Popularity of apps like Natural Cycles highlights serious issues with contraceptives today

Natural Cycles

Many women have made a dramatic change in their use of contraceptives of late. Specifically, use of “contraceptive apps” such as Natural Cycles, a smartphone app that predicts the days on which a woman is fertile and can be used for contraception (as well as planning pregnancy), is on the rise. By closely tracking a woman’s cycle and temperature, such apps designate unprotected sex safe or unsafe each day. When unsafe, the use of barrier methods of protection is advised.

Natural Cycles was developed by CERN scientist Elina Berglund and her husband, Raoul Scherwitzl, whose scientific background has lent the app a certain kudos. And as “the only app certified for contraception” in Europe and, as of August 10, the US, women who might otherwise be suspicious of the method, which is at the end of the day simply jazzed up natural family planning, have taken the plunge.

The fact that many women are spurning more “medical” kinds of contraception, such as the pill or IUD, in favour of such apps, along with discussion in some cases of their failures, are once again drawing public attention to the hazards of being a pre-menopausal, heterosexual, sexually active woman. The risks of contraceptives range from milder side effects to rare but potentially serious complications. These, of course, come alongside the ever present risk of unintended pregnancy through contraceptive failure.

Many women report side effects with the contraceptive pill, but often aren’t listened to.
Suriyachan/Shutterstock

Understated side effects

When choosing a method of contraception, women routinely have to balance the impacts of each method against its likely effectiveness. Most of the evidence suggests that it is common for women to choose the least bad option in terms of side effects, rather than something they are really comfortable with. Consequently, it’s not surprising that a technology that promises to overcome many of these difficulties would prove to be popular.

Being able to control fertility is essential for women’s equality, yet the means to do this are currently all imperfect. Side effects are a common experience and are a major cause of women stopping using particular birth control methods. In contraceptive consultations, the frequency and severity of side effects and other more serious health risks are often understated.

Research suggests that health professionals seek to avoid mentioning issues they believe would cause undue concerns. This reluctance to disclose may be linked to historic ideas that women are not fully capable of rational decision making. The assumption that women are not to be trusted with contraception is most clearly seen in the promotion of long-acting reversible contraception (LARC): the injection, implant, and hormonal and copper coils. The evidence shows that some women who encounter difficulties sometimes struggle to get health professionals to remove their LARC. Women are expected to put up with side effects rather than taking a bigger risk of unintended pregnancy.

A perfect woman

Culturally speaking, unintended pregnancies are usually frowned upon. This is particularly the case for younger women and those in marginalised circumstances. This denigration links to ideas about irresponsibility more generally. Popular stereotypes of “feckless” families who have babies for benefits are commonplace, but are rarely accurate. In the US for example, the idea of the “welfare queen” has been shown to be false.

In the UK, it is government policy to limit the number of children claimants can receive benefits for. As in-work poverty means increasing numbers of families are reliant on benefits, more and more women will have their fertility judged.

Stereotypes of who would be or not be a “good” mother can be seen in healthcare providers’ assumptions of who would particularly benefit from LARC. It is also important to remember that the stigma surrounding abortion builds on assumptions of irresponsible women failing to successfully control their fertility. This is despite the evidence that contraceptive failure is a significant reason for needing abortion.

Failed contraceptives are a major cause of unwanted pregnancy.
Vadim Zakharishchev/Shutterstock

The cultural notions that women fail, rather than the fault being with contraceptive technologies, has even become standardised within health information. Many contraceptive information pages have institutionalised notions of women’s irresponsibility by including statistics on effectiveness reporting “perfect” and “typical” use. Given that “perfect” use for some methods is actually beyond women’s control (for example, the impact of a stomach upset on the pill), just showing “typical” use would ensure women were informed properly but without being judgemental.

Although women are largely held responsible for failure, that does not necessarily mean they are seen as responsible enough to make decisions over which birth control method to use. Although in other parts of the world, emergency hormonal contraception is available in supermarkets or even vending machines, in the UK and Australia, women wanting access need to have a consultation, even if this just takes place in a pharmacy. This is not necessarily to access them medically, but so they can be “advised” to avoid future “mistakes”.

Gendered inequality

In an age where relationships are supposed to be equal partnerships, contraception raises equality issues. To date, the “male pill” still has not materialised, leaving men with few options. Condoms are often not seen as “proper” contraception for ongoing relationships. The protection they provide against sexually transmitted infections means that they are associated with casual partners.

Condoms tend not to be used by those in ongoing relationships.
BORIMAT PRAOKAEW / Shutterstock.com

Meanwhile the idea of vasectomy (which should obviously only be undertaken if a decision of no future children is made) is popular with women for equality reasons. It allows couples to take turns over contraceptive responsibility over time. But many men do not seem to be that keen.

It’s also important to remember that pregnancy carries some risks for women alone. Even if they are supportive partners, men do not face the same biological issues of either continuing or ending a pregnancy. While there are now challenges to the expectations that women should always be the primary carer of children, changes in attitude cannot overcome this biological reality of pregnancy.

So it’s unsurprising that such apps are popular. Avoiding the health difficulties that many women experience with other contraceptive methods is appealing. But women are still waiting for better contraceptive solutions. In the meantime, reducing the stigma and costs of unintended pregnancy and abortion would an extremely useful step in recalibrating the understanding of the difficult balance women make between embodied impacts and the effectiveness of the current options.

Pam Lowe, Senior Lecturer in Sociology, Aston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Social egg freezing: balancing hope and hype

The topic of social egg freezing once again hit the headlines last week (8th August) with the release of a statement from the Royal College of Obstetricians and Gynaecologists (RCOG) which called for caution over the technology and greater recognition of its limitations. Drawing on my research on this topic, I was pleased to provide various comments on this statement live on Sky News, Radio Four, and BBC News throughout the day.

Dr Kylie Baldwin live on Sky News (08/08/2018)

The statement from the RCOG came following the release of two papers published in the British Journal of Obstetrics and Gynaecology on social egg freezing, and offered guidance and advice to women who are considering freezing their eggs. This advice is much overdue and is the first to come from an official UK body in almost 10 years (Cutting et al, 2009). The lack of such easily accessible advice thus far is surprising, if not concerning, not only because the numbers of egg freezing cycles being performed has risen by over 400% in the last eight years (HFEA, 2018), but also because several authors have raised questions about the quality and limitations of the reporting of the technology on clinic websites as well as in the popular media (Avraham et al, 2014; Mayes et al 2017; Wilkinson et al 2017).

In their statement the RCOG recognised the potential of egg vitrification in enabling women to have children later on in life, but also provided a warranted word of warning to women considering freezing their eggs noting the high cost of the technology and low rates of success. Research shows that women are currently on average 37 years of age at the time of freezing their eggs, and in 2016 less than a third of the egg freezing cycles performed were done with women aged 35 years or below (HFEA, 2018). This is significant given that a woman’s age the time of undergoing the procedure and the number of eggs frozen are recognised as the most important predictors of a future live birth (Doyle et al, 2016). Offering further comment from the RCOG, Adam Balen Professor of Reproductive Medicine, suggested that women who are considering the procedure should freeze their eggs as early as their 20s and certainly before the current average age of 37. However, women are only able to store frozen eggs for 10 years unless they can prove that they have become prematurely infertile in which case an extension to the storage period can be obtained up to 55 years. As I have described elsewhere this means that if a woman freezes eggs at 28 years of age she must use them by the time she is 38 or they will be destroyed leaving her without a fertility ‘back up’ plan right when she may need it the most. It is for this reason why myself and colleagues have launched a campaign to see the storage time limit extended.

Echoing other professional guidelines, the RCOG noted how clinics have a responsibility to provide women with a realistic idea of the likelihood of a live birth with their eggs relevant to their age at time of freezing. However, my research interviewing users of this technology found that women struggled to elicit age-specific and clinic-specific success rates about their chance of a future live birth and instead had to rely on limited published data from other centres that often did not reflect, or were not specific to, their age at time of freezing. This is most likely because unlike the success rates of IVF treatment which are published on the HFEA website, it is much more difficult to obtain success rates of IVF using previously frozen eggs as currently only small numbers of women have returned to use their eggs to attempt conception. This lack of clear data about their chance of a future live birth was troubling for some of my participants, yet women often suggested that by undergoing the procedure they would always be improving their chance of motherhood in the future. However, the problem facing these women as well as prospective users of egg freezing now, is that it is difficult to estimate to what extent they will be improving their chances. I suggest that a vague notion that egg freezing may increase the chance of a live birth in the future could lead a woman to spend the £5,000 plus required to freeze eggs. However, if the same woman was provided a more evidenced-based estimate that the chance of success may only be 5-15% she may feel under less pressure to undergo the procedure ‘just in case’ due to the low rate of success she may encounter. This is significant as my research found that a fear of future regret, of not making use of the technology and suffering unwanted childlessness in the future, was a key factor motivating many women to engage with the technology. Thus, if women are provided with information which clearly articulates the limitations of egg freezing they may feel under less pressure to engage with the technology and may feel less blame and guilt about their non-motherhood status both in the present as well as the future.

Whilst the RCOG provided some useful information to prospective users of egg freezing it was not able to offer insights in to what it is like to undergo the procedure. As such we were pleased to learn that on the same day of the release of the RCOG statement a paper by myself and Professor Lorraine Culley examining women’s experiences of social egg freezing was accepted for publication in the journal ‘Human Fertility’. In this paper we discuss how the process of egg freezing poses a different set of challenges for women compared to those experienced by individuals undergoing IVF to conceive. In particular, the women in our research often reported feeling lonely and isolated when undergoing the procedure, in part due to the fact that they were doing so without a partner. They also described a degree of stigma and embarrassment about making use of egg freezing and for ‘still being single’ at a stage in the lifecourse when normative expectations often included marriage and motherhood (Becker, 1997). As such, in many cases the most challenging aspect of undergoing the procedure for our participants was doing so alone and at a time where they would have preferred to have been pursuing motherhood naturally with a partner.

The participants in our research were generally satisfied with the care they received from the clinic, however they believed that clinics could improve their support of women undergoing egg freezing. This included by ensuring better awareness among clinic staff that women might be at the clinic to freeze eggs and not to attempt conception; by providing more time in consultations for women attending alone; and by displaying greater sensitivity and understanding of the reasons behind women’s use of egg freezing.

Our upcoming paper will reiterate the comments made by the RCOG and suggests that to ensure egg freezing is not oversold as a way to ‘stop the biological clock’ it is imperative that women are given as much individualised information as possible about the likelihood of having a live birth with frozen eggs or at the very least, are clearly informed of the limitations of current evidence. Furthermore, we suggest that it is important to make clear to all women, men and couples that the postponement of childbearing always lowers the chances of becoming a parent, even if they have access to IVF, and that IVF and ICSI have limitations and risks as does pregnancy in later life (Bewley et al, 2005)

By Dr Kylie Baldwin

References

AVRAHAM, S., MACHTINGER, R., CAHAN, T., SOKOLOV, A., RACOWSKY, C. AND SEIDMAN, D.S., (2014) What is the quality of information on social oocyte cryopreservation provided by websites of Society for Assisted Reproductive Technology member fertility clinics?. Fertility and Sterility, 101(1), pp.222-226.

CUTTING, R. et al. (2009) Human oocyte cryopreservation: evidence for practice. Human Fertility, 12 (3), pp. 125-136.

MAYES, C., WILLIAMS, J. AND LIPWORTH, W., (2017) Conflicted hope: social egg freezing and clinical conflicts of interest. Health Sociology Review, 27(1), pp.45-59.

WILKINSON, J., VAIL, A., & ROBERTS, S. A. (2017). Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites. BMJ open, 7(1), e012218.

Human Fertilisation and Embryology Authority (2018) Fertility Treatment 2014-2015 Trends and figures. HFEA Available at https://www.hfea.gov.uk/media/2563/hfea-fertility-trends-and-figures-2017-v2.pdf Accessed 14/08/2018

DOYLE, J.O., RICHTER, K.S., LIM, J., STILLMAN, R.J., GRAHAM, J.R. AND TUCKER, M.J., (2016) Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertility and Sterility, 105(2), pp.459-466.

BECKER, G. (1997). Disrupted lives: How people create meaning in a chaotic world. Univ of California Press.

BEWLEY ET AL (2005) Which career first? The most secure age for childbearing remains 20 – 35. British Medical Journal, 17, pp. 588-589.

 

Personal Reflections on Non/Mothers, Other-Mothers, Mothering and Being Mothered

We live in a world where the identity of woman and mother are still often seen as interchangeable. As a result, there are many ways that women who do not (currently) mother in traditionally defined and valued forms can feel excluded. Furthermore, many of those without a mother similarly experience their difference to others as painful.

Mother’s Day, and accompanying Hallmark inspired celebrations, can be difficult for those who are motherless and/or nonmothers and yet these identities are more fluid than is often acknowledged. Mothering Sunday then might be a better term for such celebration given as it allows for the inclusion of our memories of being mothered and our past, present and future experiences of mothering children and other adults – in both our personal and work lives – in many and varied ways. This includes, but is not restricted to, women whose children have died, are estranged from them or who live far away; women who mother children to whom they are not biologically related; women who mother children (and adults) through their paid or voluntary work life; and the mothering of friends.

My personal identities as non/other mother (M/Other) and as daughter (now ‘orphaned’), alongside my professional identities as teacher, researcher, supervisor and mentor, have been significant to, and within, my auto/biographical work as a feminist sociologist (see for example Letherby 2017, Brennan and Letherby 2017). I have attempted a critical auto/biographical approach to explore aspects of my professional and personal identity with reference to (non/other) maternal status and experience. I have undertaken research and written (alone and with others) in the areas of perinatal loss, ‘infertility’ and ‘involuntary childlessness’ (written in quotation marks to highlight problems of definition) teenage pregnancy and young parenthood; experiences of pregnancy and early motherhood for women living with long-term health conditions; identity issues for women with polycystic ovary syndrome; older motherhood; stay-at-home mothers; the ‘voluntary’-‘involuntary’ childlessness continuum; and non/motherhood within institutions (including universities and prisons). I have also recently begun to reflect and write on the experience of being mothered.

Alongside my academic writings I write fiction, memoir and political opinion pieces some of which refers or relates to my academic work in these areas. This is an extract from a piece I wrote for Mother’s Day (in the UK) in 2017:

‘Thirty-two years ago, when I had my miscarriage my central aim was to be a mother and I felt that I was only half a woman without a child.  Any doubts or ambivalences I had about becoming a mother I denied. I now feel very different. I no longer see myself as a lesser woman (or less than adult) for not mothering children. I am also able to accept the equivocal nature of my desires – that is, a part of me enjoys the freedom that I have had and have because of my biologically childless state. And if I had become a biological mother I know that I would have felt opposing emotions in relation to that experience also. Of course, I cannot know how my life would have turned out if I had carried my baby successfully to term. My return to education a couple of years after my loss would likely not have happened but given the opportunities I have not had I will be forever grateful for the fulfillment my studies and subsequent work in higher education have given me. It is not only the intellectual stimulation I am thankful for but also the relationships I have made with students and younger colleagues. Indeed, most of my working life, as nursery nurse and as academic, has provided me with opportunities to support and encourage younger people. Although, I am amongst the first to critique the view that women should automatically be expected to care at work as well as at home, personally I feel privileged to be able to do this.’

As my maternal desires, intentions and experiences have changed I am aware that I have shifted my position on what James H. Monach (1993) calls the ‘voluntarily’/ ‘involuntary’ childless continuum. I prefer this to Anne Woollett’s (1996) description of her own move from ‘infertile’ to ‘childless’ for I have always had children in my life (through my work and in my relationships with the children and grandchildren of close friends). Now in my late fifties my life is a fulfilling mixture of paid and voluntary work (both within and outside of the academy) some political activism and time spent with close and loving friends (of all ages).

I still grieve for the children I do not have and am regularly reminded of what is missing from my life, in terms of daily interaction with children and grandchildren of ‘my own’. However, I appreciate the value of my life as it is and the many positives and privileges associated with it.

Throughout my career I have, on occasion, had my academic choices challenged. My auto/biographical approach has been devalued or dismissed as not academic (enough) even self-indulgent (Letherby 2000) but I have always felt confident enough to counter this with academic argument (e.g. Letherby 2013). The ‘critique’ of my personal, as opposed to my academic, identity has at times been harder, at least emotionally, to counter. On the break-up of his previous relationship my second (late) husband John was given custody of his two teenage sons. For the first eight years of our time together both boys lived with us full-time and on occasion spent long periods of time at home well into their twenties. These relationships made me think again about my own biological childlessness and were both a challenge and a revelation to me. I never defined myself as the boys’ mother and they did not see me this way either but I do feel that my relationship towards them was, for many years, parental.Thus, there were times when it felt appropriate to say yes when asked if I had any children and in an ironic twist on my status there were times when I felt like an ‘involuntary’ parent. When writing about this in a journal article the editor of the feminist publication changed my reference to ‘a parental relationship with John’s two sons’ to ‘a kind of parental relationship’.

Throughout our 53 years together, and since her death six years ago, friends and acquaintances have commented on the rapport and warmth between my mother and I. Indeed, not least with reference to my status as non(biological) mother. As I have described elsewhere: ‘I feel sure that I would not have survived intact, reformed as whole without my mother’s support and unconditional love. For her it was all about me, always about me and it was not until after her death that I realised she never, ever, spoke of her own loss, no babies for me, no grandbabies for her’. Despite this, it has been suggested to me, several times, at academic conferences and seminars and in published pieces, that a woman can never really understand, or be completely close to her own mother until she becomes a mother herself.

Outside of academia there is also exclusion. One recent experience demonstrates how my academic and personal identities interconnect. In 2017 At ‘The World Transformed’ at the 2017 Labour Party Conference a group called Mums4Corbyn launched. To accompany this the New Socialist put out a call for a series of articles on the ‘politics of contemporary motherhood’. I submitted a pitch for consideration:

My concern is with the political significance of all women whether mothers, nonmothers or other-mothers (women whose mother status is considered lesser, even ‘unreal’). This is important because the ideologies and expectations of ideal motherhood affect all women, in our private and our public lives and the image of the ideal woman – which is arguably synonymous with the image of the ideal mother – also affects us all, whether mother, other-mother or nonmother. Feminism can be criticized for focusing on motherhood at the expense of a consideration of sisterhood. Yet any (political) understanding of motherhood and mothering needs to embrace the experience of nonmothers and other-mothers. It is only through such holistic reflection on our similarities and our differences that as sisters together we can challenge that which divides us and holds us back and celebrate our ‘collective and communal relations’ which will enable to us work together for ‘transformative change’.

Sadly, the editors felt that my piece did not ‘quite match’ their intended agenda. Which in turn, I would suggest, is a further denial of the relevance of the very many of us who have an identity and experiences defined by society as lesser (see here for more on this).

This rejection has prompted more reflection and writing. I’ll end here with an extract from a piece of prose poetry:

Being Other

. . . .

Yet, there remains a sense of difference, compounded at times by exclusion.

Still feeling other and sometimes being othered.

Being also, at least at some level, an expert in my own experience, and through much study and research the experience of similar others, does not always protect me from distress.

So what of the latest exclusion, that which forces me to relive my loss (yet again), and its’ social, emotional and material aftermath, more than thirty years on from the life-changing night when all this started?

This time a denial not only of our contribution and our value but also a rejection of my knowledge and expertise.

I appreciate then that my pride is hurt on top of all the rest.

I will recover, I always do.

But for the moment I’m left reflecting on the fragility of it all.

Contentment, self-worth, security in one’s achievements and meaningfulness, perhaps even some small legacy.

In a heartbeat all threatened.

Walking on ice.

Careful steps now …  

https://www.abctales.com/story/gletherby/being-other

Written by Professor Gayle Letherby, University of Plymouth

References

Brennan, M. and Letherby, G. (2017) ‘Auto/Biographical Approaches to Researching Death and Bereavement: connections, continuums, contrasts’ for Morality: Promoting the interdisciplinary study of death and dying 22(2): 155-169

 Letherby, G. (2000) ‘Dangerous Liaisons: auto/biography in research and research writing’ in G. Lee-Treweek and S. Linkogle, S. (eds.) Danger, Gender and Data in Qualitative Inquiry London: Routledge

Letherby, G. (2013) ‘Theorised Subjectivity’ in G. Letherby J. Scott and M. Williams Objectivity and Subjectivity in Social Research London: Sage

 Letherby, G. (2017) ‘To Be or Not to Be (a mother): Telling Academic and Personal Stories of Mothers and Others’ in G. Rye, V. Browne, A. Giorgio, E. Jeremiah and A. L. Six (eds.) Motherhood in Literature and Culture: interdisciplinary perspectives from Europe London: Routledge

Monach, J. H. (1993) Childless No Choice: the experience of involuntary childlessness London: Routledge