Reproduction Inequality

Last week seemed to be the week of news outlets endlessly repeating the “isn’t this amusing, vasectomies are up” story. (I’ve noticed this trend more and more in the media of late, the tendency to grab tenaciously to one story and to keep circulating it over and over, presumably because most newspapers lack actual reporting staffs now, so they are forced to pull all their coverage from Reuters.) At any rate, the story got me thinking.

First of all, the framing is deeply flawed. All of the stories are written in a tone which suggests that men are getting vasectomies because of the recession, and they don’t want babies. In fact, no hard statistics are kept on the rate of this relatively simple procedure, so there’s no real way to tell when the rates are increasing. Furthermore, while men may be driven by economic concerns, it may be just as much because they are running out of health coverage and they want to get it taken care of. And, given that the procedure is basically irreversible, I doubt that men who don’t want children right now are leaping into it, because they might want children later.

And could it possibly be that all of our agitating for more equality in handling reproductive choice is finally coming to fruit?

I’ve long been frustrated by the fact that the responsibility for contraception is placed primarily upon women, because it’s annoying, and because it’s fucking expensive. For those of you who happen to not be ciswomen, the plumbing gets pricey to maintain, let me tell you.

If you want any form of prescription birth control (and most women do, because it’s more effective), you have to get an annual exam, which can cost upwards of $200, assuming you also get a basic STI screening with it. If you’re fortunate enough to have access to insurance, your insurance company will probably cover it, but don’t count on it. And, assuming you get a prescription, don’t assume that your insurance will pay for that, because a lot of insurance agencies will not cover birth control. Penis pills, no problem, but birth control, no. And less you think that I’m complaining about a paltry expense, the method I use costs over $800/year.

The only real form of male-controlled birth control available is the condom or the vasectomy, which cuts men out of hormonal birth control options which they might appreciate having. Condoms are relatively cheap when compared to prescription options for women (and women somehow end up bearing the cost more than men anyway), while a vasectomy costs between $500-1,000. If I could go in for a single, low-risk medical procedure which would render me sterile for that cost, I’d be there in a heartbeat. Yet, that option isn’t available to women (although we’re getting closer). Because of the increased complexity of our anatomy, or is there perhaps some other reason, like a desire for more control over women and our bodies? Permanent sterilization is pretty much the ultimate way to take control of your own reproductive system, for those who don’t want to have children.

When the Pill was first marketed to women, it was very male-controlled, right down to the delivery method. Those placebo pills were placed in the pack at behest of men, not out of any real concerns about the potential effects of continuous birth control on long term health. Now, some 40 years later, a handful of companies are marketing products which allow women to control their periods like it’s a big deal, a totally new invention, when in fact the earliest prototypes of the Pill had no placebos, or set up a seasonal menstruation schedule rather than a monthly one, just like that fancy extra expensive designer birth control does today.

I find it fascinating that women are expected to take responsibility for birth control, and that options for women are significantly more expensive, and they can be harder to access. A man who wants a vasectomy can just schedule an appointment and do it. A woman who wants a tubal ligation will have to go to a counselor, and even then, her husband/partner may  have to indicate that he’s ok with it. That’s ludicrous, and insanely antiquated.

In states like California, programs exist to provide reproductive health services to low income women, but many of these programs push sterilization over other methods, which sounds suspiciously like eugenics to me. That’s right, if you’re poor, the state will pay for a tubal ligation! It’s blatantly about keeping poor women from having babies, because women who have been sterilized are no longer eligible for free Pap smears and annual exams to monitor their health; once you can’t pop out any babies, the State doesn’t care. And while it’s great for low income women to be able to access other reproductive health services, that doesn’t really help women in higher income brackets who may still be struggling to cover reproductive health services.

Supposedly, there’s some mythical world in which boyfriends help their girlfriends pay for birth control, and even participate in the discussion about contraceptive methods and responsibility. But most of the women I know who have sex with men say that they are expected to take total responsibility for the whole business, including cost, and some have even told me that their partners still don’t trust them. A simple way to deal with that might be, say, taking responsibility for wrapping your little soldier, but apparently it’s much easier to stand over your girlfriend while she takes her pill to make sure she swallows it.

A small part of me wants to imagine that the alleged and impossible to prove uptick in vasectomies is all about a new generation of socially aware and responsible men who want to take charge of their own contraception. Wouldn’t that be nice?

5 Replies to “Reproduction Inequality”

  1. I’ve always paid for my birth control, even when I was a broke college student. It’s interesting that it never even occurred to me to ask my partners over the years to share in the cost, though I was lucky enough that my then-husband decided to get a vasectomy after finding out how dangerous it would be for me to get my tubes tied. And it always irked me that birth control wasn’t covered by insurance.

    BTW, my mother told me that when she first started taking the Pill back in the 1960s, she had to prove she was married and make a case for why she should be allowed to have it! The dosages were so huge back then that she kept getting sick…and pregnant.

    Yet another excellent post.

  2. A vasectomy is actually easier and safer to reverse than a tubal ligation as well as being a much safer procedure.

    BTW, I always believed that contraception in a relationship (as opposed to the one night stand thing) should be a joint decision. So when my now husband and I started living together, I solicited his input. That is how we ended up married and procreating due to a total misunderstanding.

  3. Vicki, that’s why I said “If I could go in for a single, low-risk medical procedure which would render me sterile for that cost, I’d be there in a heartbeat” in reference to vasectomies, because they are indeed safer and easier to reverse, so if you’re going for permanent birth control in a couple, the vasectomy makes sense. But I still wish that there was a comparable option for women. (I guess Essure is a step in the right direction?)

    And I also wish that men had access to the middle ground between condoms and sterilization that women have in the form of hormonal birth control, IUDs, diaphragms, etc etc.

  4. Essure sounds like it could be a good option, but whoo-boy, do they ever drive home the message that “this is for after you’ve already had babies and attained white, middle class hetero-normative bliss.”

    Ah, well- I suppose they’re trying to cover their butts in case of attack from the anti-choice firing brigade.

  5. I also suspect that Essure really wants to underscore that it’s permanent, which is why they talk about “after your family is complete” so that upstarts like me don’t think it’s a good option. (Although technically speaking, my family is complete. Just not complete in the traditional way.)

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