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Abstract
Many contraceptive studies are framed in terms of clinically recognised side effects, effectiveness and discontinuation. Few explore the relationship between contraceptive use and women’s sexual lives. Long-acting reversible methods are recommended by authorities as safe and effective, but little is known about women’s views on them.
In a large qualitative project, ‘Contraceptive Understandings and Experiences of Australian Women’ (the CUE study), 94 women were interviewed in depth in 2012–2013 in New South Wales. Transcripts were analysed thematically, using a symbolic interactionist perspective, to explore women’s experiences and understandings of contraceptives in the context of their sexual lives.
A systematic review of clinical and epidemiological studies on method discontinuation indicated that women’s use of contraception was framed by a biomedical model. This fails to capture women’s experiences. In our interviews, many women discussed the insertion of a foreign object in the body, and some found this distasteful. Vaginal bleeding was a major issue for many women, and women’s perceptions of bleeding were analysed in detail. Many women valued menstruation because they perceived that it cleansed their body or confirmed their fertility and wellbeing, but they also appreciated the ability to control their menstruation.
Analysis provided three new insights. Firstly, women saw the responses of their own bodies as an indicator of the suitability for them of a given contraceptive method. Secondly, there was often a discourse gap between women and doctors that neither party was aware of. This occurred because the meanings and values attached to words such as ‘bleeding’, ‘spotting’ and ‘naturalness’ varied, and influenced understandings in the interaction. Thirdly, women valued the stories they heard from family and friends as first-hand evidence based on real-life experience. Women acknowledged the importance of scientific evidence, but valued personal experience and narratives of friends and family even more highly, and they used these to interpret their own bodily experiences.
I conclude with reflections on the findings, methods used and theoretical approach, and make some suggestions for further research and implications for clinical training and practice.