So, I am just about at my wits’ end. Here is my situation: I am getting married in 2 1/2 weeks. Therefore I need to sort out contraception.
Yes, I said it, out aloud. I am from a culture that talks about these things since we are about 10. Admittedly, school tries to keep things very serious and biological and then we usually giggle and throw prophylactics at each other screaming “you’ve got cooties now! Gross” and behave in other age-appropriate manners. Well… maybe that was just me, but we do at least talk about it.
Now, while it is not a topic of general conversation “Hi, my name is Sarah, and I have a diagphram – do you know where the brown sugar is?” it is not a ‘problem’ topic. Because, see, contraception is everywhere. A slightly tongue-in-cheek and light hearted history of the British Attitude to contraception goes:
Britain: “Gasp! The rest of Europe is so open sexually. They are so immoral! Look at all these naked people on TV / CD covers etc! We disapprove! Now shush about the topic, lest its sordid implications corrupt our beautiful pure youth”.
Rest of Europe: “Your beautiful pure youth have horrendously high rates of unplanned pregnancy and STDs”
Brtain: “Hmmm. This is true. But what can we do?!?”
Rest of Europe: “Well… you could educate them about sex and contraception and the physical and emotional health issues that go along with it. And try… you know… to be a little more open about it”
Britain: “Interesting suggestion. But… but if we do that – people might start having sex! And we don’t want that! We are a terribly prudish and stand-offish race! And we will stay this way to keep a chaste youth.”
Rest of Europe: “Right. But… uh… as you have an 11-year old mother, and a cute 13-year old, who looks about 8, but claims to have fathered a child with a 15-year old girl, that two other children (but which we mean under 16 years) claim to have fathered too, perhaps your approach isn’t working?”
Britain:”It is not! We agree, but if we start being open about sex, and teaching kids about it, and giving them access to contraception, they will start doing IT. We are repeatedly telling them how to say no, and how not to have sex.”.
Rest of Europe: “You have one of the highest teen pregnancy rates in Europe. I think they already are”.
So, I believe I have witnessed a bit of an about turn wrt contraception in the UK, in my lifetime. From ‘don’t do’ to ‘don’t ask, don’t tell’ to ‘you don’t have to do, but here’s what to do if you do’. As my friend (American) put it: “Britain gives contraceptives out like tic tacs”. It’s sorta true. I has heinously bad period pains from the age of 12 onwards. Think: vomiting so hard I pulled my tummy muscles and then passing out into my own vomit. Lovely. Think: when I was snowboarding with a broken arm I refused to believe it was broken as it wasn’t as bad as period pains. Even when I was pushing my whole body weight with said arm. Nice. So, my PCP put me on the contraceptive pill at about 14. I went with my Dad. It was OK. 22% awkward, but OK.
Eventually, I used to get my refills at my local walk-in clinic as it was closer to the bus stop. I would toddle along, they would take my blood pressure, ask a few questions, then hand me 6-months worth of free pills. And charge me nothing for the pleasure. Then they would offer me condoms, and I would say ‘thank you very much, but I am not having sex. Really’. It was an anonymous service so I didn’t have to lie, but they would always say “hey – take some anyway. You never know”. And I would say “I do know!” and they would give them to me anyway, in a nice unmarked brown paper bag (because brown bags never look suspicious and remind people of hidden porn / alcohol) and throw in a load of femidoms, dental dams, information leaflets and so on. “Have them anyway… Give them to your friends” was the advice. Frequently I would arrive home with my bounty and my Ma would eye it suspiciously and say “Do we need to talk?”. Which we didn’t, but to be fair it did open the door for me to be able to talk (however awkwardly / angrily / sullenly) with her about this through those difficult teenage years.
At some point I went on a health kick (an unempirical health kick) and decided the pill wasn’t good for me. And a vane-kick when I decided it made me fat. I was coming off this darn thing dammit. I went to my doctor. She talked me through about 20 other options both for contraception and for the period pains. She fitted me with an IUS (a super expensive intra-uterine device) within 2 weeks (I had to wait for some tests to come back first, which were done that day). For free. She gave me a load of free counseling. She gave me a load of condoms. Nice expensive ones as I am allergic to latex. I think I sold them 🙂
When it came time to have the IUS out I was in the UK. I was there for a period of 2 weeks and decided to remember this about 2 days before I left. Now in the UK there are walk-in clinics in every county and every county has both weekend and evening ones. If you cannot make any of those, GPs are obliged to see you. So, I call a walk-in clinic and explain the problem – they tell me they are full for 2 days, but give the numbers of others – all within easy distance. The others are full, or the times don’t suit me (why? Honestly? Because I am catching up with friends). So my local GP has to see me. They do. They next day. They whip it out for free, and offer me a new one. I decline, and they say “are you sure? The pain might come back”. I tell them I will sort it out in the US and they say they don’t think they is a good idea. This shocked me, and I ignored it. They offered me 6 months of the pill. I turned it down as I was not having sex (we’re British, no sex please. Oh, apart from all those pregnant teenagers). She really wanted to know if I was *sure* and then let me go with a promise to come back and see her when I was next back from the US.
Fast forward to my return to Alabama. Boyfriend proposes. I gaily accept. Hoorah. I plan a wedding. Double hoorah. 3 weeks before the wedding I think I should sort out contraception. I call my GP here and am told she is not accepting new patients. I tell them I not a new patient and they don’t care and I get a random GP. That’s cool, I don’t really care who does this. I go see her the next day. I am impressed – she is on time (rare in the NHS, and certainly better than the 2-4 hour wait at walk in clinics in England) and I pay a slightly annoying, but affordable $20. I tell her the situation and that I would like to avoid hormones. I don’t want to use condoms. She says “OK, you need a diaphram. You need an OB/GYN. You can see one in 6 weeks”. I point out this might be shutting the stable door after the horse has bolted. She says there is nothing she can do. So I say “OK, how about I use hormones for a short while?”. “Not a good idea” she says, and has no other suggestions. I am floored. I glare at her. She says that there isn’t time for me to use hormones. This is actually incorrect. They (depending on the method) can be used from Day 1 – Day 5 of your cycle. She has my cycle dates and Day 1 is next week. I start to throw a shit-fit. She has no other suggestions (lower , localized hormones? Femidom? Even frikkin’ fertility tracking? Anyone?). She takes my blood pressure and says that because it is elevated, I can’t have hormones as it is dangerous. Again, this is factually incorrect. Raised bp is one long-term risk factor; I am not overweight, I don’t smoke, there is no history of thrombosis and I have a successful history of taking the pill. And bp fluctuates. And she was STRESSING me out. And I hadn’t slept much, if at all, for 3 out of the last 4 nights [because, duh, I am excited to GET MARRIED and planning a wedding and submitting a grant and seeing my very best friend in just 12 days]. Really? She says. And 2 nanoseconds later I am leaving her office, slightly dazed and confused, with a prescription for a benzodiazepine, and a refill, and no follow-up.
THAT is giving things away like tic-tacs.
I could have an IUD – not recommended given my medical history, but an option. In 6 weeks. And it’ll cost around $500 all- in- all. Because I really have that when I am postdoc, my fiance is a student and we’re planning a wedding (did I mention the wedding? Might have done. Little bit excited). No, it is not covered by insurance (but, if you were wondering… Viagra is. Yes, you did read that correctly. Wonder what the gender is of the people who make that decision? Perhaps the women are all off having babies). But anyway, it is OK, because if I can’t afford an IUD an abortion can be as low as $400.
So, I return to my office, very upset. My office mate gives me the planned parenthood number and I call them the next day. “Yes, the Alabama clinics don’t prescribe contraception”. Oh. Really? That’s good planning there. My office mate suggests the student health centre, which for $30 are seeing me tomorrow, which is pretty impressive, and I hope it is a good score for UAB (who have been universally wonderful to me so far) and I hope it works out.
The thing is: contraception is so free and widely available in the UK not just because it is a health issue, but because it is an equality issue too. For two reasons:
(1) The UK believes women have the right to regulate their fertility as much as men. That is, they have the right to go out and have meaningless one night stands without consequences (it can be consequence free for men who abscond into the night).
(2) The burden of contraception usually falls on the woman – although it does not have to, it usually does. We want to help balance this out by givign her the ability not to pay (when she is already paying for feminine products) and not to have to take time out of work.
I have already lost $20 and a few hours from work. I will now have to lose more time and more money. My fiance’s response? He wants to be supportive. He volunteered: “If I’m not at work, I’ll come with you”. Because work is optional for me. I don’t blame him at all, but I see no reason not to see that statement as indicative of underlying attitudes. If I get pregnant, well, no one is going to force him off work… (that is not his attitude, just a statement).
And my honest thoughts? “Fuck it (pardon the pun). I don’t see my fiance really busting a gut to sort this out. Why should I? I want kids in the next year (he doesn’t for a couple of years, we agreed to compromise and try in a years time when we are financially better off, settled into marriage, knowledgeable about where my career will take us… all good reasons)… But perhaps I will tap out and see what happens, ‘coz quite frankly my grant not going in, not having a dress to wear, not getting these papers in, missing collecting my friends from the airport – well none of them are as important to me as not having a child when I’m married, that I want”. I am not going to do it. If possible, I would like to bring a child into the world with planning. But, it’s tempting.
Sort it out Jefferson. Educate your medical practitioners on more methods. Free up medical practitioners to give people contraception. Get evening clinics. Get anonymous clinics. Try to talk people reluctant to use the best methods of contraception for them (like me) into doing so. Push alternatives. And don’t just whack them out on anti-anxiety drugs.
Just a thought. (A frustrated one – I think the drugs must have worn off. Perhaps my GP can give me something else to keep me quiet).