Contraception – who should be able to use it, and the role of government in its provision – has become a contentious issue, in part due to disagreements over the Affordable Care Act mandate positing that all private insurance plans must cover prescription contraception for women. The issue is not trivial, because nationally representative surveys show that more than 10 million women in the United States use the pill as their current method to prevent pregnancy. The pill is the most popular form of reversible birth control.
Across the political spectrum, both citizens and public officials tend to understand birth control as a “women’s issue” rather than as a healthcare or social policy issue. Usually, birth control is discussed as a matter of reproductive health and rights or treated as an aspect of women’s personal responsibility for managing their own sexuality. But where do men fit? How do they benefit from the availability and use of prescription birth control coverage? Could a better understanding of the ways prescription birth control coverage benefits heterosexual couples improve bipartisan discussions about coverage for contraception? My research provides insight into both of these questions.
Women’s Contraceptive Use and Couples’ Protection from Pregnancy
Contraception presumes the sexual involvement of couples, but surveys typically ask individual people about what method(s) they as individuals use to prevent pregnancy. By default, a woman who uses the pill for contraception also provides her partner with protection from pregnancy; and if her partner wears a condom, then both participants benefit. Contraception and condoms can be used together, but research shows that, in practice, couples in long-term relationships often move from using condoms to relying solely on prescription contraception.
Notably, interviews I conducted revealed that women who use prescription contraception for long periods of time rarely receive financial help from partners in purchasing it. Thus, although women’s birth control covers men, too, the men do not have to pay for this coverage and its benefits.
Men reap the positive effects of women’s use of prescription contraception in at least three ways: they gain protection from pregnancy without much effort; they avoid using condoms when couples transition to solely using prescription contraception; and they can spend money they might have spent on contraception on other items and pursuits. There is also another way that men benefit from female contraceptive use that is not often mentioned. Women must deal with the downsides of whatever type of prescription birth control they use – including downsides such as physical side effects like nausea or depression and hassles like having to repeatedly refill prescriptions at the pharmacy. Their male partners are freed from such issues.
Contraceptive Use and the Unequal Burdens of Dissatisfaction
Preventing pregnancy is generally not something that couples enjoy, because it can be stressful, costly, and bothersome. Although public attention focuses on men’s dissatisfaction with condoms, much less attention is paid to women’s dissatisfaction with prescription birth control methods. My research using survey data finds that nearly 40% of women ages 23 to 44 who had ever used hormonal contraception had stopped using it at some point because they were dissatisfied. Yet even though many women stop using a particular type of prescription contraception, they rarely stop contraception use altogether. They try various methods – different pills, or long-acting reversible contraception devices like implants and intrauterine devices – until they find something that feels right for them. As my in-depth interviews show, although many women experience dissatisfaction with side effects of particular birth control methods, they still believe that they should continue using some kind of prescription method.
Discussions that focus only on the benefits that prescription contraceptive coverage provides to women hide the ways that prescription birth control is very much like other medications – it can cause unpleasant and consequential side effects. By persisting despite dissatisfactions in their search for effective ways to prevent pregnancy, women provide tangible benefits for their partners, who get to avoid pregnancy without sharing such costs. Even when women find it difficult or unpleasant to use certain methods, they cannot always count on getting male partners to wear condoms – or otherwise take responsibility for the couple’s contraception. This may explain why data from nationally representative surveys show that women who experience dissatisfaction with contraception are at higher risk of unintended pregnancy. When the burden of responsibility for birth control is too great, some male partners cannot be counted on to pick up the slack.
What Does the Full Picture Mean for Debates about Contraception Coverage?
Recognizing that men as well as women benefit from prescription birth control coverage is crucial for appropriately evaluating the costs of rolling back the Affordable Care Act mandate for prescription contraception coverage. A nationally representative survey shows that only a very small percentage of people recognize that married women are the most likely to use prescription birth control. This may be because many of us are conditioned to see birth control as something affecting women rather than couples. Public debates might very well change if more Americans understood all the ways that women, men, and society at large benefit from women’s access to prescription birth control – and their willingness to use it despite dissatisfaction. Too often, pundits and partisan debates treat contractive coverage as simply a women’s issue or benefit. But if women, especially married women or women in long-term relationships, lose access to the most popular form of reversible contraception, so will men. Both men and women will experience new frustrations and costs.
Read more in Joanna Reed, Paula England, Krystale Littlejohn, Brooke Conroy, and Monica Caudillo, “Inconsistent Contraception among Women 20-29: Insights from Qualitative Interviews.” Family Relations (2014); Krystale Littlejohn, “‘It’s Those Pills That are Ruining Me’: Gender and the Social Meanings of Hormonal Contraceptive Side Effects.” Gender & Society (2013); and Krystale Littlejohn, “Hormonal Contraceptive Use and Discontinuation because of Dissatisfaction, Differences by Race and Education.” Demography (2012).