What are the basic assumptions about sexuality, health decision-making, and the doctor-patient relationship that inform the positions of opponents and proponents of emergency contraception (EC)?
Emergency Contraceptives (ECs) have been defined as a post coital method of contraception that is effective if taken within 72 hours of intercourse. Although the primary method of post coital contraception is ingestion of oral pills, copper bearing intra-uterine devices (IUDs) have also been known to be effective (Parker 2005). Parker (2005) also informs that the most effective regimen is a progestin only pill. However, an alternative to this is the Yuzpe method (Parker 2005) which is considered less effective. McLaren (1990) argues that comparatively less successful post coital contraceptives have been available for hundreds of years, although they were mostly douches or disinfectants, and marketed as “female hygiene products” (Ziebland 1999). As reported by the media, modern efforts to make EC more available have been met with frequent resistance. This is because it has been repeatedly equated to abortifacients, and seen as a tool to create a morally degenerate population. In contrast, proponents see it as an option within the wider reproductive health agenda, and argue that it allows greater autonomy for women and reduces health issues associated with unwanted pregnancies. In the following paragraphs, we explore the opposition and proposition of EC in the context of female sexuality, health decision making, and doctor-patient relationships.
Emergency Contraception and the Female Sexuality:
Historically, women’s sexuality has only been considered “respectable” when it’s either passive or completely absent (Turner 1995). Barett and Harper (2000) say that the very strong influence of Church doctrines in conceptions regarding sexuality means that the female sexuality was deconstructed into two polar opposites: ‘Virgin’ (Mary, mother of Christ) or ‘Whore’ (Eve, the original sinner). This continued into the middle ages, where women were still seen as morally inferior individuals more prone to ‘sin’. This was demonstrated in the witch trials where women were characterized as sin-loving, insatiable creatures who are more likely to fornicate with the devil; this was further amplified with biblical references to Eve, who was said to be consumed with ‘devilish desires’. Even beyond the Middle Ages, this idea of females being devilishly inclined to be immoral perpetrated society. This is demonstrated by the puritanistic views of the Victorian society where sexuality was considered acceptable within marriage (that is when sanctioned to be with a man), and for the sole purpose of procreation. Similar views are mirrored in different geographical locations (Barett & Harper 2000).
Despite the inherent atrocity of the aforementioned views of female sexuality, similar but milder views are echoed in modern society (Hawkes 1995). It is within this sphere of blatant mischaracterization of female sexuality that the EC debate exists. Opponents; therefore, argue that by removing the barriers between sexual activity and pregnancy, greater sexual and moral depravity is encouraged. This is especially true for emergency contraception as it does not require forethought, and can be ingested within a fairly reasonable time frame after intercourse. Opponents fear that easy availability of emergency contraception will cause an insurgence of unregulated sexual activity in females. Bartett & Harper (2000) also inform that their in depth telephone interviews reveal that women who consume ECs are considered ‘devious, chaotic and sexually irresponsible’ by many.
On the other hand, proponents argue that women who seek ECs are primarily victims of condom accidents, or women who don’t have any previous long term contraceptive arrangement (Lo & Ho 2012). This goes on to show that the...