Just Get on the Pill

The Uneven Burden of Reproductive Politics

Krystale E. Littlejohn

• Publisher: University of California Press
• Year: 2021
• ISBN:
  9780520973763
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Understanding the social history and urgent social implications of gendered compulsory birth control, an unbalanced and unjust approach to pregnancy prevention. The average person concerned about becoming pregnant spends approximately thirty years trying to prevent conception. People largely do so alone using prescription birth control, a situation often taken for granted in the United States as natural and beneficial. In Just Get on the Pill, a keenly researched and incisive examination, Krystale Littlejohn investigates how birth control becomes a fundamentally unbalanced and gendered responsibility. She uncovers how parents, peers, partners, and providers draw on narratives of male and female birth control methods to socialize cisgender women into sex and ultimately into shouldering the burden for preventing pregnancy. Littlejohn draws on extensive interviews to document this gendered compulsory birth control—a phenomenon in which people who give birth are held accountable for preventing and resolving pregnancies in gender-constrained ways. She shows how this gendered approach encroaches on reproductive autonomy and poses obstacles for preventing disease. While diverse cisgender women are the focus, Littlejohn shows that they are not the only ones harmed by this dynamic. Indeed, gendered approaches to birth control also negatively impact trans, intersex, and gender nonconforming people in overlooked ways. In tracing the divisive politics of pregnancy prevention, Littlejohn demonstrates that the gendered division of labor in birth control is not natural. It is unjust.

1

His Condom

You know, I don’t really remember there being very much sexual education. Like I never took health because I think I opted out of it. I forget what I took instead. No, I took health online. There wasn’t really much talk about it in my family. It was weird. I never got the birds and the bees conversation, like I used to read romance books but they never talked about birth control. Never. No one would be like, “And he put his condom on.”

AUDREY, 20 years old, white

Although many girls like Audrey never get the “birds and the bees” talk, they learn their ideas about condoms from somewhere. Research exploring the meaning of condoms shows that women may hesitate to ask partners to use condoms because they fear it signals a lack of trust or indicates that the woman herself is unfaithful.¹ We know very little about nonrelationship contraceptive meanings, despite the fact that sex outside of “committed” relationships is more common today than in years past.² These more casual contexts are the very ones in which people are most likely to use condoms.³ Thus, how do women think about condoms? And how do these understandings shape how they use them with their partners? In this chapter, as in the rest of this book, I argue that gender plays a central role.

People are socialized into gendered bodies at young ages,⁴ and social framings of birth control serve as one more tool to teach people how to think about their bodies and behavior. Teaching people to behave according to standards expected of their gender (gender socialization) includes communicating expectations that girls should be moral and chaste,⁵ boys should seek sex for pleasure and status,⁶ and young girls should be especially careful to avoid pregnancy.⁷ Through gender socialization, girls also learn they must act as sexual “gatekeepers.”⁸ These are more or less well-known gender norms dictating what people should and should not do sexually. In this chapter, I argue that these norms coexist alongside taken-for-granted ideas about how genders should protect themselves sexually. As condoms come into contact with both partners’ genitals and protect them both from pregnancies and sexually transmitted infections (STIs), it is theoretically possible to think of condoms without invoking gendered ideas about difference. I show that in practice, however, condoms are separated into versions for “males” and “females,” and these ideas have important consequences for behavior.

Public health campaigns aimed at reducing teen and “unplanned” pregnancy play an important role in both reflecting and shaping ideas about birth control. Despite efforts to get couples to use condoms during penile-vaginal intercourse, the broader discourse in medicine and public health communicates the very gendered message that some condoms are for men and some are for women. Take the most widely used graphic on the effectiveness of different birth control methods, for example. One such chart is linked on the Centers for Disease Control and Prevention’s “Contraception” page. The chart clearly labels condoms worn externally as “male condoms” and those worn internally as “female condoms.”⁹ People looking up information about birth control online are unlikely to be enthralled by a more technical chart on the effectiveness of different methods. They may, however, read other information that the CDC posts to encourage “safe sex.” The message they receive there is not any less gendered. Indeed, perusing the contraception page leads to a “His Condom + Her Birth Control” infographic used to encourage people to use two methods of birth control (a condom plus a prescription method).¹⁰ Both a policy statement released by the American Academy of Pediatrics¹¹ and a committee opinion released by the American College of Obstetricians and Gynecologists¹² also explicitly refer to the “male condom.” These are only a few examples. Gendered messages linking particular condoms to particular bodies are widespread in public health.

Thinking of condoms in this way may seem both natural and unproblematic. I argue that it is neither. Condoms need not be tied to the gendered bodies that people presume will use them. Women having sex with women can use male condoms and men having sex with men can use female condoms. In fact, research shows not only that some men having sex with men already use the female condom with their partners but also that some of them actually prefer it over the male condom.¹³ Thinking of condoms as “male” and “female,” therefore, has less to do with biological necessity than with social thinking about bodies and heterosexuality. Not only does this framing leave trans and intersex people’s experiences out of the conversation but it also suggests that the condoms that men wear are by definition out of women’s control—that is, men are the “implied user,” as feminist scholars have articulated in other domains.¹⁴ In this way, the social framing of contraception plays an important role in reinforcing gendered expectations of heterosexual behavior by encouraging women to center men’s desires in condom use.¹⁵ Just Get on the Pill extends work in this tradition by examining pregnancy prevention as a site where heterosexuality and gender operate as social structures that sustain inequity but do not receive widespread critique because biological determinism dominates explanations of inequality. I show that social ideas about to whom condoms “belong” matter tremendously for decision-making autonomy in contraception.

Messages that “condom” is synonymous with “man” coexist with strategies to change that messaging, even if only to get women to buy condoms. Ironically, the marketing strategies aimed at changing women’s behavior only further underscore the entrenchment of gendered ideas about birth control in US society. Trojan, “America’s Leading Condom Brand,” for example, introduced a condom line just for women in 2017. Its name? The XOXO condom—a condom that is no different functionally than its regular Trojan condom. The XOXO condom simply has “Softouch thin latex and aloe-infused lubricant,” with packaging (lavender) that “is designed to be discreet, so [women] can carry it as confidently as [they] carry [themselves].”¹⁶ The vice president of marketing emphasized that the new line reflected a viewpoint positing that “it’s not just like, ‘Hey, I’m the guy, I bring the condom.’ ” Instead, the company had to introduce a condom line for women because “[Trojan] did not want to make this pink-washed. . . . This [the external condom] is not a girl’s condom.”¹⁷ Indeed, regardless of new marketing strategies, women are taught that it is a man’s.

In this chapter, I show how larger cultural messages like those just described reflect on-the-ground thinking about birth control. I argue that women associate external condoms with men’s bodies and men’s actions, and they feel much less comfortable bringing, buying, and interacting with condoms as a result. These messages are both communicated and reinforced by families, friends, sexual partners, and health professionals. Indeed, this chapter shows that the gender-based assumption that external condoms are for men (largely because they are worn by them) is pervasive.

“THEY SEPARATED THE GIRLS AND THE BOYS AND TAUGHT THEM DIFFERENT LESSONS”

Compared with the more explicit gender-based messaging that teen girls might receive from sex education (like avoiding promiscuity),¹⁸ gendered messaging around birth control appeared to be more subtle in women’s discussions. Most women who had taken sex education discussed learning about both condoms and “the pill.” Few recalled explicit details about exactly how educators framed the methods. Their descriptions demonstrated nonetheless how sex education could normalize gendered logics around birth control—sometimes even before students were actually having sex. Miranda (28 years old, white) recalled how she first learned about contraception:

I think from like, what do they call those classes in elementary school? Like “Family Life” or something like that. They had some really funny name for them. That’s the first time I remember hearing about it was like, fifth or sixth grade . . . . I remember that they separated the girls and boys and they taught them different lessons, but I remember that everybody talked about it afterward and like, swapped stories. So yeah, I generally remember what they said. It was pretty basic.

Whether her school “separated the girls and boys” because of maturity concerns over teaching young people about sex, or because they actually intended to teach separate lessons, as Miranda contended, the notion that the sexes are intrinsically different is a central component of gender ideology.¹⁹ Separating girls and boys during sex education helps establish the gendered expectation that different bodies necessarily need different birth control. In fact, for women like Olivia (26 years old, Asian), sex education included learning to use explicitly sexed technologies, such as “how to use different kind[s] of condoms, female condoms, male condoms, [and] pills.”

It might be argued that, while it is certainly gendered, framing condoms as “male” and “female” matters less for gender inequality because women at least have the internal condom as their own. Even when bracketing my contention that marketing different condoms to different genders is harmful, this thinking is flawed—namely, because the internal condom is more expensive than the external one and use is low around the globe.²⁰ Though a minority of women in this study mentioned internal condoms, very few of them had used them. Isis (21 years old, Black) was one of the few women who even expressed interest in doing so. Her mother had talked with her about “the female condom,” the ring, and spermicide (“as another method that women can use”). In a portion of the interview, in which she discussed what her mom had told her about birth control, Isis mentioned “the female condom” and said simply that “I’ve never used it but I think I might want to try or figure it out.” That was the extent of the conversation. Indeed, internal condom use seemed to be an afterthought for most women, if it was even considered an option at all.

External condom use was a much more popular topic of conversation, but parents did little to facilitate women’s use with their partners, even when they supported the behavior. With respect to parents as potential facilitators of contraceptive access, what they did mattered more than what they said. And what they did usually encouraged young women to conform to gendered norms around birth control, wherein they abdicated responsibility for condoms. Parents, for example, might tell their daughters to use condoms but not do anything to help them. Instead, they focused much more on getting their daughters prescription birth control. In recalling her experience learning about contraception, Molly (20 years old, white) said, “We had the fifth-grade talk about your body changing, and I’m sure at some point we had this sex ed. talk because I seem to recall one. Although maybe not. Maybe my mom was like, ‘You should use a condom if you have sex.’ I don’t know.” Although Molly believed that her mom encouraged condom use, that support did not translate into financial help. Molly had the following conversation with the interviewer:

MOLLY: [My boyfriend] bought the condoms. So I never did that and I never asked my mom. But with [prescription] birth control, she was all for it. My dad knows I’m on birth control. I mean also because it really was at first for my cramps. It’s not like my mom didn’t know I was having sex because she definitely did. I never brought it up with my dad but my mom is totally cool with it. She pays for it and everything.

INTERVIEWER: So your mom knew that you were having sex?

MOLLY: Yes, I told her.

INTERVIEWER: How did that conversation go?

MOLLY: She was mad at [him]. She was like, “I thought he was a good Christian boy and you were gonna wait until you were married.” But then she got over it pretty quickly.

Thus, while Molly’s mom may have told her to use condoms, she never actually followed up to make sure Molly had access to them. Instead, her mom focused on supporting Molly’s use of a prescription birth control method. I return to parents’ role in facilitating girls’ prescription birth control use in the next chapter. The point here is to demonstrate how parents’ lack of financial support for condoms could reify the message that girls need not worry about condom provision itself, even when parents were supportive of their daughters using the method.

Interestingly, while fathers did not usually discuss any method of birth control with their daughters, they almost always discussed condoms when the topic came up. This may be surprising if one considers only gendered messaging about condoms and sexual promiscuity for girls but not if one considers the broader gendering of birth control methods that I articulate in this book. In this framework, it makes sense that fathers would teach daughte...