Contraception: The “acceptable” medical need vs “just” recreational baby prevention debate

Have you ever had that experience where you’re walking along and someone tries to hand you a religious tract, and you smile politely and say no thank you and try to keep going, but they reach out again and for whatever reason you stop, and then the following conversation happens?

“Can I tell you about Jesus?”
“Thanks, but I’m a Buddhist.”
“But have you heard the word of our lord and saviour?”
“Actually, I was raised Catholic, so—”
“Oh but that’s not a REAL Christian, let me tell you—”

And then you have to break whatever it was that made you stop, feel rude, and just walk away, because you realize that no matter what you say or do, they’re going to keep pressing because no answer but the one they want to hear is good enough?

I often feel like that about birth control.

Almost inevitably, if the topic of birth control comes up, someone will come along to tell you that there are some really unacceptable risks to whatever birth control you’re talking about, but have you thought about these other, better birth control options? And of course, hopefully the person being this imposing is a friend (but let’s be honest, it generally isn’t) and you smile and say yes, thanks, and go back to your conversation except you’re interrupted again. “But have you tried…” and the well-meaning person goes through every birth control option they find acceptable.

In my case, since I’m utilizing a hormonal birth control (the Mirena IUS), whomever is acting critic will start asking about non-hormonal options. Sometimes, I’m nice and I’ll play along. “Yes, nasty contact dermatitis makes it not fun. Yes, with that, too. No, I don’t really trust options with failure rates that high. Yes, I’m aware of perfect vs real world use, but failure is not an option.”

Because, you see, I have that in my back pocket. Not one trump card, but two. Because even if people find my “yes, well, I was nearly hospitalized for blood loss before I had a Mirena inserted” an unacceptable medical excuse (and there are some who do), I have a final saving grace trump card, the one that says “it is medically advised that I never have children, due to my severe, degenerative nerve damage; having children could leave me permanently disabled and bedridden for life, if not worse.”

Funnily enough, that gets a pass from pretty much everyone except the very worst of the Republican politicians.

The thing is, I shouldn’t have to detail out my medical history in order to get a pass for deciding to use hormonal birth control. No one should have to detail out their medical history in order to show an “acceptable” medical need vs “just” recreational baby prevention; at most, a friend has the right to say “well, I’m concerned about the risks, are you familiar with them?” A “yes” response means drop the conversation, not run through every other birth control option out there. A “no” response means ask if more information is welcome, not immediately launch in to it.

The minute you get into dissecting out what is and is not a medical reason for birth control, you start wandering over into the territory that is labeling the choices and decisions women are making, and for hopefully understandable reasons, that makes little pro-choice, pro-birth control-as-part-of-basic-healthcare me nervous.

Are women making bad choices for themselves out there? Undoubtedly. There are shitty doctors. There are uninformed women. But taking the default position that every woman is uninformed is not the answer. No woman should have to lay out her entire medical history (or that of her partner!) in order to “get a pass” on contraceptive use.

When a woman tells you she’s utilizing birth control, don’t ask her if it’s medicinal or for contraception, don’t tell her she has better options, don’t immediately launch into the laundry list of why her choice is bad for her. We—those of us who are pro-women’s health, pro-choice, pro-birth control—are better than that.

Or, at least, we should be.

For a quick overview of contraception options and risks of pregnancy see this Planned Parenthood graphic.