Effectiveness of Contraceptive Methods. Gender Power Imbalance

No contraceptive method is 100% effective, and pregnan­cies resulting from contraceptive failure are often aborted. All methods have an intrinsic failure rate, but for the meth­ods that depend strongly on the users’ compliance such as the pill or behavioral methods, most of the pregnancies are caused by incorrect use by the woman or couple (Indian Council of Medical Research, 1996).

The contraceptive pill’s effectiveness is close to 100% in controlled clinical studies, but the pregnancy rate in actual use can be as much as 6-8% per year of use in population-based studies. Knowledge of correct use, as well as user error, contribute to its decreased effectiveness outside of clinical trials.

Failure rates due to user error are negligible for meth­ods that do not depend on user compliance, such as intrauterine devices and implants. The very high effec­tiveness of these methods in actual use makes their avail­ability critical in the effort to reduce the number of unwanted pregnancies and abortions.

Gender Power Imbalance. Knowledge about and access to contraceptive methods is not enough if women do not have control over their use every time they have sexual relations. Coerced sex is far more common than has traditionally been acknowledged, because most studies are limited to the incidence of rape, defined as imposed sexual intercourse using force or the threat of force. The far more common cultural imposition of male so-called rights over a woman’s body, ranging from sexual coercion (in exchange for maintaining a job or satisfying other personal needs) to the woman’s sense of obligation to have sex with a stable partner, is usually not counted in these studies.

Prevalence of sexual violence varies from less than 10% to close to 40% of women of childbearing age, according to different studies. The variation between studies depends both on the social environment and on the definition of sexual violence. According to the United Nations definition, gender-based violence includes threat­ening and coercion, but many studies consider only direct physical imposition as sexual violence.

The woman’s cul­tural acceptance of her obligation to satisfy the sexual desires of a partner or husband above her own wishes and above the risk of unwanted pregnancy is seldom con­sidered. This more subtle cultural imposition of unwanted sex and women’s lack of power to negotiate use of protec­tion against pregnancy are far more relevant than actual rape as a cause of unwanted pregnancy and abortion.

A good illustration of this cultural conditioning is a study carried out among adolescent girls and boys in the United States, which showed that a large proportion believed that boys who had invested time or money in entertaining their female partners had the right to have sex with them. In South Africa, an overwhelming majority of adolescents had the same opinion.

In addition, studies also show that both adolescent and adult males believe that protection against pregnancy is the responsibility of women; therefore, men may often be an obstacle to contraceptive use. One-third of unwanted pregnancies among women who requested legal abortion in India could be attributed to the husband’s unwilling­ness to use contraception (Banerjee et al, 2001).

The review of several studies on the subject strongly suggests that male dominance in the decision to have sex and the lack of male responsibility with respect to con­traceptive use contribute to the incidence of unintended pregnancy. This may be a major hurdle to reducing the incidence of abortion among adolescents, who are more resistant than adults to interventions against unwanted pregnancy and abortion.