Proponents of birth control persuasively present it as an effective method of controlling population explosion, particularly in the developing countries. However, birth control methods attract significant controversy due to concerns linking it to infertility. In the US, three in four sexually active women under 30 use some form of birth control. A significant proportion of these women are concerned about the possibility of birth control hurting their chances of conceiving once the right time arrives. There is a consensus among scientists and healthcare professionals that birth control does not cause fertility. It has been proven that women who stop using birth control can take from one month to a year to conceive. On the contrary, such an understanding has not eliminated concerns about the association of birth control with infertility. There are personal accounts of women who have been trying to conceive without success after stopping birth control.
There is evident lack of clarity on the mechanism of action of birth control methods, hormonal methods in particular. As a result, there has been a shift towards fertility awareness methods. These forms of birth control include tracking one’s cycle, body temperature, and cervix mucus to determine the time of ovulation, hence the green (infertile) and red (fertile) days. A recent study in Australia noted a substantial rise in the use of natural birth control methods in target populations despite availability of modern methods (Freilich, Holton, Rowe et al. , 2017). A similar case was presented earlier in a study conducted in Italy, in which Gribaldo, Judd, and Kertzer (2009) demonstrated that the country’s lowest birth rate in the world corresponded to the predominant use of traditional birth control methods despite availability of modern contraception. Preference for fertility awareness methods demonstrates individuals have reservations about the ethics of birth control, which are largely driven by failure those concerned to integrate cultural perspectives into family planning programs. This paper explores the effects of differential ethical and cultural perspective on association of birth control with infertility.
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The Ethical Paradigm
The biblical verse that people should be fruitful and multiply can have serious implications to birth control programs. It raises the moral and ethical aspects of the programs. On the other hand, increases in population in the developing countries has exerted immense pressure on the environment and condemned many people poverty. Population control is used to justify regulation of birth control independent of economic concerns. Many people have expressed serious moral objections to birth control as a means of population regulation.
There are no laws in the US that restrict contraception, but objections by various movements have resulted to contradictory perceptions of birth control programs. Many opponents of birth control base their objections on religious dogma, asserting that contraception is an immoral practice that promotes prostitution and spread of sexually transmitted disease. Some of these movements have outlawed contraception. On the other hand, there are substantial concerns about the association of contraception to infertility in women. Bailey (2010) noted that the most relevant law on contraception was found under the “Comstock” statutes (Sect. 312) that illegalized the selling, lending, or distribution of "obscene" publication, or article used for contraception or abortion. Section 305 of the Tariff Act of 1922 forbade the importation of any contraceptive information or means. The laws were declared unconstitutional in 1919 for being haphazard and capricious, and lacking "any clear, broad, well-defined principle or purpose. The current laws on contraception are associated with human right discourses, but are embraced by federal government despite opposition by those with moral reservations. The federal government funds contraception for low-income families.
According to Bailey (2010), review of the association between population decline in the US in the 1960s and the introduction of contraception revealed that the pill was responsible for the accelerated post-1960 decline in marital fertility. There are a number of provisions in the law that influences how the medical community handles the issue of birth control. The law that limited contraception to married partners was found to violate the equal protection rights of single persons. The law on distribution of contraception limited the process in cases involving minors under sixteen years to physicians. In addition, health insurance companies objected to covering contraception because it violated religious beliefs.
A number of ethical issues drive the objections of contraception among different groups. Cultural imperialism is a contributing factor because introduction of birth control to a given community change the relationships and power dynamics within it. Contraception is also criticized for interfering with and individual right to have as many children as they wish. In addition, concerns have been raised about the possibility of birth control being used to reduce birth rates in certain classes, castes, or ethnic groups. Moreover, gender bias is a major issue because contraception mainly targets women fertility, putting them at risk of infertility. The medical community may face difficulty in explaining such diverse concerns.
Money, power, and control influence the consumption of birth control substantially. In addition to funding of contraception for low-income families by the federal government, developed countries use it to control population of the world. Birth control is considered a form of imperialism because it is funded in the developing countries by the rich countries. In some instances, rich countries are accused of demanding implementation of birth control programs in exchange for financial aid. Physicians and other stakeholders are left with little choice but to comply. The practices are regarded as bribery incentives and may play an important role in advancing practices that are considered unethical including coercion, unfairness, undermining human dignity, and abortion to get benefits where birth control methods fail.
The Cultural Paradigm
Culture plays an important role in shaping opinions and perceptions of contraception, hence its uptake by the community. According to Greil, McQuillan, and Slauson‐Blevins (2011), progressive perception of infertility as a medical condition rather than a private problem of couples, qualifies it as health or disease problem, which are socially constructed objective states. Culture is one of the vantage points from which to study birth control and infertility. In a cross-sectional study by Missmer, Seifer, and Jain (2011) on women from different ethnic and racial groups, it was established that African American and Hispanic women took longer to conceive. In addition, they found it challenging to get an appointment with the doctor, time off work, or pay for treatment. However, majority were concerned about the stigma of infertility, which was related to concerns about disappointing one’s partner. Under the circumstances, assertions of the association between birth control and infertility are likely to impede their uptake of contraception. Children are highly valued in some communities irrespective of the number or gender, thus any potential risk of infertility would be avoided at all costs.
The ideal family size for people in the developing countries and other communities in the developed world is large and polygamy may be practiced, but falling pregnant in quick succession may be an abomination (Mairiga, Kullima, Bako, & Kolo, 2010). Such cases may necessitate the use of contraception. Cultural factors have the potential to influence acceptance of contraception by couples from different backgrounds in distinct ways. Culture channels most human thoughts, feelings, and actions, hence the need to adopt extreme degrees of determinism that allow people the freedom to deviate from cultural patterns. Anthropologists perceive culture to be significant in understanding human fertility rates in modifying sexual activity by relating sex and reproduction to the culture's value system. Therefore, in relation to birth control and infertility, culture has the potential to influence patient preferences and behaviors, health care system factors, and provider-related factors (Dehlendorf, Rodriguez, Levy et al., 2010).
There is a consensus that communities in the developing countries are largely affected by contraception because of lack of awareness. However, Missmer et al. (2011) demonstrated that in the US, women from minority groups including African Americans, Asian Americans, and Hispanics are the most affected. Cultural factors contribute to poor utilization of family planning methods. For instance, the value attached to children means a couple can only be regarded to be worthy of recognition if they have children. In addition, misconceptions about birth control in these communities contribute to vehement opposition of family planning programs. Gender roles also play an important role because women are always considered the ones with the problem. Affirmative action is absent to eliminate the gender bias where birth control is concerned,
In communities that still have strong attachment to cultural practices, few women use modern methods of contraception. However, traditional techniques are predominant. Family planning to these societies is conceptualized from the child spacing perspective where practices such as prolonged breastfeeding, spiritual invocations, herbs, and ornaments in various forms are used. In addition, integration of region with culture contributes to low uptake of modern birth control methods.
Conclusion
The association of birth control with infertility is a controversial topic that needs to be addressed conclusively. Despite the consensus among researchers and medical community about the safety of contraception, there are accounts of women who have failed to conceive for years after stopping using contraceptives. Such accounts raise diverse ethical issues on birth control, which is highlighted by lack of clear laws on the subject. In the US, birth control is a common practice among sexually active women, but some have reservations about their chances to conceive later in life. Women in marginalized communities and regions echo similar sentiments. However, a number of ethical issues are related to the use of birth control in these marginalized groups where access to contraceptives is funded by the federal governments. Such programs have been questioned due to links to unethical population control practices. In addition, cultural factors are instrumental in determining the uptake of birth control. Most communities place significantly high value on children, and having many children is independent of the socioeconomic status. Under such situation, infertility is frowned upon, influencing women to give birth control programs a wide berth. It is important to understand that the consensus by professionals about the efficacy and safety of birth control methods in relation to infertility is not shared by the actual consumers of contraceptives. Affirmative action is needed to bring all stakeholders to the same level of thinking by addressing pertinent ethical and cultural concerns about family planning.
References
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