collar jobs and women who do not
receive ﬁnancial assistance from their children’s fathers. That the government does not
assist all women and that those it does help are given minimal aid (e. g. Medicaid and
welfare) leaves the majority of women vulnerable to the harms of working full time and

mothering ﬁrll time.

Harms Associated with Abortion
In addition to the harms associated with pregnancy and mothering, that there can
also be harms for women who decide to end their pregnancies. Choosing to have an
abortion is a difﬁcult decision for some women, one that often elicits feelings like guilt
and shame. Plus, there is a stigna attached to having an abortion; it is generally not

something one openly shares witln others, even if one needs to talk about it. In addition to

190

the social and emotional effects, abortions can range ﬁ'om physically uncomfortable to
deadly depending on who performs the procedure. Since abortions are illegal in various
countries, women have to risk legal repercussions to have the procedure. Even in
countries where abortion is legal, it is often difﬁcult for (adult) women to get an abortion
due to cost, distance from abortion providers, gestation linnits, and harassment from anti-
abortion protesters (see Finer and Henshaw for more details). Women under the age of 18
face even more obstacles, including parental notiﬁcation laws. A third of insurance
companies do not cover abortion, so women are forced to pay out of pocket for a
procedure that averages $341 to $1,067 (in 1995 dollars), depending on weeks of
gestation. Even when abortion is covered, some women decline to use their insurance
company because of conﬁdentiality concerns, especially if their insurance is through
someone else, particularly their parents or partrner (Finer and Henshaw 57). In short, there
are many challenges and potential harms women must deal with when they decide to
have an abortion. These harms are not inherent to abortion. Rather, many of them are
culturally created and mediated. In a society that accepts abortion, women would not
have to overcome many of the aforementioned obstacles and thus abortion would be

much less likely to cause harm.

Men’s Moral Duty to Prevent Unintended Pregnancy
The harms associated with abortion, pregnancy, and motherhood are well known.
Because men causally contribute to pregnancy and they know that sex can lead to
pregnancy and all its potential harms, they are morally responsible for such harms if they

do not try to prevent them. There are only two ways for men to prevent the harms

191

 

 

associated with pregnancy: abstain or contracept. Thus, men who are sexually active have
a duty to contracept according to the principle of nonmaleﬁcence.

Given the myriad and sometimes extreme nature of the possible harms ﬁ'om
pregnancy and motherhood, claiming that men should contracept does not seem
unreasonable. That is, what is required of men to prevent pregnancy does not seem
disproportionate to potential harms caused by pregnancy. As argued in the previous
chapter, in order for the principle of nonmaleﬁcence to be justly applied, the harms we
incur in preventing harm must be less signiﬁcant than the harms we could cause to others
if we did not try to prevent harm. Men’s moral duty to contracept to avoid unintended
pregnancy is fair: the harms women may face from unintended pregnancy are much more
serious than the harms men may experience from contracepting. Currently, the only
reversible contraception men can use is the condom and the drawbacks to using a condom
are minimal: small cost, minimized pleasure (for some men), and interrupting sex to put it
on.

As a way of strengthening my claim that men have a moral duty to prevent harm,
let us examine an analogous situation. Imagine that Sanjay has Chlamydia, a reversible
and easily treatable STD. I contend that most people would claim that when Sanjay has
sex with his partner, Olga, who does not have Chlamydia, he has a duty to wear a
condom to prevent Olga ﬁ'om acquiring the disease. The reason for this is that Sanjay
should avoid knowingly harming others (and perhaps in particular people with whom he
has a close relationship). He knows that having unprotected sex would probably result in
infecting Olga with Chlamydia. While Chlamydia is medically treatable, it can be a

painﬁrl disease and one that can lead to serious consequences, including pelvic

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inﬂammatory disease and sterility. Moreover, many women who have Chlamydia are
asymptomatic and by the time they ﬁnd out they have the disease, permanent damage has
been done. Even if one discovers that one has Chlamydia immediately and avoids any
permanent damage, tlnere are other harms involved with contracting this disease, such as
the cost of seeing a doctor and paying for the medication (especially if one is uninsured),
the emotional stress of having this disease, and the effect on one’s interpersonal
relationships (especially with the partner from whom the disease was acquired). Given
the potential harms Chlamydia poses, Sanjay should wear a condom to prevent Olga from
experiencing these harms. Requesting that he wear a condom seems like a minor sacriﬁce
in comparison to the magnitude of possible harms. If Sanjay did not wear a condom and
Olga contracted Chlamydia, most people would hold him morally responsible because he
knowingly inﬂicted a harm upon her that he could have easily prevented. And, in fact,
some governments might even hold him legally accountable, though most cases involving
legal repercussions for STD transmission center on HIV. For example, in 2006 “the
Califorrnia state Supreme Court ruled that ‘constructive knowledge’—when it is
reasonably foreseen by a reasonably intelligent person that their actions could lead to
harm—of the possibility that HIV transmission may occur, is enough to allow for civil
liability.” Taking it one step ﬁrrther, the highest court in Switzerland proclaimed in July
2008 that all people with HIV can be criminally liable for spreading the disease, even if
they are unaware that they have it (Bernard).

While many may agee that condom use is a fair burden for men to take on in
order to prevent unintended pregnancy, some may question whether vasectomy and

ﬁrture hormonal methods are also fair burdens. The concern here is that hormonal

193

methods typically involve more bodily invasion and entail worse side effects. First off, it
is important to note that even though vasectomy and future hormonal methods may be
more effective than condoms, men do not have to choose one of the latter metlnods to act
according to the principle of nonmaleﬁcence. What matters is that they choose a method
that they believe is the best choice to prevent pregnancy given their values and the
circumstances. Clearly, we might be suspicious of an educated man in the US. who
decides that his contraceptive metlnod will be to eat ice cream daily.39 Most people would
regard him as not taking his contraceptive responsibility seriously. But if a man prefers
using condoms—a method that has been empirically shown to signiﬁcantly reduce the
probability of unintended pregnancy—to other male methods, then he is upholding his
moral duty to contracept even though he is not using the most effective form of male
contraception.

Even though male hormonal methods are years away from hitting the market, I
want to examine whether the burdens they entail are justiﬁable according to the principle
of nonmaleﬁcence. However, this is somewhat difﬁcult to do since there is limited
information about what the burdens of these male contraceptives are. Some reports say
there are few or no serious side effects, while others warn of prohibitive side effects. On
the one hand, scientists have developed a male inj ectable contraceptive that has no short-
terrn side effects and a type of male contraceptive pill that does not show any long-lasting
side effects (Scott 1; No autlnor April 29, 2006). On the other hand, some scientists are

concerned about the side effects of testosteroncL-a commonly used component in male

 

39 Different cultures may have different beliefs about what is the best way to contracept. While I know of
no culture that claims that ice cream works as a contraceptive, I want to allow for various cultural
perspectives. The social context I am focusing on is the U.S., where ice cream is not considered an
eﬂective form of contraception, but condoms generally are.

194

contraceptives—that can include decreased levels of HDL (“good”) cholesterol, the
potential to contribute to prostate cancer, and effects similar to steroids such as lean
muscle weight gain, acne, and temporary shrinking of the testes (Nuzzo F3).
Additionally, another potential contraceptive worries some: a male contraceptive that is
being researched after scientists realized that some drugs that treat schizophrenia and
high blood pressure also prevent ejaculation. Journalist Fiona Macrae states that “side-
effects including dizziness and drowsiness mean these medicines could not be marketed
as contraceptives.”40 Although the lack of an ejaculation does not affect the quality of
orgasm, urologist Harry Fisch, claims this side effect will prevent many men from
considering this contraceptive: “I don’t think a lot of men are going to take this . . . The
ejaculate coming forward is a signiﬁcant part of a man’s sexuality” (Macrae; Fisch
quoted in Trai ster). Even with this limited information about male LARCS, it is clear that
the side effects are more signiﬁcanttlnan with condoms. This is not surprising since
hormonal methods for women tend to have more dangerous side effects. Most of the male
LARCS under research are hormonal methods; one notable exception is the Intra Vas
Device (IVD), “four ﬂexible cylinder-shaped, medical-gade silicone pieces designed to
block sperm ﬁ'om traveling tlnrough the vas deferens” (Randle).

Let us assume that the side effects for male hormonal methods are comparable to
those for female methods. Are the burdens of hormonal methods too geat in comparison
to the possible harms of unintended pregnancy to justify their use as a way of fulﬁlling
men’s moral duty to prevent harm? Let us return to the example of Sanjay and Olga to

respond to this question. Chlamydia is easily treated and cured with antibiotics. Is it fair

 

40 I am not clear, and Macrae never explains, why these side effects prevent this drug from being used as a
contraceptive. One of the concerns with contraceptives is that they are taken over a long period of time, but
so are drugs to treat chronic conditions like schizophrenia and high blood pressure.

195

for Sanjay to undergo antibiotic treatment to prevent transmitting Chlamydia to Olga?
Legally, Sanj ay has the right to refuse medical treatment. Furthermore, he cannot be
legally compelled to bodily invasion for the sake of another as decided in the
Pennsylvarnia court case of McF all v Shimp.41 Robert McF all took his cousin David
Shimp to court to mandate that Shimp provide him with the bone marrow transplant he
needed to live. The judge ruled that our right to bodily integity supersedes the medical
needs of others to use our bodies, even if it is a matter of life and death:

Our society, contrary to many others, has as its ﬁrst principle, the respect

for the individual, and that society and government exist to protect the

individual from being invaded and hurt by another. .. .For our law to

compel the Defendant to submit to an intrusion of his body would change

every concept and principle upon which our society is founded. To do so

would defeat the sanctity of the individual and would impose a rule which

would know no limits. (McFall v Shimp)

While we cannot and should not legally force Sanj ay to take antibiotics, taking
antibiotics to ensure that Olga does not acquire Chlamydia does not seem overly
burdensome. I am not claiming that Sanjay must take antibiotics instead of or in addition
to using condoms. Again, my position is that he has a moral duty to prevent harming
Olga and there is more than one way for him to fulﬁll this duty (e. g. condoms, antibiotics,
abstinence). In contrast to the potentially serious symptoms of Chlamydia, the majority of
common side effects of antibiotics are mild, such as nausea, diarrhea, and increased
sensitivity to sunlight. However, some people have some severe reactions that can be life-
tlnreatening, usually due to allergy (WebMD). Additionally, antibiotics are typically taken

for a matter of days, whereas the health consequences of Chlamydia can last a lifetime.

While there is no doubt that taking antibiotics involves. more bodily invasion than

 

4] Pregnant women are sometimes not afforded the right of bodily integity, as seen by the history of forced
c-sections in the U.S., most famously the case of Angela Carder (see Minkoff and Paltrow).

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condoms, given the short duration of treatment and the minimal side effects, the harms of
antibiotics seem much less than the harms of Chlamydia. One more point: taking
antibiotics also behooves Sanjay, so it is not as though he is expected to be self-
sacriﬁcing. In sum, antibiotic treatment is a fair way for Sanjay to prevent spreading
Chlamydia to Olga.

For many of the same reasons, using hormonal contraceptives is a fair way for
men to prevent unintended pregnancy. The harms of urnintended pregnancy are typically
geater than the harms of contraception and men are (at least partially) causally
responsible for pregnancy. Men who contracept are usually not doing so just for the sake
of their partrners; that is, they are not being self-sacriﬁcing. Men often use contraception
for other reasons as well, such as to prevent harm to themselves and to their potential
fetuses and children. So, it is not the case that most men are motivated to contracept only
because of their partrners. They experience personal beneﬁts in assuming contraceptive
responsibility, including the ability to control their fertility and sometimes protection
against STDs. Additionally, just like in my example of Sanjay, men can choose to wear
condoms to prevent harm rather than taking a medication that involves more potential
sides and more bodily invasion.

Some may reject this analogy of treating Chlamydia via antibiotics to using
hormonal methods to prevent urnintended pregnancy for a couple of reasons. First, the
duration of use for antibiotics is short, while hormonal methods are used indeﬁnitely.
However, while this is true for female hormonal contraceptives, researchers are
developing a male hormonal contraceptive that is taken before sex rendering men infertile

for only a matter of hours (Macrae). Even if this short-term contraceptive is never

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available to the public, it is not unreasonable for men to use a long-acting contraceptive
given the long-lasting nature of the harms of unintended pregnancy, especially the social
and economic challenges of raising a child. I do not want to imply a simplistic tit-for-tat
comparison: the effects of unintended pregnancy are long-term, so it is fair that men
contracept for the long-term. At the same time, however, comparing the duration of
effects is important to get a sense the overall severity of the harms. While the economic
and social challenges of being a parent sometimes never completely disappear, if male
hormonal methods are similar to female hormonal methods, then their adverse side
effects are likely to abate after a few months.

Second, the side effects of LARCS are probably more severe than those of
antibiotics. This may or may be true depending on the type of male contraceptive. Even if
it is true, the harms of unintended pregnancy are generally more serious than those
associated with contraception, which may make the harms men take on justiﬁable.
Furthermore, if at least some of the male contraceptives currently being researched
become available to the public, men will have a choice in which one to use. Thus, like
many women do now, they can try different types of contraceptives to see which one they
like best and hopeﬁrlly ﬁnd one that has few or no side effects for them.

Assuming that the side effects of male hormonal contraceptives will be similar to
those in female hormonal contraceptives (as I have), the harms men would take on in
contracepting are justiﬁable in comparison to the harms of unintended pregnancy not
only for women, but also for men and potential fetuses and children. Given that the harms
of the currently available male contraceptives are generally much less serious than the

harms associated female hormonal contraceptives, men who rely on these methods (e. g.

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condoms and vasectomy) to fulﬁll their duty to prevent harm are not unduly burdened. In
sum, the harms men may face in fulﬁlling their moral duty to prevent unintended

pregnancy by contracepting are just.

Unequal Power Relations Regarding Sex

Some may object to my overall argument so far and claim that it is women’s, not
men’s, responsibility to prevent the harms of unintended pregnancy by using
contraception. For many of the same reasons I have outlined for men, I agee that women
should use contraception: not contracepting can harm both themselves and potential
fetuses. That women also have a duty to contracept does not minimize or eliminate men’s
duty. Contraception is not a zero sum game in which if one person has a duty to
contracept the other person does not. In short, both can have a simultaneous duty to
contracept. While some may agee that both women and men have a duty to contracept,
they still may insist that women’s duty is stronger because pregnancy is something that
only women experience. In other words, according to the dominant ideology, women
should be the ones contracepting since “Pregnancy ‘happens to tlnem,’ therefore they
must ‘protect themselves’” (Stubbleﬁeld 82). It is true that pregnancy is sometlning that
only happens to women; however, women alone are not causally responsible for it. Men
also causally contribute to pregnancy (except in the case where women use anonymous
donor sperm or where men’s sperm was taken by force or by fraud). The fact that
pregnancy “happens” to women does not mean that they are fully (or even more)
responsible for preventing it. If anything, the opposite should be true: men should be held

just as responsible or even more responsible for inﬂicting a potential harm on women

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because this would be consistent with the general social pattern of assigning blame and
taking legal action.

It is a common intuition that people are more concerned when their actions
adversely affect others than when their actions only affect tlnemselves, especially when
the others are vulnerable or less powerful in some way. In other words, harming oneself
or someone who is not vulnerable or less powerful in comparison does not generate moral
outrage like harming someone vulnerable or less powerful does.42 As an oppressed goup,
women have less power (e. g. political inﬂuence, access to resources, ﬁnancial
independence) overall as well as in the case of contraception. Even though there is this
power imbalance, there is little to no moral outrage toward men who do not contracept
(and thereby risk harming women). Part of the reason for this is due to the dominant
ideology that women should be the ones contracepting. But it seems that a more subtle
and subconscious motivation contributes as well: expecting women to contracept
reinforces patriarchy by absolving men ﬁom responsibility and by usually blaming
women for contraceptive mistakes (i.e. unintended pregnancy). This is the same sort of
“blame the victim” rhetoric used to fault women for staying with their abusers and for
“instigating” rape while simultaneously minimizing or ignoring men’s roles and
responsibilities. Many feminists have argued that blaming women for such events is
unfair since women are not causally responsible for them; rather, they are a result of
men’s actions within a patriarchal power structure. I extend this argument to

contraception. I am not positing that women have no control over sex, a claim that

 

42 The saying “pick on someone your own size” reﬂects this concern for the less powerful. Until the recent
Supreme court case Kennedy v. Louisiana, six states allowed the death penalty for child rape. That these
states did not permit the death penalty for adult rape implies that violence against someone more vulrnerable
(and perhaps someone perceived as more innocent) is considered a more heinous offense (Greenhouse).

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implies that women lack agency altogether in sexual matters. Rather, drawing on the
work of Catharine MacKinnon and Andrea Dworkin, I argue that women’s sexually
subordinate positioning makes using contraception more difﬁcult. In contrast, men face
fewer barriers in contracepting because they tend to control sex (and women).

MacKinnon and Dworkin persuasively argue that under a system of gender
inequality, men not only control sex, but they also use sex to dominate women. From an
early age, girls absorb that they and their sexuality are deﬁned by male use. MacKinnon
states:

Gender socialization is the process through which women come to identify

themselves as such sexual beings, as beings that exist for men, speciﬁcally

for male sexual use. It is that process through which women internalize

(make their own) a male image of their sexuality as their identity as

women, and thus make it real in the world. (MacKinnonl 10-1 1 1)
Through gender socialization, girls and women “train” to be sex objects for boys and men
by learning the “right” (read: patriarchal) ways to dress and act and the “right” desires to
have. For example, women realize that dressing in a feminine and sexy (but not too sexy)
way will often result in positive male attention, whereas dressing androgynously typically
leads men to ignore or mock them. As this example shows, women who succeed in being
“real” women, that is, feminine women, are socially rewarded and those who do not are
socially punished or ostracized. This example should not lead one to think these social
rewards and punishments are trivial. The opposite is true: the rewards are often social
goods (e. g. food, money, shelter) that ensure a certain quality of life and sometimes life
itself, while the punishments are serious harms, like violence, rape, and even death. These

rewards and punishments are ubiquitous and often extreme in order to ensure women’s

compliance with their sexual subordination. Indeed, tlnrough these rewards and

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punishments, as well as gender socialization and cultural inﬂuences more generally,
women learn not just to objectify themselves, but also to understand and identify
themselves as objectiﬁed beings. This internalization of her own objectiﬁcation reduces a
woman’s autonomy, for “conform[ing] in body and type and behavior and values to
become an object of male sexual desire requires an abandonment of a wide-ranging
capacity for choice” (Dworkin 139). In accepting themselves as objectiﬁed, women limit
themselves to prescribed gendered social norms and roles. Furthermore, they actively
reinforce their own objectiﬁcation through their choices and beliefs, and through their
often vehement rejection of feminism. As Dworkin sardonically remarks, objectiﬁcation
(and, more generally, patriarchy) “is the best system of colonialization on earth: she [all
women] takes on the burdern, the responsibility, of her own submission, her own
objectiﬁcation” (142).

_ Additionally, men generally play a signiﬁcant role in women’s objectiﬁcation and
subordination. One of the main ways men dominate women is by controlling their bodies;
for example, limiting their mobility, denying them reproductive rights, restricting their
options in the public realm, and, most importantly for my purposes here, controlling sex.
According to Dworkin, men “use the fuck to create and maintain a social system of
power over women, a social and political system in which the fuck, regulated and
restrained, kept women compliant, a sexually subjugated class” (Dworkin 159). In order
to uphold patriarchy, men reduce women and their bodies to objects—commodities—that
they possess and control. “Women’s sexuality is, socially, a thing to be stolen, sold,
bought, bartered, or exchanged by others. But women never own or possess it”

(MacKinnon 172). Even mundane and seemingly innocuous examples of heterosexual

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interactions are based on men’s dominance and ownership of women’s bodies. For
example, when a man takes a woman on a date and pays for everything, he often assumes
that he will receive some form of sexual compensation—a sentiment summed up by the
crude saying “he pays, she puts out.” What motivates his belief that he deserves sex is the
understanding of her body as something that he can (perhaps indirectly) purchase. This
example shows that blatant and sometimes illegal examples of women’s objectiﬁcation,
such as rape, pomogaphy, and prostitution, and women’s everyday and legal realities are
part of the same continuum. Both the extremes and everyday realities systemically instill
in women their inferiority and subservience to men by conveying certain messages about
women’s bodies: that their bodies are objects controlled by others and that their worth is
limited to the bodily functions (e. g. sex, reproduction) they can provide for men. The
everyday examples of women’s objectiﬁcation are, in some ways, more insidious than the
extreme examples because they normalize men’s access to women’s bodies, thereby
teaching men that they are entitled to women’s bodies and teaching women that their
bodies belong to men. Moreover, the normalization of women’s objectiﬁcation ensures
women’s subordination: “The legal fuck helped to create compliance by defuning the

woman’s body as breachable, owned through the fuck” (Dworkin 159).

Women’s Subordinate Positioning Affects Their Ability to Contracept

So far I have argued that women’s objectiﬁcation simultaneously reduces
women’s autonomy and gants men power over women’s bodies. How does this power
dynamic affect contraception? Because women have diminished bodily autonomy, they

are often not the ones making contraceptive decisions. Social science research conﬁrms

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that the larger the power differential between women and men, the less control women
have over their bodies and, speciﬁcally, their ability to contracept. In other words,
relationships that conform to “traditional” (read: sexist) gender roles—ones in which men
have signiﬁcantly more power than women—typically limit women’s ability to
contracept. For example, a study in Ornarn, a highly gender-stratiﬁed society, showed that
men alone decide whether or not they and their wives will use contraception in nearly
half of all relationships (Al Riyami et al. 151). Even in less gender-stratiﬁed societies,
like the U.S., studies have shown that men who uphold sexist gender roles are more likely
to believe that they should be the ones making contraceptive decisions (Grady et al. 1996,
224). Moreover, “the higher the status of the man, the more likely he is to view himself as
the dominant decision-maker, while the higher the status of his partner, the more likely he
is to adopt a view of her as either an equal or as the dominant decision-maker” (Grady et
al. 1996, 225). In relationships where tlnere is a signiﬁcant power differential and the man
clearly sees himself as dominant, such as relationships involving physical violence and
relationships in which the man is much older than the women, nonuse of contraception is
higher (Marnlove 271).

Overall, the general pattern of contraceptive use is that it is lower among women
in unequal relationships than women in egalitarian relationships (Hartrnann 52). Looking
at gender ideologies and women’s objectiﬁcation help explain why this is the case. Men
in unequal heterosexual relationships are more likely to uphold dominant gender
ideologies. (The women in such relationships may not agee with such ideologies, but
may be pressured or coerced into following them. However, there are women who

strongly believe in such ideologies, such as conservative women and deeply Christian

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women in the US.) Men in such relationships are likely to assert themselves as the
dominant decision-maker because they have learned that men are more capable of
making good decisions than women. Furthermore, these men may feel responsible for
protecting their female partners, which they may interpret as making decisions for them.
Part of what motivates many men to “protect” women is the gendered imagery of the
knight in shining armor saving the damsel in distress; that is, the cultural belief that men
are strong and brave, while women are weak and helpless. Additionally, women’s
objectiﬁcation—the view of women’s bodies are objects for men to possess and
control—also leads some men to think that they are justified in making decisions about
women’s bodies because they “own” or have some sort of claim over women’s bodies.
Yet, even for women in more egalitarian relationships, who ostensibly have the
power to use contraception, there are subtle factors at play that diminish their autonomy
and ability to demand contraceptive use. Women are socialized to be passive, to defer to
men’s judgnents, and to believe that their bodies belong to men. Consequently, when a
woman is making a decision about contraception (whether or not she has discussed it
with her partrner), there is a good chance that she will acquiesce to his opinion because
she wants to please him both. Indeed, empirical evidence reveals that men’s attitudes and
preferences play a signiﬁcant role in women’s contraceptive use and contraceptive choice
(Nass and Strauss 117). This is especially the case when decisions about contraception .
are determined during sex rather than beforehand. Studies in the US. have shown that
women are more likely to “jeopardize contraceptive protection for an intimate male

partner” (Manlove 272).43 As previously discussed, one of the social norms for women is

 

43 This same pattern seems to be at play in other cultural settings as well. For example, a study on
contraception use by university students in China revealed that 47 percent of women would consent to have

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that they be self-sacriﬁcing, especially with their children and male partners. It is
therefore not surprising that studies demonstrate that a large number of women and more
women than men are willing to sacriﬁce their own protection from pregnancy and STDs
for the sake of their partrner. Put differently, many women choose their partner’s desires
over their own safety.

Prioritizing their partners over themselves can lead women to consent to sex they
do not want, and more speciﬁcally, sex without contraception. Women may rationally
consent to unwanted and unprotected sex because they perceive it as their best option.
For example, women may have sex to get certain social goods and/or to make their lives
more bearable. While women may not consciously understand the systerrnic nature of
gender oppression, they do realize that using their sexuality is a way, and sometimes the
only way, of acquiring certain things. That is, they understand that their bodies are
objects or goods that they can trade for other objects or goods. “Women have needed
what can be gotten through intercourse: the economic and psychological survival; access
to male power through access to the male who has it; having some hold—psychological,
sexual or economic—on the ones who act, who decide, who matter” (Dworkin 128).
Moreover, women recognize, at some level, the power dynamic at play in their
relationships, as many women ﬁnd abiding by their partners’ wishes is easier and better
for them (in certain ways) than trying to assert their own wishes. Consequently, women
may rationally consent to sex, and, more speciﬁcally, sex without contraception. Here I
quote Robin West at length because she eloquently identiﬁes some of the reasons women

may consent to sex they do not want:

 

sex even if their partrner refused to use any form of contraceptive (and the women are not using form of
long-acting contraception) and 19 percent said they would have sex but would take the morning-after pill
(China Post article).

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A woman might consent to sex she does not want because she or children
are dependent upon her male partner for economic sustenance, and she
must accordingly remain in his good gaces. A woman might consent to
sex she does not want because she rightly fears that if she does not her
partner will be put into a foul humor, and she simply decides that
tolerating the undesired sex is less burdensome than tolerating the foul
humor. A woman might consent to sex she does not want because she has
been taught and has come to believe that it is her lot in life to do so, and
that she has no reasonable expectation of attaining her own pleasure
through sex. A woman might consent to sex she does not want because she
rightly fears that her refusal to do so will lead to an outburst of violent
behavior some time following—only if the violence or overt threat of
violence is very close to the sexual act will this arguably constitute a rape.
A woman may consent to sex she does not want because she does desire a
ﬁiendly man’s protection against the very real threat of non-consensual
violent rape by other more dangerous men, and she correctly perceives, or
intuits, that to gain the friendly man’s protection, she needs to give him, in
exchange for that protection, the means to his own sexual pleasure. A
woman, particularly a young woman or teenager, may consent to sex she
does not want because of peer expectations that she be sexually active, or
because she cannot bring herself to hurt her partner’s pride, or because she
is uncomfortable with the prospect of the argument that might ensue,
should she refuse. (West 318)

These reasons higlnlight the double bind women face: either have unwanted sex or suffer
potentially serious repercussions. Given their limited control over sex, women often have
trouble insisting upon contraceptive use. For example, a woman may worry that asking
her male partrner to use a condom would make him angy because he would think she
wants to reduce his pleasure or that she does not trust him. A woman may be concerrned
to ask her male partrner to wait while she inserts a cervical cap or diaphragn because she
knows he gets mad when he does not. get what he wants immediately or that he thinks
these types of contraceptives reduce his pleasure. A woman may fear asking her partrner
for money and/or assistance accessing LARCS because she believes he does not want to
pay for her contraceptive needs or because he wants to be the one making contraceptive

decisions. In sum, the fact that the circumstances surrounding sex are unequal—men

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typically control sex (when, why, and how it happens) and women often have sex in
order to get social goods or to make their life (more) bearable——means women have
diminished ability to use contraception themselves or ask their partners to use
contraception.

Other factors that further diminish women’s ability to contracept are gendered
social norms about chastity and promiscuity. As brieﬂy mentioned in a previous chapter,
Anna Stubbleﬁeld argues that norms of chastity, which are group-speciﬁc for women,
discourage women from using contraception due to “ the belief that a woman who uses
contraceptives has sex frequently and/or is sexually aggressive and therefore has
abandoned the traditional role of female sexual passivity” (90). In other words, although
women may want to use contraception, they may choose not to because they do not want
to be labeled a “whore.” Women are stuck in a no-win situation: they often have sex at
men’s will, yet protecting themselves from certain harms of sex (i.e. pregnancy and
STDs) by contracepting is not a palatable option due to the social stigma. Consequently,
as Kristin Luker discovered in her well-known study, many women engage in
“contraceptive risk-taking” even though they know that not consistently using
contraception could result in an unintended pregnancy. Women are generally held
responsible and blamed for unintended pregnancies. It is thought to be their fault because
they knew unprotected sex could lead to pregnancy and they still chose not to use
contraception. Yet, blaming only women is unfair, as doing so not only ignores the role
men play in reproduction—further absolving men of contraceptive responsibility—but it
also overlooks how the patriarchal structuring cf society affects and, more speciﬁcally,

oppresses women. For example, in order to meet the norms of feminine passivity, women

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should not actively plan or prepare for sex but rather wait for men to “swept them off
their feet.” Likewise, during sex women should not make requests or, worse yet,
demands, but instead let men make decisions. These gendered norms contribute to
women’s oppression by teaching, encouraging, and coercing them to act in a particular
way—not contracepting—and then blaming them for the results of that action—
unintended pregnancy. In Stubbleﬁeld’s words, “Social norms such as those in the case
of contraceptive risk-taking that assign blame to women for unwanted pregnancies while
simultaneously coercing them to engage in premarital sexual intercourse without using
contraceptives are oppressive” (85).

Contracepting is easier for men because, unlike women, they do not face norms of
chastity. Gender ideologies suggest that it is normal (and hence good) for men to be
sexually active and so preparing for sex by carrying condoms does not carry the same
sort of negative connotation that it does for women. In fact, men who carry condoms are
likely to receive a positive response for being “studs,” that is, for being sexually active
and even promiscuous. However, men who use contraception contradict another gender
ideology: men are supposed to be so tough that they do not need protection, including
protection against pregnancy (and STDs). While men may feel “feminine” or “weak” for
using contraception, that they are (heterosexually) active somewhat counters any
perceived weakness, as having sex is an important signiﬁer of their masculinity.
Moreover, men who contracept often reap social beneﬁts since women may see them as
“sensitive” and “responsible,” as men who care about their female partners and take
action to protect them. In other words, by contracepting, men fulﬁll the cultural

expectation that men should care for and protect women.

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Men’s privilege enables them to more easily contracept both because they are
equipped with the power and conﬁdence to make such decisions and because they face
fewer obstacles and disadvantages in doing so. In short, the reason it is easier for men to
contracept is due to an unjust social structuring, oppression. The word “easier” should not
mislead readers to think that men have only a minimal advantage, like a one inch height
difference in a slam dunk contest. Men’s advantage is hugely signiﬁcant. It is systemic,
permeating every aspect of their lives and granting them rights, privileges, and power—
typically at women’s expense. As discussed in chapter 2, women unfairly bear most of
the burdens for contraception. In order to achieve a more egalitarian contraceptive
situation, men too must contracept. Indeed, since men contribute—perhaps inadvertently
or unknowingly—to this unfair contraceptive arrangement, they should work to alleviate
it. And considering men’s privileged positioning, they have the potential to make great

changes.

Why Men in Monogamous Relationships Have a Duty to Contracept

Some may claim that it is not always necessary for the man to contracept; it is
sufﬁcient for the woman to contracept in a monogamous relationship if the couple has
discussed it and sees this as their best option. Couples may believe that using condoms in
addition to a more effective, LARC is not worthwhile due to cost, potential decreased
pleasure, minimal extra protection against pregnancy, etc. If couples think it is only
necessary for one person to contracept, it makes sense why they would choose the
woman given the greater variety and more effective forms of female contraceptives.

However, I am concerned that the disparity in female and male contraceptives will

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continue to serve as an excuse to saddle women with ﬁrll contraceptive responsibility. In
other words, my worry is that men will be able to absolve themselves of contraceptive
responsibility due to the lack of equally effective male LARCS. I advocate for the
development of LARCS for men to ease the contraceptive burden women currently face.
If there were LARCS for men available, then sharing contraceptive responsibility would
hopefully be a more palatable and real option.

In the meantime, until these male contraceptives become readily available, do
men in monogamous relationships have a duty to contracept? Some may argue that such
men do not have a duty to contracept so long as they take responsibility in other spheres.
This position relies on the belief that it is acceptable for couples to split responsibilities—
she weeds the garden, he mows the lawn, she cooks dinner, he washes the dishes, and so
on—if they do so fairly. Many couples are able to divide their responsibilities so that
neither partner has more time-consuming, physically difﬁcult, or emotionally demanding
tasks than the other. Prima facie, adding contraception to the list of responsibilities to
split seems like a good idea. However, I think there are a couple of problems with this
solution. First, depending upon how the tasks are divided, couples many be perpetuating
traditional gender roles. For example, if she cares for the children and the household——
private realm responsibilities—while he is publicly employed and takes care of ﬁnancial
tasks—public realm responsibilities—then this couple follows a gendered division of
labor. If women take on the responsibility for contraception, then this gendered division
of labor is ﬁrrther reinforced, as contraception is a private task. Moreover, women taking
on contraceptive duties strengthens women’s association with reproduction, making it

seem “normal” and “natural” for women to assume contraceptive responsibility.

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Second, using contraception, especially long-acting methods, involves bodily
invasion—something not required by other responsibilities. Female barrier methods, such
as the sponge, diaphragm, cervical cap, and female condom, are only used during sex,
like the male condom, so their bodily invasion is temporary (though it is worth noting
that their time within the body can be signiﬁcantly longer than the male condom, as the
male condom cannot be used until sex and speciﬁcally until the man has an erection,
while these female methods can be inserted well ahead of sexual activity). In contrast,
IUDs and hormonal methods are constantly inside women’s bodies. Few responsibilities
entail this degree of continuous invasion of bodily integrity (except perhaps pregnancy
and breastfeeding). My concern with this bodily invasion is not just the negative side
effects that often accompany it, as I discussed in chapter 2, though it is unfair that women
as a group bear them. I am also worried about the effects such bodily invasion has on
women’s agency given that the body is “the basis of privacy and freedom in the material
world for all human beings” (Dworkin 137). The bodily invasion women experience from
contraceptives compounds and exacerbates their objectiﬁcation, thereby minimizing their
autonomy. LARCS add to women’s everyday experience of having their bodies entered
and occupied, often without their consent or because it is the best of bad options; other
examples include sex (see Dworkin) and pregnancy (see Purdy). Some women feel
violated by the presence of LARCS, especially hormonal ones since they can affect one’s
mental health. Even if women are fortunate not to have any negative side effects, many
are not fond of the idea of constantly pumping hormones into their body or having a
metal or plastic IUD sitting in their uterus for years at a time. Part of the unease here is

providing medical treatment to an otherwise healthy individual (and the adverse effects

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that it can entail), but just as conceming is the violation of bodily privacy and integrity.
This violation is particularly problematic because there is no equivalent violation that
men experience from other responsibilities. Women alone experience such bodily
invasion, as none of the other responsibilities that a couple splits requires it.

Due to these two reasons—reinforcing a gendered division of labor and
demanding another type of bodily invasion ﬁ'om women—it is problematic for
heterosexual couples to make contraceptive responsibility just the woman’s job. In the
next chapter, I will describe my vision for shared contraceptive responsibility. Part of this
vision involves LARCS for men. Until such male contraceptives are available, men in
monogamous relationships should share contraceptive responsibility by using condoms
(or having a vasectomy). If both partners agree that just the woman will contracept, men
should, at the very least, acknowledge the unique problems at play with this arrangement
and should try to ﬁnd ways of mitigating them. For example, men may take on more
private realm responsibilities so the gendered division of labor is lessened. Moreover,
men should be supportive of women’s contraceptive responsibility in all ways
(emotionally, ﬁnancially, etc.). I will discuss the various ways men can be supportive of
their partners contracepting as well as how they can be more involved in contraceptive

responsibility in the next chapter.

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Chapter 7. Achieving Shared Contraceptive Responsibility

In the previous two chapters, I argued that (heterosexually active) men as a group
have a moral duty to contracept and that this duty is not dependent upon whether women
contracept. That is, there are good reasons why men should contracept that hold
independent of whether women do or should contracept. Throughout the dissertation, I
have argued that although men as a group may not be trusted to contracept, this distrust
does not absolve them of contraceptive responsibility. I made a positive case for why
men have a duty to contracept that does not rely upon their trustworthiness. In doing so, I
revealed that trust and responsibility do not always go hand-in-hand. Second, positing
that men have a moral duty to contracept lays the groundwork for my overarching
argument of shared contraceptive responsibility. By providing reasons why men should
. contracept that are independent of women contracepting, my claim that men should
participate in and share contraceptive responsibility is strengthened.

In this chapter, I ﬂesh out what I mean by shared contraceptive responsibility,
which is more than just a numerical achievement (e. g. increasing the number of men
contracepting). Shared responsibility means that women and men are both responsible for
contraception and there are open conversations between partners about how to share
responsibility for contraception. Then, I suggest three governmental strategies for
working towards the goal of shared responsibility. First, the government, private
pharmaceutical companies, and nonproﬁt organizations should focus efforts on
developing contraception for men so that they have better contraceptive options,

especially long-term reversible options. The lack of male contraceptives makes it difﬁcult

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for men to assume responsibility for contraception and they often push contraceptive
responsibility onto women. Second, shared responsibility for contraception ought to be
taught and promoted on every level: health care providers, schools, and laws. Health care
providers need to encourage shared responsibility, which means including men in
contraceptive discussions and decisions. Currently, men’s reproduction is typically
ignored in part because there is a lack of reproductive information and services for them.
Schools should teach children accurate sex education that holds men responsible for sex,
not only with regard to contraception but also for other issues, especially rape. Our
government also needs to hold men accountable for sex through laws, policies, and social
norms. Third, the government must strive towards more equal relationships between
women and men. Studies have shown that men with more egalitarian views on gender
roles are more likely to assume contraceptive responsibility and value shared
contraceptive responsibility. Increasing women’s education will enable them to make
better contraceptive decisions. Studies have shown that the male partners of educated
women are more likely to hold more egalitarian views on gender roles. Additionally,
increasing women’s power and opportunities in other realms, especially the public realm,
will give them more power and opportunities in the private realm and with regard to

reproductive issues.

A Vision of Shared Contraceptive Responsibility
As described in detail in chapter 2, the current contraceptive arrangement is unfair
and oppressive to women. A shared approach to contraceptive responsibility would

mitigate many of the injustices most women currently experience. My vision of shared

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contraceptive responsibility is not just about making numerical changes, such as
increasing the number of male contraceptives or the percentage of men contracepting.
Nor does my vision merely translate into a simple type of equality in which monogamous
partners split contraceptive use ﬁfty-ﬁfty and casual sex partners both contracept. While I
think these suggestions are a step in the right direction, they are not sufﬁcient for shared
contraceptive responsibility. Shared contraceptive responsibility means that both women
and men take their reproductive health and responsibilities, as well as the reproductive
health and responsibilities of their sexual partners, seriously. In order for this to possible,
people must view both themselves and their partners as reproductive beings with
reproductive responsibilities. Furthermore, they must be committed to fairly sharing
contraceptive responsibility, which typically requires open and continual conversations
between partners about sex, reproduction, and contraception.

I will not make any universal claims about how precisely shared contraceptive
responsibility is achieved, as couples will have different circumstances, needs, and
values. However, it will generally involve both partners contracepting at some point,
perhaps at the same time or alternating. What is most important is that one person is not
mostly or permanently saddled with full contraceptive responsibility, especially without
the emotional, social, and/or ﬁnancial support of her/his partner. In other words, any
contraceptive arrangement that closely resembles the current one is unjust. Other
contraceptive arrangements can be unjust even if they do not mimic the current one (e.g.
mandatory contraception). Since I oppose reproductive paternalism and am only

discussing moral, not legal, duties to contracept, individuals should determine the

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contraceptive arrangement for themselves, in conjunction with their partners, that is best
and fair for both of them.

Yet, given our dominant contraceptive and gender ideologies, it seems improbable
that many pe0ple will elect fair—that is, nonsexist—contraceptive arrangements despite
the fact that they may try to. Ideologies discipline our behavior and encourage us to act in
ways that uphold current power structures. Since current dominant ideologies align
contraceptive responsibility with norms of femininity, women are disciplined to assume
this responsibility, whereas men are not. One previously discussed example that shows
this is the following: even though both women and men have sterilization procedures
available to them, the rates of tubal ligation are three times as high as vasectomy in the
US. By extension, even if male LARCS were to hit the market tomorrow, it is doubtful
that they would gain the popularity of female LARCS without any other cultural changes.
Without a transformation of our dominant contraceptive and gender ideologies, it is
unlikely that most people will start viewing men as reproductive agents with moral duties
to contracept. Such a transformation is necessary for shared contraceptive responsibility
to become not only socially accepted, but also the norm.

But how do we achieve such an ideological transformation? This sort of deep
societal change will not be easy or quick. To achieve the most success, change must
come from both the top-down and the bottom-up. Just implementing top-down policies
may lead to behavioral changes, but they do not always usurp beliefs. Moreover, since
these approaches typically target behavior, not beliefs, they generally do not address the
factors that contribute to the behavior. For example, China’s infamous “one-child” policy

seeks to limit women’s fertility. While the Chinese government and family planning

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ofﬁcials have been successful at altering women’s reproductive behavior, they have been
less successful in changing women’s preference for wanting more than child, though
some change has occurred. Part of the reason the one-child policy has struggled to
transform women’s fertility preferences is that it does not deal with women’s motivations
for wanting more than one child, such as the strong preference for a son and the need for
more farm workers in rural areas. The one-child policy did not (and still does not) take
women’s perspectives into account and therefore it is not surprising that it conﬂicts with
many women’s views (Merli and Smith).

In analyzing development policies and programs like one-child, some feminist
theorists44 argue that top-down approaches are not only more likely to fail, but also that
they are ethically problematic because they privilege one viewpoint—the viewpoint of
people in power. These theorists suggest empowering women (and other oppressed
groups) through participation as a way of improving development outcomes. Majid
Rahnerna explains the ideological transformation from a top-down approach to the more
bottom-up approach of participatory empowerment ﬁ'om the point of view of
development agents. They (social activists, ﬁeld workers, and other development agents)
began

to attribute most of the failures of development projects to the fact that the

populations concerned were kept out of all the processes related to their

design, formulation and implementation. In their great majority, they

started to advocate the end of ‘top-down’ strategies of action and the

inclusion of participation and participatory methods of interaction as an

essential dimension of development. (Rahnema 117)

These participatory pro grams were (and are) generally more successﬁrl than top-down

programs (ibid.). This ﬁnding intuitively makes sense, as when people play an active role

 

44 See, for example, Naila Kabeer, Gita Sen and Caren Grown, Saskia Wieringa, Jane Parpart, and Majid
Rahnema.

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in a designing and implementing a project, they are usually more invested in it and hence
more likely to push for its success. In contrast, there is often resistance to top-down
programs, especially if they go against cultural beliefs. Although people’s acquiescence
to top—down programs may eventually lead them to accept and uphold such programs and
their corresponding beliefs, these programs are less likely to lead to deep, genuine, and
long-lasting ideological change. Close to thirty years after the one-child policy was
implemented, that this policy is the bi ggest determinant of whether most Chinese women
become pregnant (and carry their pregnancies to term) shows that while behavioral
change has occurred, ideological change has not (Merli and Smith).

Participatory and empowerment approaches are especially important when
seeking ideological transformations that involve oppressed groups. “The theme of
collective identity,” according to Naila Kabeer, “underpins most empowerment
strategies” (253). Actors in top-down programs and policies that do not incorporate
women’s voices are often unable to make connections among women’s experiences so as
to see oppressive patterns. Development workers and policymakers who examine the
lives of individual women on a case by case basis, instead of looking to a general
community of women, might view individual women as being ill used, yet not piece
together the ways in which women as a group experience oppression precisely because
they are a member of the group called ‘women.’ As Marilyn Frye posits, oppression
happens based on one’s membership in a group and therefore cannot be detected if we
only see atomistic individuals who exist outside of social groups (8). Looking at
individual women rather than communities of women makes it easier to overlook the

deeply entrenched gender ideologies in laws, institutions, and cultural practices. Workers

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and policymakers who listen to the experiences of women, or better yet, include women
and give them access to the experiences of other women are more likely to recognize the
systemic oppression that women as a group face. Moreover, women themselves need
access to the experiences of other women (e. g. consciousness-raising groups) in order to
understand the systemic nature of patriarchy. This access to other women’s experiences is
episternically necessary for women to recognize their own oppression. Understanding the
social nature of their oppression allows women to imagine and strive for alternative,
nonoppressive social arrangements. In Kabeer’s words,

The social basis of male domination is often concealed through powerful

ideological mechanisms, including the ‘naturalization’ of the status quo,

so that women experience subordination as inevitable and interpersonal.

Recognition of the shared aspects of subordination points to its

collectively enforced, and hence collectively changeable, character and

forms the basis of strategies for change. (253)
Having their voices heard and sharing their experiences with other women is an
important aspect of women’s empowerment. According to Saskia Wieringa, “the process
of empowerment of women [involves] exposing the oppressive power of the existing
gender relations, critically challenging them, and creatively trying to shape different
social relations” (Wieringa 832-833).
Only by empowering women through participation and being heard can development
workers, policymakers, and women themselves get the broad perspective to recognize,
understand, and begin to work against the far-reaching tentacles of patriarchy.

Prima facie, participatory and empowerment approaches and top-down
approaches may seem to be contradictory. However, this does not have to be the case. By

including a diverse group of people in all stages of strategy development and

implementation, it is unlikely that a top-down governmental approach will reﬂect the

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view of just the powerful. Although such a strategy is top-down in that it is imposed on
the public by the government, the decision-making process is bottom-up: listening to and
involving the voices of people of all social positions. One of the main concerns with
governmental top-down policies and programs is that the government is often
inconsistent and sometimes even ﬂippant in its decision-making processes. Indeed,

the state is a contradictory force in the process of women’s empowerment.

It has the power to override certain kinds of local constraints and to

provide the enabling conditions for women to mobilize around their own

self-deﬁned priorities. But where such activity conﬂicts with other

interests of the state, it is unlikely to prove a reliable ally. (Kabeer 260-

261)

However, if participatory and empowerment approaches were incorporated into top-down
governmental decisions, then it seems likely that the government would be a more
consistent and supportive force in women’s lives.

In what follows, I argue that the government should seek to mitigate the
oppressive burdens women face in assuming full contraceptive responsibility through (at
least) three different strategies: developing new male contraceptives, teaching shared
contraceptive responsibility, and promoting gender equality through women’s education
and employment. The exact details of such strategies are best left up to the diverse groups
of people involved in the strategy decision-making. These groups of people should
include women of all social positions, especially in leadership roles.

A main reason I focus on governmental strategies to achieve shared contraceptive
responsibility is that although the government’s support for women is uneven, the
government plays a constant role in women’s lives. Whether by omission or commission,

the government shapes women’s lived reality through laws, policies, and social norms

(e. g. while certain types of violence against women are illegal, for other types of

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violence, the government does not take a position and hence these types are permitted).
Since the government does not play a neutral role in public life, it is important not to

ignore its impact.

Developing Male Contraceptives

One way to encourage men, especially men in long-term, monogamous
relationships, to contracept is by developing male LARCS. For many men in long-term,
monogamous relationships, neither of the two currently available male contraceptives is
well-suited for their contraceptive needs: they want a long-acting contraceptive,
particularly one that does not need to be used during sex, that is not permanent (in case
they decide to have biological children). The lack of such options for men forces many
men in monogamous relationships to rely on their partners to contracept.

Why are there so few male contraceptives and so many female contraceptives?
The answer to this question is complex, and is deserving of its own project. However, it
is worthwhile to enumerate some of the factors that have contributed to this discrepancy
since they will have to be overcome if more male contraceptives are to be developed. As
discussed in chapter 2, dominant gender ideologies have shaped who is thought to be
responsible for contraception. That women are generally considered responsible for
contraception inﬂuences the decisions of researchers, developers, and pharmaceutical
companies about what type of contraceptive research to conduct and support. Dominant
ideologies about women’s and men’s bodies have also played a role such decisions. Some
scientists, physicians, and developers claim that it is more difﬁcult to create male

contraceptives because men’s bodies are more complex than women’s. They often

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compare the reproductive systems of women and men bodies to support their claim: for
example, women release one eg a month, while men produce millions of sperm a day;
women’s fertility is limited to a handful of days each month, whereas men are
consistently fertile (see Knight and Callahan 12 for more examples). At play in these
comparisons are implicit and sexist assumptions about the mind/body dichotomy:
women’s bodies are more simplistic and “nature-like” and men’s bodies are more
advanced and less “nature-like.” Nelly Oudshoom explains:

Biomedical scientists and traditional philosophers have encouraged us to

assume that women’s bodies are simply closer to nature, and consequently

easier to incorporate into biomedical practice. In this view, techniques to

intervene in male reproductive bodies have not proliferated because the

male reproductive system is by nature more resistant to intervention than

that of women. (8)

The trope that women’s bodies are more controllable and better suited for medical
intervention underlies many scientists, physicians, and developers’ beliefs and actions
regarding contraception.

Some may claim that while cultural stereotypes may play a role in the discrepancy
between the number of female and male contraceptives, developing contraceptives for
women is in fact easier than for men. The belief that women’s bodies are better suited for
contraceptive research is prevalent, as many “Studies show there is also a common
misconception that product development for men is more difﬁcult than it is for women”
(Randle). However, some scientists assert that men’s bodies are in fact better suited to
contraception and that “if scientists had simply followed nature, they would have
developed male contraceptives rather than female methods” (Oudshoom 46). Regardless

of whether it is easier to develop female or male contraceptives, there are other factors

that have contributed to the dearth of male contraceptives. Notably, it was not until the

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19708 that scientists began researching new types of male contraceptives. Previously,
scientists’ work on male contraceptives was limited to improving the condom (ibid. 19).
Scientists have been researching the relationships among hormones, contraception, and
the female reproductive system since the l9ZOs—ﬁfty years before research on male
contraceptives commenced (PBS). Because it has been studied for so much longer, more
is known about the female reproductive system and hence it is easier to develop
contraceptives for women. Indeed, various “scientists ascribed the gap between female
and male methods to a lack of fundamental knowledge of the male reproductive system,
caused by institutional reasons” (Oudshoom 46). Others active in the contraceptive
realm, such as policymakers and activists, agree. For example, Elaine Lissner, director
and founder of Male Contraception Information Project, states that the lack of knowledge
about and research on men’s bodies is what led to the discrepancy in the number of
female and male contraceptives (Randle).

Although there are fewer male contraceptives, much more money is allocated to
female contraceptive research. The distribution of research and development money in
the 19905 was as follows: “60% high-tech female methods, 3% female barrier methods,
spermicides, and natural fertility control methods, 7% to male methods, 30% to multiple
methods (though mostly for women)” (Yanoshik and Norsigian 70). Some researchers
who would like to study male contraception cannot due to lack of funding. For example,
Richard Anderson, a professor of clinical reproductive science at Edinburgh University
says that “most of the work [on male contraception] has been initiated by university
investigators and the World Health Organisation. There has so far not been a lot of

money from corporate companies” (quoted in Moss 12). Despite positive ﬁndings on a

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male contraceptive pill, Anderson and his team at Edinburgh University have not been
able to conduct trials because no pharmaceutical company will ﬁnancially support them
(ibid.). The main reason pharmaceutical companies decline to fund male contraceptive
research is that they do not think male contraceptives will be lucrative. Pharmaceutical
companies are mostly motivated by money: “Corporations do not view themselves as
instruments of social change. They are in business to make money” (Segal 138). Indeed,
pharmaceutical companies prefer to develop blockbuster drugs that will have many users
and will generate a signiﬁcant proﬁt rather than work on contraceptives, for which there
are an uncertain number of potential users (especially for male contraceptives) and which
are usually not as proﬁtable. To be fair, there are numerous obstacles that may make
contraceptive research unpalatable, such as liability concerns, “insurance costs,
unwillingness to cannibalize existing markets, and company image” (Segal 141). Yet,
these obstaclesaffect research for both female and male contraceptives.

While public and nonproﬁt organizations also research contraception, “the
contraceptive market is dominated by large pharmaceutical corporations” mainly because
they have the money, resources, and power to conduct such research (Y anoshik and
Norsigian 69). The World Health Organization (WHO) had been one of the more visible
and active nonproﬁt organizations working on male contraceptives, but today it “focuses
its contraception work entirely on females because it sees that focus as a key to issues in
developing countries” (Oudshoom 192-3; Dow 6). Given the limited budget of nonproﬁt
organizations, it is not surprisingly the WHO discontinued its research on male

contraceptives for practical reasons.

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Since private pharmaceutical companies typically are not interested in developing
male contraceptives and nonproﬁt organizations usually lack the resources to do so, if
male contraceptives are to be readily available in the near future, then a third party, such
as the federal government, needs to step in. Unlike most nonproﬁts organizations, the
US. government has the money and the resources to devote to developing male
contraception. Furthermore, in contrast to private pharmaceutical companies, the
government is, or at least should be, interested in developing male contraceptives.
Politicians often lament what they see as the prevalence of abortions as well as the high
rate of unintended pregnancy, especially among teenagers and unwed women. The
government’s response to these “problems”——abstinence-on1y education—~has not been
successful. Instead of pouring more money into these failing programs, over one billion
dollars and counting (Wire), the government should divert money to research on male
contraceptives. Allocating money for male contraceptive research would be in line with
other government initiatives aimed at involving men in, and in particular increasing
men’s responsibility for, reproductive and domestic matters.

As private companies continue to pull out of contraceptive research (both for
female and male contraceptives), by default the government is going to play a larger role
in this arena. For example, between 1970 and 1988, the percent of contraceptive research

that received federal funding rose from 25 to 60 percent mainly because private
companies were halting their research programs (Knight and Callahan 308). The majority
of contraceptive product launches in the US. in the 20003 have been initiated by publicly
supported programs, not private cempanies (Segal 138). Although the government has

emerged as a dominant actor in contraceptive development, this does not mean that its

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involvement is necessarily to the degree that it ought to be. Nor does this mean that the
focus of such research is where it ought to be. The percentage of research devoted to
male contraception is in the single digits, a clearly neglected area (Y anoshik and
Norsigian 70).

The government (its politicians, policymakers, and citizens) should have an
interest in contraceptive research because unlike most private companies, part of its
inherent purpose is to promote justice. Whereas private companies are mainly motivated
by proﬁt, government players ought to be compelled to act according to what is good and
fair. Indeed, the government should act as an agent of social change. According to this
perspective, it is reasonable for the government to allocate money to contraceptive
research, especially male contraceptives, both to decrease unintended pregnancy and
abortion rates and to alleviate the social injustice women typically face by being fully

responsible for contraception.

Teaching Shared Responsibility

Although developing more male contraceptives, especially LARCS, will make it
easier for men to contracept, it is unlikely that men will start contracepting at the same
rates women do without any changes in dominant ideas about contraceptive
responsibility. Technology (i.e. new male contraceptives) alone will not lead to deep
changes in our current contraceptive arrangement. Education, among other things, is also
a necessary factor. Sheldon Segal makes a similar point:

Technology, in itself, will not encourage the positive involvement of men

as supportive partners in reproductive health. This will take education, the
building of comfort and capacity to discuss contraception, and the

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willingness to come to joint decisions on a matter so personal in the lives
of husband and wife. (127).

Promoting shared contraceptive responsibility through education can pave the way for
profound, ideological change. I suggest bottom-up and top-down three ways the federal
government and other institutions can teach shared contraceptive responsibility.

First, the federal government can encourage (through funding) or even mandate
that primary and secondary schools teach shared contraceptive responsibility in
comprehensive sex education classes. The suggestion that the federal government shape
the sex education curriculum is not new. In the last eleven years, the federal government
has spent well over one billion dollars on abstinence-only education. Although all ﬁfty
states except California originally signed on to receive this federal funding, seventeen
states now decline it. The decision to reject federal funding reﬂects many state
politicians’ dissatisfaction with abstinence-only education programs and preference for
comprehensive sex education (Wire). Given the current movement against abstinence- '
only sex education, especially in light of the recent studies showing that it generally does
not delay teenage sexual activity, it seems likely that many state governments would
welcome federal funding for comprehensive sex education (Kohler, Manhart, and
Lafferty). Although the federal government is free to endorse various comprehensive sex
education programs, shared contraceptive responsibility should be a key tenet in all of
them. Explicitly teaching children and teenagers not only to use contraception, but also to
share contraceptive responsibility increases the likelihood that they will both contracept
and share contraceptive responsibility. Stressing the importance of shared contraceptive
responsibility before or around the time children and teenagers become sexually active

prepares them to make good and just decisions about sex and contraception throughout

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their lifetime. Currently, children and teenagers often learn about “normal” sexual
activity through the media, which rarely includes contraception, or other sources (e. g.
friends, pornography) unlikely to seriously and accurately discuss contraception. In
contrast, comprehensive sex education programs send the clear message to children and
teenagers that shared contraceptive responsibility is a normal, and expected, part of
sexual activity. Normalizing contraception reduces its stigma and promotes its use. In
sum, in giving states money for comprehensive sex education and perhaps even requiring
that states adopt such programs, the federal government enacts a top-down method for
teaching shared contraceptive responsibility to young people that can lead to deep
ideological change in how these individuals view sex and contraception.

Second, and similar to the previous suggestion, postsecondary schools for health
care professionals (e. g. medical school, nursing school) should include shared
contraceptive responsibility in their curricula. In addition to teaching health care
professionals the value of shared contraceptive responsibility, it is also imperative for
these professionals to learn ways to pass this message onto their patients. That is, the
point of changing the curricula is not only so that health care professionals recognize the
importance of shared contraceptive responsibility, but also so that they encourage their
patients to share contraceptive responsibility. Discussing contraception may be more
relevant in certain realms of medicine (e. g. gynecology and internal medicine) than others
(e. g. ophthalmology and orthopedics). However, although the study of medicine is
divided into bodily sections and functions, the human body is not; consequently, various

bodily sections and functions can affect others. There may be times when it is necessary

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for specialists to discuss sexual activity and contraception, so it is useful for them to have
an educational background and training in promoting shared contraceptive responsibility.
Additionally, including shared responsibility in the curricula is beneﬁcial because
it highlights that men are typically excluded ﬁ'om reproductive matters. Betsy Hartrnann
exclaims, “more often than not, family planning programs are geared exclusively toward
women, ignoring the basic reality of male dominance or male responsibility for birth
control” (52). Family planning providers are sometimes hostile to men, for example, not
believing what men say if it contradicts their female partners’ statements. Moreover,
family planning providers often fail to discuss sex and contraception with men, even
when the primary reason for the visit is treatment of a STD. Men generally do not think
reproductive health includes them (Edwards 78). And as Hartrnann and Sharon Edwards
assert, it often does not. Here is another glaring example: whereas women are supposed
to see a gynecologist once they become sexually active, there is no equivalent for men
(ibid.). Expanding the health care professional school curricula the health care
professional school cunicula could also lead to structural changes that would foster
shared contraceptive responsibility, such as more reproductive services directed at men
and the potential burgeoning of the ﬁeld of andrology (the medical specialization of
men’s health; that is, the male equivalent of gynecology (see Rankin». The suggestion of
incorporating shared contraceptive responsibility into health professional school curricula
would not only effect ideological change for health care professionals, but also for their
patients. This suggestion, combined with the ﬁrst one (teaching comprehensive sex

education at the primary and secondary levels), would reinforce the importance of shared

 

contraceptive responsibility.

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A third suggestion does not entail direct instruction, but rather indirectly shaping
people’s behavior through laws and policies. One way to indirectly promote shared
contraceptive responsibility is to hold men legally responsible for their sexual and
reproductive decisions. Examples of such laws already exist: forcing men to pay child
support for children they fathered and classifying rape as a crime. Politicians and
policymakers should work to strengthen existing laws and policies and strive to pass new
ones, such as eliminating the statute of limitations on rape cases (New York recently
eliminated their very restrictive statute; see Emily Goodman). Since morality and legality
often go hand-in-hand, laws that hold men responsible for their sexual and reproductive
decisions send the message that men have a moral obligation to act in certain ways
regarding sex and reproduction and to assume responsibility when they do not. Creating
legal consequences for men’s sexual and reproductive choices teaches men to take
responsibility for their actions, which hopeﬁrlly pushes them to make better decisions and
minimizes their ability to shirk from responsibility and blame. While laws alone will not
engender a profound ideological transformation, they produce behavioral changes that

can lead to ideological changes.

Striving Toward Gender Equality: Women’s Education and Employment
While the previous two suggestions—developing male contraceptives and
teaching shared contraceptive responsibility—focus on reproduction, it is important to
look beyond the reproductive realm in order to make deep and lasting changes within it.
Reproductive matters do not exist in isolation, but rather are strongly inﬂuenced by and

reﬂect matters in other realms and in society at large. As Ruth Dixon-Mueller asserts,

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“women’s reproductive rights depend in fundamental ways on the exercise of women’s
rights in other spheres” (xii). In order for women and men to support the idea of shared
contraceptive responsibility and for men to accept their responsibility to contracept, they
must not only afﬁrm gender equality, but also strive toward it.

Numerous studies have conﬁrmed that there is a reciprocal relationship between
gender equality and contraceptive use and between gender equality and shared
contraceptive responsibility. Indeed, couples who more equally share power are more
likely to accept contraceptive use (Hartrnann 52). Patricia MacCorquodale elaborates:

The more egalitarian an individual’s gender-role attitudes, 1. the geater

the likelihood of believing that contraceptive use and responsibility should

be shared, 2. The more ﬁequently she or he will have discussed

contraception before having intercourse, 3. The more frequent and more

effective the contraception used will be. (5 8)

Note that this reciprocal relationship exists for both men and women. A study by William
Grady et al. shows that men “who held more egalitarian attitudes were more likely to
think that men and women have a shared responsibility for contraception” (221).
Likewise, women who maintain equal relations between women and men usually believe
contraception should be a shared responsibility. In contrast, men who uphold traditional
gender roles typically assume that contraception is “women’s work.” Similarly, women
who follow traditional gender roles are more likely to believe they alone should take on
full contraceptive responsibility. Although women who uphold traditional feminine roles
may be held responsible for contracepting, they are not always the ones making
contraceptive decisions. In some unequal heterosexual relationships, particularly those in

highly gender stratiﬁed cultures, men make most if not all of the decisions surrounding

sexual and reproductive matters (see, for example, Al Riyami et al.).

232

 

Women’s education and employment are crucial for equal gender relationships.
Education and work outside the home are signiﬁcant sources of empowerment for
women. It is well documented that female literacy is a necessary component for
improving the lives of women and their families in “developing” countries. Speciﬁcally,
education is “an essential factor in preparing people to lead healthy, socially rewarding,
and economically productive lives (Hammad and Mulholland 103). In addition to
improving women’s lives more generally, women’s education and employment are
statistically shown to decrease women’s fertility (Sen 1053). And this makes sense—
when women have more knowledge and power they are better equipped to autonomously
make decisions about their reproduction and, moreover, they have the capability to act
upon their decisions (i.e. use contraception to control their fertility). Educated women not
only feel more conﬁdent in making their own reproductive decisions; men are more
likely to be respectful of educated women’s autonomy. Men with educated partners
typically support contraceptive use and are usually less likely to exhibit male dominance
in the reproductive realm (Hartrnann 52; Grady 223). In short, when women are educated
and when they work outside the home, there is a greater probability that men will
perceive them as equals, rather than as subordinates. And consequently men will be more
willing to afﬁrm women’s ability to make their own reproductive decisions and to
support their choices.

Given the considerable effect women’s education and employment has on gender
relations, governments (both in the US. and abroad) should prioritize girls’ education
and Women’s employment. Girls’ education should be mandatory (as it currently is in the

US). Yet, in many places in the world, even if girls are legally required to attend school,

233

they often lack the ability to do so; for example, they have to work on the farm all day,
they do not have transportation to the school, their parents prohibit tlrerrr from attending
school, etc. The obstacles girls face are complex and varied and are beyond the scope of
this project. However, governments, perhaps in conjunction with nonproﬁt organizations,
should strive to make education a reality for girls. Furthermore, governments should
encourage women’s work in the public sector through programs like afﬁrmative action.
Supporting women’s education and public employment is a ﬁnancially smart move for
governments since it leads to reduced fertility and a greater percentage of citizens
contributing to the economy. These approaches are also good from a social justice
perspective, as they are a way of combating patriarchy. Women who are empowered
through education and public employment are more likely to be able to negotiate
contraceptive use, and more speciﬁcally, shared contraceptive responsibility.
Additionally, women’s empowerment has the potential to improve women’s lives in all
realms, not just the reproductive realm. For example, expanding women’s economic
opportunities and increasing their wealth will likely augment their overall health and the
health care they receive.“ Improving women’s lives overall and minimizing, and
possibly eradicating, unjust gender roles is beneﬁcial both to women and to society

overall.

Achieving Shared Contraceptive Responsibility
Due to the systemic nature of oppression, patriarchy needs to be challenged on

multiple fronts in order for the vision of shared contraceptive responsibility to be

 

45 Countries with a more equitable distribution of income tend to have citizens with better health outcomes
than equally wealthy countries with unequal distributions of wealth (Daniels, Kennedy, and Kawachi).

234

realized. The goal of this chapter has been to provide a few practical strategies for
achieving this vision. Clearly, these are not the only strategies, though they are a good
starting point, especially because they address different areas of change. Developing male
contraception, and in particular male LARCS, is important because men are more likely
to assume contraceptive responsibility if there are palatable contraceptive options
available to them. Additionally, the availability of male contraceptives, and their eventual
normalization, will encourage men to contracept. However, since the mere existence of
male contraceptives will not change contraceptive ideologies, it is imperative that shared
contraceptive responsibility is explicitly taught. Instilling children, health care
professionals, and the general public with the belief that men ought to be and will be held
responsible for their sexual and reproductive decisions lays the groundwork for
ideological transformations about contraceptive responsibility. In order for deep and
lasting ideological changes in the realm of contraception, there also needs to be
ideological change more generally. Empowering women through education and public
employment puts us on the path toward gender equality, which includes shared
contraceptive responsibility.

Shared contraceptive responsibility is best way, and perhaps the only way, of
achieving contraceptive justice. Working to eliminate contraceptive and gender
ideologies that portray women as untrustworthy is an important step in increasing their
reproductive and overall autonomy. Women’s reproductive autonomy is also enhanced
by holding men responsible for their sexual and reproductive actions. When men are held
responsible for contraception, women no longer experience full contraceptive

responsibility and all of its associated burdens. In an ideal arrangement of shared

235

contraceptive responsibility, neither partner faces limited autonomy, distrust, or unfair
contraceptive burdens. Moreover, in such an arrangement, both partners are empowered
and trusted to control their fertility, which typically leads them to make better decisions
and have better outcomes. Improved decision-making not only beneﬁts the agents of such
decisions, but it also behooves other individuals (especially potential fetuses in the case
of contraception) and society at large. Given the advantages of shared contraceptive

responsibility, individuals and governments should strive to achieve it.

236

APPENDICES

237

 

TABLE 1: WOMEN AND CONTRACEPTION USE IN THE US.

(IN NUMBERS AND PERCENTAGES)

 

 

 

 

 

 

 

 

Category Who Number (in millions) Percentage
A People in the US. 2937* N/A
B Women in the US. 149.1* 51% ofA
C Women Ages 15-44 62 42% of B
D Women Ages 15-44 Who Need to 43 70% of C
Contracept (They are fertile and
sexually active and do not want to
become pregnant)
E Women Ages 1544 Who Do Not 19 30% of C
Need to Contracept (They are
infertile, pregnant, postpartum,
trying to become pregnant, have
never had sex, or are not sexually
active)
F Women Ages 15-44 Who 38 62% of C
Contracept and 89% of
D
G Women Ages 15-44 At Risk of 5 7% of D

 

Unwanted Pregnancy: Due only to
not contracepting

 

 

 

 

Due to rounding, numbers may not exactly equal 100.

* Source: US. Census Bureau. All other information comes ﬁom The Alan Guttrnacher
Institute, 2008b.

 

 

238

 

 

TABLE 2: CONTRACEPTIVE FAILURE RATES, 2004

 

 

 

 

 

 

 

 

 

 

 

 

Contraceptive Method Perfect use (%) Typical use
(%)
Chance 85 85
Coitus interruptus (withdrawal) 4 27
Male condom 4 15
Diaphragm 6 16
IUD 0.1-1.5 0.1-2.0
Oral contraceptive 0.3 8
Intramuscular long-acting progestin (Depo Provera) 0.3 3
Rhythm 9 25
Spermicidal foam 8 29
Vasectomy 0.10 0.1 5
Tubal ligation 0.5 0.5

 

 

 

 

Source: Hatcher 2004, foreword

 

239

 

 

 

 

TABLE 3: CONTRACEPTIVE METHOD BY POPULARITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method No. of users (in 000s) % of users

Pill 1 1,661 30.6
Tubal sterilization 10,282. 27.0
Male condom 6,841 18.0
Vasectomy 3,51 7 9.2
3-month injectable 2,024 5.3
Withdrawal 1 ,513 4.0
IUD 774 2.0
Periodic abstinence (calendar) 450 1.2

. II)r:lrt;;lhant, l-month injectable, 461 1.2
Periodic abstinence (natural
family planning) 133 '4 I
Diaphragm 99 .3
Other* 354 .9
TOTAL 38,109 100.0

 

 

* Includes the sponge, cervical cap, female condom and other methods.

Source: The Alan Guttrnacher Institute, 2008b

 

240

 

 

TABLE 4: PERCENTAGE OF CONTRACEPTIVE USE BY WOMEN’S AGE

 

30-34

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method 1544 15—99 20-24 25-29 35—39 40-44
Female sterilization 25.6 0.3 3.6 16.0 27.7 38.6 46.7
Pill 24.9 35.4 47.6 36.6 26.8 10.5 5.5
Male condom 18.9 29.7 24.0 22.8 17.3 15.9 11.5
Male sterilization 10.1 0.0 1.0 4.2 9.8 17.6 19.0
No method 7.5 19.3 8.6 6.4 5.7 5.6 6.7
Withdrawal 2.9 3.3 3.0 3.5 2.7 3.0 1.8
Irrjectable 2.7 7.9 5.6 3.9 1.7 1.0 0.3
Rhythm 2.2 1.1 0.9 1.6 3.0 2.7 2.4
Diaphragm 1.7 0.0 0.1 0.3 0.4 0.5 0.3
Implant 1.3 2.2 3.4 1.9 0.6 0.3 0.1
Spermicides 1.3 0.8 1.1 ' 1.6 1.4, 1.0 1.8
IUD 0.7 0.0 0.3 0.7 0.8 0.9 1.2
Other* 0.1 0.0 0.1 0.0 0.3 0.1 0.5
Female condom 0.0 0.0 0.1 0.0 0.0 0.0 0.0

 

 

 

 

 

 

 

 

 

* Other includes cervical cap, sponge, and other unspeciﬁed methods.

Source: Hatcher 2004, 223

 

241

 

 

TABLE 5: ANNUAL COST IN DOLLARS FOR CONT RACEPT ION

(INCLUDES METHODS AND SERVICES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method Public Provider Managed Care
Setting Setting
Tubal ligation* 1190.00 2466.80
Vasectomy* 353.28 755.70
Oral contraceptives 228.96 290.00
Injectable 186.20 272.00
Progesterone-T IUD (effective 5 years) 155.22 359.00
Female condom 103.75 303.78
Implant" 103.62 164.70
Sponge 68.89 124.50
Male condom 27.39 83.00
Copper-T IUD (effective 10 years) 18.22 46.10
Cervical cap° 6.33 10.33
Diaphragm° 5.00 6.00
Withdrawal 0 0
Rhythm 0 0
No method 0 O

 

 

 

 

*One time cost

" Includes method, insertion, and removal divided by 5 years, which is the length of
effectiveness for Norplant, the most common implant in the US. There are other types of
implants with different ranges of effectiveness. For example, Irnplanon lasts for 3 years.

° Does not include spermicide cost or price of ﬁtting (ﬁtting costs $38.00 for a managed
care setting and $15.59 for a public provider setting). Source: Hatcher et al. 245

 

242

 

 

TABLE 6: MEDICAL INVOLVEMENT FOR CONTRACEPT ION MEASURED
BY PHYSICIAN VISIT AND PRESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method Physician Visit" Prescription*
Oral contraceptives Yes Yes
The patch Yes Yes
The ring Yes Yes
Injectable Yes Yes
Tubal ligation Yes No
IUD Yes No
Implant Yes No
Cervical cap Yes No
Diaphragm Yes No
Sponge No No
F ernale condom No No
Vasectomy Yes No
Male condom No No
Withdrawal No No
Rhythm No No

 

 

 

 

A Physician visit means that the patient must see the doctor at least once in order to
acquire the contraceptive.

*Prescription is deﬁned as having to go to the pharmacy or doctor to continue renewing
one’s contraceptive method.

 

243

 

 

TABLE 7: HEALTH-RELATED DANGERS, SIDE EFFECTS, AND
N ONCONTRACEPTIVE BENEFITS OF CONTRACEPTIVES

 

 

 

 

 

Method Dangers Side Effects N oncontraceptive
Benefits
Combined Cardiovascular Nausea, headaches, Decreases menstrual
hormonal complications dizziness, spotting, pain, PMS, and blood
contraception (stroke, heart weight gain, breast loss; protects against
(pill, patch, and attack, blood clots, tenderness, symptomatic PID, some
ring) high blood chloasma cancers (ovarian,
pressures), endometrial) and some
depression, hepatic benign tumors
adenomas, possible (leiomyomata, benign
increased risk of breast masses), and
breast and cervical ovarian cysts; reduces
cancers acne
IUD PID post insertion, Menstrual None known expect
uterine perforation, cramping, spotting, progestin-releasing
anemia increased bleeding IUDs, which decrease
menstrual blood loss
and pain
Male condom Anaphylactic Allergy to latex Protects against STDs
reaction to latex
Female condom None known None known Protects against STDs

 

 

 

Implants Infection at implant Tenderness at site, May decrease
site, complicated menstrual changes, menstrual cramps, pain,
removals, hair loss, weight and blood loss
depression gain

Injectable Depression, allergic Menstrual changes, Reduces risk of
reactions, weight gain, seizures, may protect
pathologic weight headaches, adverse against ovarian and

 

gain, possible bone
loss

 

effects on lipids

 

endometrial cancers

 

244

 

 

 

TABLE 7 CONTINUED: HEALTH-RELATED DANGERS, SIDE EFFECTS,
AND NONCONTRACEPTIVE BENEFITS OF CONTRACEPTIVES

 

 

Diaphragm, Vaginal and urinary Pelvic pressure, None known
cervical cap, and tract infections, vaginal irritation,
sponge toxic shock allergy, vaginal
syndrome discharge if left in
too long
Sterilization Infection; Pain at surgical site, Tubal sterilization
anesthetic psychological reduces risk of ovarian
complications; if reactions cancer and may protect
pregnancy occurs against PID
after tubal
sterilization, high
risk it will be
ectopic

 

 

 

 

 

Source: Hatcher et al. 2004, 241

 

245

 

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246

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