Written by Sophie Butcher, School of Social and Political Sciences, University of Edinburgh; Molly Gilmour, Department of Sociology, University of Glasgow; Federica Cucé, Department of Medicine, University of Padova; Elise Kearsey, Deanery of Biomedical Sciences, University of Edinburgh; Ruwa Mahdi, Department of Social Science and Public Policy, King’s College London; and Kehinde Whyte-Ilori, School of Medicine, University of Leeds
In the United Kingdom (UK), an estimated 87% of women and 74% of men access contraception every year. Meanwhile, 95.9% of those surveyed in a 2019 report by CERT (N = 295), a policy research group specialising on contraceptive education in Scotland, believed that contraception needed change and reform. As such, improvements to experiences of accessing and using contraception would be wide-reaching.
Research shows that people’s experiences in accessing and using contraception are shaped by their gender. For instance, contraceptive experiences are often gendered as within heterosexual relationships, there is a tendency for the burden of responsibility to fall on women. This is partly due to a lack of options for ‘male contraceptives’. Women disproportionately suffer from problems and side effects associated with contraception, and as a result, they are also the ones that would benefit most from improvements. At present, ill-suited contraception causes unpleasant and unwanted mental and physical side effects for the user. These side effects are a major cause for discontinuation or change of contraceptive method. So, change and reform are needed and have transformative potential – but what could this look like?
This is what our research team of six students from the UK and Italy sought to find out by investigating what constitutes a positive contraceptive experience.
Initially, we conducted a systematic literature review; using 31 key terms (2010 – present) and the ‘Web of Knowledge’. This literature review found that current research conducted on contraception in the UK didn’t explore ‘what works’, it focused on exploring problems associated with contraception, primarily long-acting reversible contraceptives and emergency contraception with white, cisgender, heterosexual young women. Experiences of male, older, queer, genderqueer, and ethnic minority contraceptive users were fundamentally neglected. Taking this as a starting point, the primary research we conducted contributed to developing an understanding of what creates positive experiences when using contraception with a population that is reflective of contemporary British society.
In light of this, we conducted a narrative analysis to help us understand how individuals interpret their everyday lived experiences. Narratives were collected using search terms indicative of ‘positive contraception’ via 25 online platforms such as YouTube, online forums and blogs. Consent was received from each author. This search yielded a total of 5,049 cases, from this, 80 individuals’ experiences were purposely selected. The authors differed in ages, ethnicity, location, and socio-economic backgrounds; we attempted to deliberately oversample from backgrounds who had been previously overlooked in the literature.
While experiences around contraception differed greatly, we found three key themes across all 80 cases selected for this research.
A sense of bodily control
Permanency: A shared characteristic of many positive experiences was that the method didn’t interrupt one’s daily routine. In other words, contraception should not be a daily pressing concern. We found that a greater sense of permanency leads to a subsequent reduction in worry.
One person “chose Mirena because it lasts 7 years and I won’t have to think about it.”
Body Image: Most notably within the LGBTQ+ community, it was found that experiences were positive when the individual’s self-acceptance and identity improved. What made a certain contraceptive ‘the one’ was its ability to make people feel in control and comfortable in their bodies and if it aligned with how people perceived their body and identity – for instance when a hormonal contraception eliminated a person’s period:
One person explained that they should never have had a period, it was not in keeping with their identity, yet now, after using a hormonal IUD, they are more at one with their body.
Informative, collaborative, non-judgmental, and discreet consultations with healthcare practitioners
The relationship between the individual and their healthcare practitioner shaped many contraceptive experiences. In some instances, different forms of contraception were perceived as acceptable while others, such as emergency contraception, were connected to “irresponsible” behavior. The accounts showed that a positive contraceptive experience is one where a healthcare professional is not patronizing.
One person’s IUD appointment was a “very positive experience” as the doctor who fitted the coil was “reassuring”. The patient felt in “safe hands” as the doctor took the time to inform her about the different types of coils, which made her feel like her decision was “supported”.
Supportive relationships with loved ones
We found that people who were supported and could communicate openly with their loved ones had more positive contraceptive experiences. For instance, people expressed gratitude when their sexual partner accompanied them to appointments. Phrases such as “he was an absolute gem’’ and “couldn’t have asked for a greater bonding experience’’ were used by individuals when describing the events. Furthermore, without support, some people might feel overly burdened with the responsibility of taking contraception.
Similarly, a lack of communication with loved ones may impact one’s health, as they may delay getting the support needed. For example, one person mentioned that they were accompanied by a parent when they consulted a doctor regarding a lump in their breast and when the doctor asked if they were on contraception, the person refrained from mentioning that they were since this parent had previously expressed judgement of hormonal contraceptives. This story highlights the interplay between healthcare professionals, and patients and their loved ones.
Conclusions and next steps
This research contributes to supporting evidence of what creates positive experiences when accessing and using contraception. We found that when the three factors presented occur simultaneously, experiences of using contraception were described as positive. While this research has evidenced many of the advancements which have contributed to forming positive experiences of contraceptive use in the UK, there remains much work to be done, in the UK and beyond. Both the need for positive experiences (rather than just neutralising negative ones) as well as the three key factors we found should be foregrounded in both healthcare practice and policy.
We believe the findings of this research have relevance to experiences internationally. Medical professionals and institutions should actively work to encourage non-judgmental consultations (especially around certain contraceptives like emergency contraceptives), to better understand how bodily autonomy factors in patient decision making, and to facilitate supportive dialogue between patients and their loved ones.
Meanwhile, policy makers and decision makers should consider these factors too. On a long-term basis, this could look like specific legislation or training plans for frontline medical professionals, more informative sex and relationship education, or reducing the need for consultations when prescribing some forms of contraception like emergency contraception. On a more short-term basis, policy decisions need to ensure it is not any harder to obtain information and contraception. For example, the British Pregnancy Advisory Service (BPAS) have already warned that the recent decision to reclassify the mini pill as an over-the-counter medicine – with a consultation – could result in overly intrusive and bureaucratic consultations, a common experience reported when accessing emergency contraception. Such a policy change would contradict our finding that non-judgmental consultations contribute to positive experiences. It is important that policymakers take steps to ensure consultations are informative, collaborative, and do not shame users.
Crucially, for medical professionals and institutions as well as policy and decision makers, all contraceptive users need to be considered when taking on board these recommendations. There is a chronic underrepresentation of male, older, queer, genderqueer, and ethnic minority contraceptive users in previous research and their experiences need to be mainstreamed into all decisions, not just added on, or researched separately. Various experiences must always be incorporated into research and policy making rather than considered as an afterthought.
There are still many unanswered questions about how contraceptive education, prescribing practices and the medical side-effects of contraception can be improved for people both in the UK and globally. Some of the issues that emerged in this research relate specifically to the narrative of ‘bodily control’. For instance, it raises intriguing and important questions about what ‘bodily control’ looks like in practice and the associated significance this sense of control creates for contraceptive users. There is abundant room for further progress in determining how such a positive sense of control can be leveraged to improve experiences in future sexual and reproductive healthcare and we argue this is an important issue for future research.
 French, R.S., Geary, R., Jones, K., Glasier, A., Mercer, C.H., Datta, J., Macdowall, W., Palmer, M., Johnson, A.M. and Wellings, K., 2018. Where do women and men in Britain obtain contraception? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ sexual & reproductive health, 44(1), pp.16-26.
 Cheney, E., Lambert, K., McIntosh, E. and Rzewnicki, F., 2019. Contraception Education And Reform Team – 2019 Report And Policy Proposal. Edinburgh: Buchanan Institute.
 Higgins, J.A. and Hirsch, J.S., 2008. Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use. American Journal of Public Health, 98(10), pp.1803-1813.
 Chao, J., Page, S.T. and Anderson, R.A., 2014. Male contraception. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(6), pp.845-857.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.