Contraception: A Shared or an Individual Practice?

The attitudes and practices expressed by males concerning their role in and influence on contraception, or even their own experiences with contraception, are largely molded by power relationships, and masculine and feminine roles, that are socially and culturally constructed regarding the meaning and values of sexuality and reproduction. The paradox to which the majority of studies refer lies in the male’s perception that sexuality is a predominantly male sphere in which he exerts control and power over the female. By contrast, the confines of reproduction and its regulation are considered a feminine space for which the woman is responsible. Nonetheless, the male is seen frequently as the key actor in terms of the power he exercises in the decision-making processes within such confines.

Mora and Villarreal (2000) emphasize how the idea that reproduction is mainly a female act has subsisted culturally and socially. This implies delegating reproduction’s costs and responsibilities to the women, while men have generally been distanced and marginalized from the consequences of their sexual activity.

The great majority of research carried out directly on men show that they usually consider women to have more influence on pregnancy decisions. They also feel that women’s desires prevail on pregnancy decisions, in addition to their being responsible for the consequences of employing or eschewing contraceptive methods (Álvarez Vázquez and Martínez, 2002). Nevertheless, it is important to note that these results contrast with those of diverse studies based on fertility surveys carried out during the 1970 in Latin America, which presented evidence that the male tends to be in opposition to and constitutes the main obstacle to utilizing contraceptive methods by women.

Again, studies that analyze the role of men in the contraceptive practice specifically in relation to abortion are scarce. Nonetheless, some of the findings documented in this chapter confirm the existence of a broad, changing array of factors and situations regarding the contraceptive practice, all of which is reflected in the male attitudes, especially those of men who have closely experienced an abortion. As expressed in texts that are presented next, men’s attitudes on contraception do not take the form of unequivocal or polarized patterns, but instead are differentiated evaluations, responses, and behaviors according to distinct social groups, cultural contexts, and above all, different generations. At the same time, a close link is found with other factors, that aside from knowledge, use and failure of contraceptive methods, the ones referred to the type of emotional bond within the couple, and the couple’s living arrangements prevailed.

In this regard, in the above study conducted by Zamberlin (2000) in a neighbourhood in the province of Buenos Aires, the author found that male interviewees did not contemplate the possibility of a pregnancy and that in general they assumed that the woman was responsible for taking care of herself, above all with older or more experienced women. Unlike older men, for adolescent and young males access to condoms or other methods were due to other factors. Non-use of condoms derives from diverse reasons such as a greater sexual desire that overcomes the fear of pregnancy, lack of awareness on the possibility of pregnancy occurring, the fact that the sexual encounter was unplanned, or the assumption that the woman is the partner who would take care of herself. Abortion was also considered by males to be a common form of regulating fertility, but they feel responsibility for this corresponds mainly to women and is one which they frequently tend not to assume,

In the research project carried out in Mexico City, Guevara Ruiseñor (1998) pointed out that an important percentage of the 52 men interviewed (43%) failed to assume any responsibility for preventing the eventual pregnancy. The author likewise identifies three response types which illustrate this attitude: that which delegates the responsibility to the women “…I thought she was taking care of it”; that which reflects the frequent prevailing social imaginary idea “…I didn’t think she’d get pregnant”, and the final type, present at a lower percentage and related to contraceptive failure, “…she used theIUD” or “…the condom broke”. The study results also corroborated the type of bond and the degree of love for their partners as being key elements in relation to the contraceptive practices used by males. When the relationship was stable (as in a relationship with a man’s fiancée or his wife) and the affective bond was strong, responsibility for contraception was shared to a greater extent and was mainly oriented toward preventing unwanted pregnancies. On the other hand, in occasional relationships, those of lovers, and those involving fewer affective feelings, there was less contraceptive responsibility by men. In addition, according to the author, in both of the latter relationship types males do not even assume responsibility for the possible consequences that unprotected sex can have on their own health.

Jiménez Guzmán (2003) found similar contraceptive practices in a study undertaken in Mexico City involving in-depth interviews of 10 men aged under 30, with children and high academic levels, all employed in non-manual occupations. The requested testimonies showed the way in which males involved in an abortion had not assumed responsibility for the use of any contraceptive method, despite having evaluated their experience with abortion as negative in terms of the responsibility they felt and the fear of confronting possible complications and uncomfortable outcomes. For these males, abortion “...is a difficult and traumatic, but feasible option” and the decision whether to abort belongs to the woman, because as they declared: “...it’s her body” (p. 125). For those who had not experienced this situation, abortion constituted an adequate solution when an unwanted pregnancy could not be prevented. These men also considered that while the decision to abort should be shared by the couple, the final decision fell to the woman.

In another qualitative study also carried out in the Mexican capital with young men who experienced the interruption of a partner’s pregnancy (GIRE 2001), results showed that knowledge of a contraceptive method did not guarantee the use of a highly effective method for avoiding pregnancy. Similarly, it was found that at determined moments, the influence of third parties, i.e., relatives, friends, etc., was more important that that of healthcare providers in deciding whether or not to opt for this type of method. As for the attitude of the male interviewees on contraception, the men displayed various behaviors individually and among each other. Their behaviors depended on their experience and the type of bond they had experienced with women at different moments in their lives. As in many other studies, they repeatedly stated that contraception was the exclusive responsibility of women. A central element highlighted in this research is the importance of analyzing the changing trajectory of contraceptive practice over time: first-time sexual relations tend to be characterized by a scant concern on the part of males about avoiding pregnancy. In subsequent relations, there tends to be greater co-responsibility for and commitment to using preventative methods by them. Some men also expressed attitudes that favoured the autonomy of their partner in relation to contraceptive methods, implying that males would even abstain from intervening in the choice of method.

This study concludes that greater male participation in the choice of contraceptive method is related, on the one hand, to the male’s conviction that this is an issue in which shared responsibility should exist, On the other hand, that the partner absence of commitment or a greater commitment to the partner determine whether or not men become involved in contraception. Additionally, confusion about or inconsistency in the use of contraceptives was exhibited by males when they were informed of their partner’s pregnancy. This response, the authors indicate, reflects the presence “...of certain imaginary elements that reduce the perception of the reproductive risk (of males) and that provides them with a false sense of security that a pregnancy will not occur” (p. 47).

Other studies have also shown that the abortion experience can lead to modifications in male behavior regarding contraception. According to the results of a qualitative research investigation carried out by Arilha in Brazil (1999), males consulted after being involved in unwanted pregnancies utilized contraceptive methods to avoid the repetition of such an experience.

The previously cited Oliviera et al. (2001) study conducted in São Paulo, with middle-class males belonging to two generations, sought to understand how the gender construction with which the subjects operate influence their perceptions, assessments and consequent options whether or not to have children and the methods used to avoid conception. Through the examination of male’s projects and practices related to having or preventing offspring, this analytical axis illuminated the importance of considering the social context in which decisions are made, allowing an exploration of the dilemmas males frequently encounter concerning their partner’s pregnancy.

Among their results, the authors found that males evaluated the contraceptive methods that they know or have already used on the basis of their effectiveness, convenience, and effect on sexual pleasure. Based on the material obtained and analyzed in their study, they clearly state that “it cannot be denied that there is a basic issue involved, namely, that no method is absolutely good, solves all (or most) of the problems, or addresses all needs”. For example, the use of condoms was associated with feelings of discomfort, difficulties in putting them on, and the most interference in sexual pleasure, although it was one of the most frequently used methods, together with the rhythm method, among the middle-class males interviewed. According to the authors, this is partially due to frustrations with the experience of hormonal pills. Pills were considered the most convenient and ideal methods for most of the interviewees, due mainly to their effectiveness and practicality, but strong concerns were expressed by males, particularly young males, that have internalized and have taken as their own the arguments expressed by women on this method’s impact on women’s health. Also, protection against HIV/AIDS has led to the need for undeviating use of the condom, particularly in casual relationship, a fact that, as the authors stressed, may possibly have the effect of establishing the condom as the basic method for the urban middle classes. In the case of resource to vasectomy, an apparently less risky method, the increasing trend in separations and divorces, and therefore men’s the prospects for new marriages with younger partners who wish for and have their right to have children, can be seen as an obstacle to this surgical method.

Although for the majority of respondents, avoiding unwanted pregnancies is considered a problem for the women to resolve, since reproduction occurs in her body, the authors argue that this idea stems more from the naturalized conceptions of reproduction and of women than from the males’ concrete experience. Males’ actual experience showed that they have adopted methods that implied their participation, such as condoms, coitus interruptus, and the rhythm method. In addition, this assumption, more common among older generations, is also due to the contraceptive cultural context in which men have lived. For older generations, this was a context in which contraceptive pills were not widespread or institutionalized and in which abortions and traditional methods like the ones mentioned were the most usual resource for regulating fertility. Among younger generations, although the same idea that women are responsible for contraception since they are the ones who suffer the consequences prevails as part of male ideology, males seem more concerned than their elders with avoiding unwanted pregnancies, guaranteeing protection against STDs, and women’s health.

Among their conclusions, the authors underscored the fact that the importance of abortion as a fertility-regulation practice in the Brazilian urban middle-class was associated with the availability of contraceptive methods and problems associated with their use. The authors also state that abortion tends to be part of the reproductive experience in educated segments of the society, despite adequate information on methods for pregnancy prevention.

Martine (1996) puts forward a similar argument in her analysis of the decrease in fertility in Brazil in the mid-20th Century. The author points out that, despite the insufficiency of statistical evidence in this respect, recurrent abortion is commonly known to be a means of limiting the number of the family’s offspring even in socially respectable families or sectors and despite the fact that abortion is a clandestine practice due to its illegal nature in Brazil.

Another recurring theme in the literature is the type of contraception utilized and the limitations and failures of each. The condom is one of the better known options and is most frequently used by the male to regulate his reproduction, although it is also one of the most frequently rejected methods.

In their qualitative study on condom use in middle-class Mexican men residing in Mexico City whose ages ranged from 18 to 35 years, Arias and Rodríguez (1998) highlight the ambiguous, dual meaning males attribute to their involvement with and commitment to those with whom they have sexual relations. The meaning they assign is dependent on their appraisal of the type of sexual partner and of women: whether they are a partner in a casual relationship with a woman they do not respect, or part of a formal couple with an implicit commitment, ergo with woman they respect. In this identification of categories of women with whom they can be involved, the subjective perception of personal characteristics, such as trustworthiness of the woman, seems to play an important role. In formal relationships, for instance, the man is not required to use a condom. By contrast, the opposite occurs with the former type of sexual partner. With respect to the commitment and responsibility males acquire concerning the consequences of their sexual relations, the authors observe that traditional and stereotypical representations of masculine identity continue to prevail. Among these are an uncontrollable and natural impulse to satisfy sexual desire, the necessity of fulfilling his duty as a macho, and the demonstration of his virility and his willingness to assume risks, as observed in interviews, particularly with the youngest males. Nonetheless, researchers make it clear that the final responsibility derived from these relations and their implications falls to the woman, the one deemed responsible for restraining male impulses.

As in other studies, the results of this last one corroborate the fact that one of the main reasons males give for using condoms is avoiding pregnancy. The authors argue that while this depends largely on the degree of commitment, closeness, and affection the male has with his partner, the male response concerning this method is highly dependent on context, because being without a condom at a given moment does not necessarily stop men from having sex. The effect of the level of commitment in the relationship on contraceptive use also extends to men in more formal relationships being more involved in the partner’s health generally; condom use in many such formal relationships therefore derives from the problems of women in employing other contraceptive methods, in addition to being a means of protecting women from possible infections due to the extramarital relationships in which men engage.

This study also examines men’s negative perceptions and rejection of condom use. Negative expectations about condom use include the reduction of pleasure, greater rigidity in sexual relations, presence of pain, fear that the condom will tear, and fear that the woman will be offended by the male’s desire to use a condom. Also, sometimes the man does not bring a condom with him when there is an obvious opportunity for having sexual relations. The authors suggest that failure to plan ahead is linked to perceptions of the notion of what is “natural” versus what is against human nature, in which spontaneity and lack of planning prevail, and also represents a demonstration of courage and willingness to assume risks in life, attitudes associated with male identify in the field of sexuality.

The results of the Cáceres survey (1998) in Lima show that contraceptive knowledge is much greater than levels of its correct and constant use would suggest. They also acknowledge differences in contraceptive practices between adolescent males and females (aged 15 to 17 years) and young adults (20 to 29 years of age) from middle- and lower-class sectors. On the one hand, adolescent females testify to having used a condom during first intercourse more than male adolescents do, while young adult men mention having used a condom more than young adult females in the same age range do. On the other hand, women overall report greater, more consistent use of contraceptives as opposed to greater use of condoms reported by males. This fact, as the study indicates, “...does not come as a surprise, given the relational implications of condom-use negotiation as a masculine method” (p. 164); due, mainly to the difficulties faced by women to demand males their use. With respect to unwanted pregnancy, Cáceres states that in addition to being a common experience in both age groups, this represents a central worry among young men in particular, especially those with a strong bond with their partner, a situation in which contraceptive use tends to be assumed as a shared responsibility. When interviewees had casual sexual partners, this responsibility was assigned to the woman. Although prevention of HIV/AIDS and other sexually transmitted diseases (STDs) was a somewhat greater concern, this did not always lead to condom use. Study participants recognized the usefulness of and greater need for using a condom in these cases, but in general they considered condom use an obstacle to experiencing pleasurable sexual relations.

In a previously mentioned study, Rostagnol (2003) found that knowledge of contraceptive methods in Uruguayan males in a low-class area was scarce, vague, and often erroneous. The knowledge they had obtained came mainly from physicians, friends and their partners themselves. Nevertheless, fertility regulation is principally considered the woman’s responsibility, described as a “woman’s business”. Reactions concerning condom use ―widely known as a contraceptive method and a method to avoid STDs but whose use is infrequent among adolescents and young men― included dissatisfaction. As other studies underscored, many males do not like to use a condom because they say that it does not feel the same as sex without one, and additionally they are unfamiliar with its correct use and unable to put it on properly.

Berglund et al (1997) also approached the contraceptive theme in a study undertaken in Nicaragua to analyze the complexity of the social, economic, cultural, and psychological contexts of pregnancy in general and of unwanted pregnancy in particular. In this study, the authors conclude that real access to contraceptives is limited less by ignorance and more by the adverse attitudes of health service personnel and other persons with key roles in society. This situation mainly affects adolescents, who encounter greater barriers to accessing family-planning services, in addition to having little experience with contraceptive use.

In the research previously cited on men who have experienced a close relationship with abortion, Mora and Villarreal (2000) note that of all males interviewed, 7% had never used contraceptives, whether due to ignorance of these methods, their rejection of them, or their having had few sexual relations. More than one third (35%) of males had stopped using some contraceptive method when the pregnancy occurred, through carelessness or due to the side effects this supposedly caused in their partners. Of the remainder of men consulted, that is, the 58% who had practiced contraception, the majority utilized the rhythm method or periodic abstinence, a condom, or coitus interruptus, methods requiring male participation. The inefficiency of the method employed, according to the males, derived from inadequate use of the method or from its being unsafe: half of those using the condom stated that it tore or was defective. This, as the authors suggest, demonstrates the difficulties that arise when these methods are used, difficulties that can be due to their effectiveness, or to the experience of those using them. On the other hand, the authors observe that a more effective use of a contraceptive method is mainly related to economic hardship situations, particularly in middle- and low-income sectors and among persons who have children from a live-in relationship with their partner, that is, a non-formalized relationship.

Another factor which Mora and Villarreal (2000) mention that has been very much favoured in research investigations on reproductive behavior, especially in relation to the use (consensual or otherwise) of contraceptive methods in the couple refers to the communication between the man and the woman. In this regard, evidence from the study conducted by these authors show that dialogue on contraception between the partners does not always lead to a shared choice, far less to the use of a certain method. Of every 10 couples who communicated with each other about contraception, four used no method to prevent an unplanned pregnancy. Of every 10 couples who reached an agreement on the last contraceptive method they used, nearly four stopped using this out of carelessness or due to the side effects of hormonal contraceptives or intrauterine devices (IUDs); resulting in their latest pregnancy ending in abortion. Drawing from the above results, Mora and Villarreal hold that unwanted pregnancies and unsafe abortions are more likely to occur when there is ignorance and a lack of dialogue within the couple concerning their desires regarding the number of offspring and their opinions and preferences on the practice of contraception. The authors confirm that this shows that although many couples talk about their sexuality and their reproduction-related needs and desires, still this communication per se is insufficient for arriving at concrete actions. This finding should be borne in mind when interpreting the results of many studies, and used to redefine the concepts and questions on the issue included in the latter.

Another aspect worth mentioning, although it has attracted little attention, refers to the development of contraceptive technologies, in which gender inequality has prevailed. As Castro indicates (1998), in the field of biomedical research, priority has been given to inhibiting fertility, and greater resources have been oriented toward feminine methods. Thus, lesser importance has been given the key role of the male, whose options for regulating his reproduction and avoiding unwanted pregnancies are reduced by the insufficiency of methods designed exclusively for his sex. Ringheim (1996) likewise states that the male’s lack of interest in involving himself in reproductive issues is also linked to the limited options for reversible contraceptive methods available to him. These are factors that should be also kept in mind in order to understand why males do not participate to the same degree as women in fertility regulation.

In a study on the same theme in Brazil, Zamberlin (2000) affirms that masculine participation in contraception has been substantially reduced and that the oldest methods, such as coitus interruptus, periodic abstinence, and condom use have come to be regarded as inefficient and to be looked down upon by family planning programs (FPP). This, as the author adds, has been clearly manifested in the implementation and further development of these programs that have oriented their actions toward non-reversible feminine methods. These programs and actions have produced changes in the social definition of contraceptive responsibility, which became the exclusive realm of the woman and have fostered a lack of commitment on the part of males “…who were excluded from the FPP, whether deliberately or by omission” (p.247). Therefore, adds Zamberlin, males are not perceived as contraceptive protagonists, and they consequently confer the responsibility for and control of this to women, or assuming at best a secondary role.

Zelaya et al. (1996) arrived at a similar conclusion in a study carried out in León, Nicaragua, on contraceptive patterns in both sexes. According to the research, the dominance of female sterilization and occasional condom use as the methods reported by males reflects a situation of less relative control in contraception and reproduction by them.

It is essential to recognize the fact that the HIV/AIDS epidemic contributed to higher condom use, although for many men condoms have principally been a means of preventing STDs, particularly HIV/AIDS. But it should also be stressed that the condom has been and continues to be one of the alternatives to which the male has access for avoiding pregnancies.

Another aspect related to the theme, approached in other studies, but on which there is still insufficient evidence, comprises sexual relations against the woman’s will, in marriages as well as in couples with unstable relationships or other situations, which is culturally linked to issues of power and male dominance. As cited (p. 85) by Faúndes and Barzelatto (2005), sex in these circumstances is commonplace, involving everything from “...from violence or physical or mental aggression, the use of force or threats of its use, to the cultural imposition of the acceptance of the ‘rights’ of the male over the body of the female, the latter being a subtle form of imposition, of accepting the desires of her partner as an obligation, placing her own desires out of reach and without considering the risk of an unwanted pregnancy”.

According to these authors, the existing evidence leaves little doubt about the frequent dominance of male desires in the decision to have sexual relations, observed to be accompanied by a lack of male responsibility concerning the risk of pregnancy or the contraction or spread of STDs. This behavior manifests itself as, among other things, reluctance of the male partner or spouse to use contraceptive methods, inappropriate or irregular use of condoms or natural methods, and as barriers that men place on their partners to prevent the woman’s access to contraceptive methods. These factors, of course, contribute to the occurrence of unwanted pregnancies, particularly in adolescents. One must also consider cases of rape or sexual abuse, in which women lack the means to protect themselves. In a study carried out in Brazil, Faúndes et al. (2000) found that nearly 35% of women consulted had had sexual relations against their will because they believed that they were obliged to satisfy the desires of their partners.

Finally, taking up questions raised at the beginning of the chapter, another aspect that should be highlighted is the power concerning abortion exercised by males outside the domestic sphere. This theme warrants particular attention because of its implications for abortion and its consequences, as well as for modern and free contraceptive practice. In effect, as has been implicitly or explicitly shown in several of the previous chapters (1, 2, 7, and the present chapter) such an influence is not only noticeable within the couple or in family environment, but also within institutional/social confines, whether judicial, medical, or religious. In these spheres, male dominance is evident, particularly in the conservative societies make up the immense majority of Latin American countries. Therefore, the practices of abortion and contraception are still far of becoming shared responsibilities in many aspects, ranging from rhetorical and legal ones to concrete or actual interventions.

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