Construction and experiences of hormonal and non-hormonal contraception

Abstract

Approximately 30% of pregnancies in Australia are unintended. One significant contributor to this is the inconsistent use or discontinuation of contraception, associated with physical and psychological side effects. Most literature concentrates on the materiality of side effects, such as the presence or absence of menstrual irregularities, acne, or weight gain. However, the embodied experience, underlying meaning, and reproductive consequences of contraception side effects remain underexplored. This is particularly the case for non-cisgender and/or non-heterosexual people, whose experiences remain overlooked in the literature. How women and trans people with a cervix construct and negotiate embodied side effects in relation to available cultural discourses of fertility, heterosexuality and femininity warrants deeper investigation.

The aim of this study was to explore the subjective and embodied experiences of contraception users with a cervix in Australia. A mixed method qualitative design was utilised, using open-ended responses from an online survey, the arts-based method of body mapping and individual interviews. During 2021-2022, 1085 participants took part in the survey which asked about contraception side effects, satisfaction, reproductive autonomy, and experiences of contraception healthcare. Body mapping with 18 participants allowed a unique visual exploration of participants’ thoughts, feelings, and embodied experiences. A follow-up interview informed by their survey responses and body mapping session was completed by 17 participants, to further explore their construction and experiences of contraception in-depth. Participants were from a diverse range of genders, sexualities, and cultural backgrounds. Reflexive thematic analysis was used to analyse data, incorporating a material-discursive-intrapsychic theoretical framework, embedded within a critical-realist epistemology.

Across participant data, two core side effects were frequently described as having influence over participants’ experiences of contraception use – changes in the menstrual cycle and changes in mood. Drawing on cultural discourse associated with normative menstruation, “nature”, and femininity, contraception that caused material changes to menstrual bleeding texture, colour or predictability was positioned as unacceptable with participants discursively positioning their bodies as abject and out of control. Intrapsychic changes associated with hormonal contraception, including anxiety, depression, and decreased libido disrupted participants’ daily lives, interactions with others, and sense of self. In contrast, many participants described positive experiences of contraception embodiment, associated with menstrual control, management of chronic health conditions, and increased libido. Positive mood experiences held deeper meanings around gendered expectations of mood stability. Having agency over their own bodies often resulted in positive embodiment. Trans participants felt affirmed in their gender where contraception distanced them from the reproductive and menstruating feminine body. However, bleeding side effects, feminising changes to body shape, and the discursive construction of hormones as inherently gendered, created significant gender dysphoria. Trans people negotiated heterosexist, cisgender assumptions in their contraception healthcare, as well as pronatalist ideologies restricting surgical sterilisation access. Both cis and trans participants spoke to the importance of feeling heard by their healthcare providers (HCPs), of trust as integral to the contraception consult, and of feeling in control of their contraception care. Discreditation of menstrual and mood side effects by HCPs generated frustration, erosion of trust in healthcare, and prolonged negative embodiment of side effects.

Overall, analysis suggests that the materiality of embodied physical and psychological contraception side effects, their constructed meaning and intrapsychic consequences heavily shape contraception choices, such as ceasing contraception, switching to different methods, or seeking permanent methods. Broader implications of these findings in relation to patient-centred contraception healthcare and public health efforts, which often focus on contraception efficacy, are explored.

Date of Award	2024
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Alex Hawkey (Supervisor)