The pill's 50th anniversary: do we have freer sex and better managed fertility?

Women are currently using contraception for longer periods then ever before. The average heterosexual Australian woman will spend at least 12 years having sexual relationships, from age 17 to 18, before she has her first child, at around 30 years of age.

The pill and condoms are by far the most popular methods of contraception to achieve this extended period of non-reproductive sex. The 2003 Sex in Australia survey reported that of 16- to 29-year-olds, 60% used the pill, 40% used condoms (some used both) and the next most popular method was withdrawal, used by 5% of the respondents.

These methods have been around for a long time and since their invention, their use has changed. The pill was designed to allow married women to space their children and to reduce family size. Introduced in Australia in 1961, the pill didn’t start contraception in marriage, but it did give it a makeover.

Contraception was no longer about messy, embarrassing things like withdrawal, diaphragms and condoms. Now you could go to the doctor, display your wedding ring and ask for pills to prevent conception.

Condoms were invented in the 1700s, in response to an outbreak of syphilis, so they were initially used to prevent the spread of sexually transmitted disease rather than pregnancy. Withdrawal has been around for as long as we have understood the role of sperm in conception.

These are the methods – one invented two generations ago, the other two centuries ago – that women rely on to achieve contraception today.

Managing sex and fertility

In the course of my PhD research in the early 2000s, I interviewed 32 women who had recently used emergency contraception (a disruptive experience like this is a good time to ask women to reflect on their choices, their experience and how they tackle the problems they face with contraception). I was interested in how women were managing sex and fertility in the post-pill era.

The women I spoke with were aged between 18 and 45. They were in a range of relationships: some casual, some in the early stages, others in more committed relationships and marriages. They were all attempting to manage the needs of both their sexual and fertile body.

We often hear rhetoric that since the sexual revolution and the introduction of the pill, sex has been freed from reproduction. This was not what I found.

It wasn’t that these women didn’t think sex was fun and an important part of their relationships and lives – it mostly was. But ideas of their fertility – existing and in future – were ever-present in their thinking, planning and decision making.

When women described the decisions they had made about contraception, they described the compromises they made to resolve the conflicting needs of their fertile and sexual bodies, which couldn’t be separated. When they were having sex and didn’t want to fall pregnant, all women felt they were taking some risks, whether it was the risk of an unplanned pregnancy or the risk that their fertility, mood or body may be compromised by the pill or other invasive contraceptives.

And why would women feel that there was a risk-free option? Even if she chooses to take the pill and use condoms (when at risk of an STI), she could still end up with an unplanned pregnancy.

Failure rates of these two contraceptives have been estimated at 9% for the pill and 14% for condoms. Recent estimates predict that in an average lifetime, each woman will have two contraceptive failures. Given these figures, is it that surprising that one in three women have an abortion in their life?

Competing demands

To summarise the characteristics of the women I interviewed, I use the term “reflexive women”. Women had to reflexively manage the competing demands of the sexual and fertile body. Far from being risk takers, women were strategically controlling risk, planning pregnancy and managing crises.

The presence of the reflexive woman, and the things she faces, informs us about our society. Women are presented with a number of unarticulated contradictions and are expected to manage these in their day-to-day lives and decision making. One contradiction is that women expect to separate sex and fertility, but in reality, no reversible contraceptive is 100% effective.

The sexual revolution shifted our expectations about the relationship between sex and fertility, but our ability to separate the two has not shifted in line with our expectations.

Perhaps if we start telling young women the truth about the likely outcomes for their fertility management – two contraceptive failures each; one in three will have an abortion; one in five will have trouble falling pregnant at the time of their choosing – young women will demand the changes that the sexual revolution promised 50 years ago.

Louise Keogh will speak tonight at the 50th Anniversary of the Pill in Australia, a free public event at Melbourne’s BMW Edge theatre, Federation Square.

Louise Keogh received funding for her research on emergency contraception from the NHMRC