“It’s those pills that are ruining me”: Gender and the meaning of hormonal birth control side effects

Littlejohn_blogimageThe unintended pregnancy rate in the United States remains staggeringly high at 49% of all pregnancies. A question at the center of academic debates is why?

Research suggests that it is not simply that couples have never used birth control.  In fact, among women at risk of unintended pregnancy, almost 90% use contraception. Nonetheless, although many couples use birth control, over half of American women will have an unintended pregnancy by their mid-40s.

While there are many types of contraception, the hormonal birth control pill is the most popular and one of the most effective at preventing pregnancy.  Despite potential hormonal birth control side effects like weight gain, mood changes, and irregular bleeding (among others), very little research examines how side effects influence women’s experiences of their bodies nor how gender shapes these experiences.

In my research, I argue that side effects are not just a medical aspect of hormonal birth control use and show how cultural messages about gender shape women’s contraceptive behavior.  My study, based on interviews with 88 women, reveals that side effects like weight gain and mood changes made preventing pregnancy more complicated than simply using a hormonal method.

Drawing on theories of gendered bodies and emotions, I show how women navigate hormonal birth control use in light of cultural scripts about the importance of being thin and appropriately emotional.  Examining women’s interpretations of weight gain and mood changes in light of these messages allows us to understand why women felt “fat” and “ugly” because of weight gain and “crazy,” “abnormal,” and out of control because of mood changes.

My analysis also shows how the negative meaning attached to these side effects influenced women’s decisions to stop using hormonal birth control, which could impair pregnancy prevention.  For example, among the 40 women who reported weight gain or emotional volatility, many stopped or switched hormonal methods, which could increase their risk of unintended pregnancy.  In fact, 36% of women who stopped their hormonal birth control experienced an unintended pregnancy as a result, compared to 20% of women who did not stop use.

In sum, the results of my analysis demonstrate the complex negotiations that women make in their daily lives as they navigate cultural messages about their bodies and emotions. Understanding their interpretations of weight gain and mood changes offers insight into why hormonal birth control should work well in theory but why it sometimes fails in practice. My results show that even when American women have access to hormonal birth control and substantial control over its use, their experiences are still bounded by gender.  As in other domains, these constraints present challenges as they try to meet a central goal in their lives: preventing pregnancy.

By Krystale E. Littlejohn on her article, “‘It’s those pills that are ruining me’: Gender and the social meanings of hormonal contraceptive side effects,” published in the December 2013 issue of Gender & Society.

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