Contraception: a battle yet to be won

For World Contraception Day, Brook’s Head of Policy and Public Affairs, Lisa Hallgarten, writes of the immense progress made towards access to contraception, as well as the work still to be done.

Women have the right to decide if, when and how often to have children. Contraception is fundamental to achieving that right, and a vital tool in achieving gender equality. It’s an area where we’ve made enormous progress, but globally and locally there’s still work to do.

In the UK there’s a consensus that contraception is a good thing. But the road to free universal contraceptive provision was a long and winding one. It took decades of pioneering contraceptive champions in the UK – from Marie Stopes in the 1920s to the Family Planning Association in the 1930s to our founder Helen Brook in the 1960s  – to put contraception into women’s hands, into medical training and onto the political agenda. A film I made to celebrate the 1967 Family Planning Act celebrates the work of some of them.

Globally it’s still a battle to be won.

The World Health Organization calculates that in three regions of the world nearly 50% of women have an unmet need for contraception. That’s a lot of women having to endure multiple unwanted pregnancies often in places with no safe, legal abortion to fall back on. In addition to political or religious resistance it’s often just seen as a low priority in areas with so many other critical health issues.

Locally we have our own challenges, including public health funding cuts, which are making it harder for people to access the full range of contraceptive methods. There are also people who can’t find a method that works for them so we still need a better choice of contraceptive methods – including ones that would allow men to control their fertility and reduce the burden on women of having to take all the responsibility.

Beyond choice and accessibility, there are other barriers to effective contraceptive use.

Most of us could do with a better understanding of fertility cycles and how different contraceptive methods work. We also need confidence and communication skills to negotiate contraceptive use within relationships, and we need to feel safe. Too many women experiencing partner violence and coercive control are being forced to use, or prevented from using, contraception by a partner who wants to exercise control over their fertility.

Of course, contraception is just one aspect in a life course of reproductive health issues for women – from period poverty and heavy menstrual bleeding, to a range of gynaecological conditions, to fertility control or fertility support, to pregnancy and childbirth, abortion, menopause and the reproductive cancers. As most women need contraception for many years of their life, discussing and providing contraception is a brilliant opportunity to educate and support them with all these other things they are likely to experience over a lifetime.

Finally, we should remember that the reason contraception is needed is because people have sex for reasons other than procreation, including the opportunity to experience sexual pleasure.

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Yet it seems that male sexual pleasure is still prioritised over women’s. It is shocking and telling that Viagra is available over the counter, while hormonal contraceptive methods with fewer medical risks still require a prescription. This implicit judgment on women’s right or ability to make decisions about their reproductive health was illustrated when one high street chemist had to apologise for using judgmental language about women choosing emergency contraception. Female sexual pleasure is still not often or adequately addressed within relationships and sex education; and nor is effective contraception often promoted as something that can enhance sexual pleasure by removing the anxiety associated with unwanted pregnancy in heterosexual relationships.

So we have a long way to go…but today we’ll be celebrating our achievements. 55 years ago, Helen Brook opened her doors to provide unmarried women with contraception.

Today, Brook continues to fight tirelessly to empower young people to make informed choices about their use of contraception, and to ensure they are able to access a wide range of methods.

Through our network of clinics, as well as our education sessions and online resource hub, we ensure that all young people can access inclusive education and services.

We also support educators to develop the confidence, knowledge and skills to deliver comprehensive and effective relationships and sex education. Our eLearning courses for professionals are available free from Brook Learn on a range of topics including contraception, pleasure and puberty.

Happy World Contraception Day!