Are We Speaking the Same Language?
Women's Health Advocates and Scientists Talk
about Contraceptive Technology

Adrienne Germain

When women's health advocates and research scientists meet to talk about the development and introduction of new contraceptive methods, divergent views are bound to appear.' For example, who decides which methods are appropriate for particular countries or family planning programs? How are these decisions made? Are the perspectives of women's health advocates taken into account, or are decisions driven primarily by technological, demographic, political, or administrative considerations? What are the implications of the development and decision making process for the quality of service delivery in different settings, for contraceptive choice, and for client satisfaction?

There is, of course, no single "women's" or "feminist" perspective on the introduction of new contraceptive technology, nor is there a single scientific or even demographic point of view. Nevertheless, it is possible to identify some underlying assumptions and objectives that shape the discourse between women's health advocates and research scientists. Some of these lead to shared perspectives, while others produce quite divergent points of view.


Assumptions about Women's Health and Rights

Women's health advocates' ideas about fertility regulation are based on their experiences as women and on their experiences with other women. They have developed agendas on the basis of at least three fundamental assumptions:

Although most contraceptive researchers would probably not disagree with these assumptions, the applications of such principles to their own work have been rather different from the applications that women's health advocates might make.

Although both groups want women to be able to regulate their fertility, each often has different objectives. Women's health advocates seek to maximize women's choices about, and control over, fertility and sexuality as the basic objective. Many scientists might well agree. But those who fund and supervise research have tended to see fertility limitation as a means to achieve societal objectives: to slow population growth, for example, and perhaps to reduce poverty or protect the environment. Each group may respect and to some extent share the other's objective, but the relative weight assigned to each has profound effects on the criteria each group uses for research and policy choices.

Also, scientists and women's health advocates judge women's capacities differently. Women's health advocates' main concern is to enable women to make their own decisions. They seek to empower women through information, counseling, or support groups, as well as through technology. Scientists tend to be preoccupied with the mistakes women might make. They seek to maximize contraceptive efficacy through method characteristics that minimize the actions required for women to contracept.

Women's health advocates and scientists both seek methods that are safe and effective. But the relative weights given to each criterion differ considerably. By and large, women's health advocates emphasize methods that minimize contraceptive risks. Scientists emphasize methods that minimize contraceptive failure within some agreed safety parameters. These two objectives are not always compatible; both pose dilemmas for women who are trying to decide on a fertility regulation method.

Women's health advocates view fertility regulation as only one aspect of reproductive health and rights. This holistic view leads them, for example, to seek methods that not only regulate fertility, but also protect against sexually transmitted diseases and their consequences, such as infertility. They also may seek methods that encourage women to gain more knowledge of their bodies, or that foster male involvement.

Scientists as well as women's health advocates recognize that women's right to control their fertility and sexuality is frequently thwarted by the woman's sexual partner, or by her elders, the community, or the state. Women's health advocates have concluded that these conditions need to be better understood and directly confronted. Scientists have sought to invent technologies a woman can use without the knowledge or interference of her partner. Many women find such method characteristics very appealing. Unfortunately, however, such methods also have risks or side effects that many women prefer to avoid.

How to achieve service delivery standards for particular methods of fertility regulation has been one of the most important issues of debate between women's health advocates and population professionals. In countries where health infrastructures are poor, women's health advocates often recommend methods that have few or no side effects and require little or no medical backup. Unfortunately, these methods often have high failure rates, which expose users to the risks of pregnancy, childbirth, or unsafe abortion. Research scientists often promote hormonal or surgical methods that have lower failure rates but do require good medical support, which is often not available. Thus, the introduction of new contraceptive technologies can expand women's choices but threaten their well-being in other ways.


Establishing the "Appropriateness" of Contraceptive Technology

Even under the best of prevailing circumstances, most sexually active and fecund women of reproductive age face profound dilemmas in controlling their fertility. These include, among others:

There is no perfect fertility regulation method or service delivery system, nor is there likely to be. In these circumstances, women's health advocates give primary attention to such questions as:

1. Whose needs for contraception have not been adequately met by existing technologies or service delivery systems? The conventional definition is "nonusers who are at risk of an unwanted or untimely pregnancy." But there are others: dissatisfied users, incorrect users, inappropriate methods users, and special needs users and nonusers, such as adolescents, the unmarried, and men. Women's health advocates also emphasize that the need for fertility regulation can change throughout a woman's reproductive years for a variety of reasons. Thus, the broadest possible choice of safe methods is essential.

2. What special circumstances face women who want contraception? Among many considerations are a woman's personal circumstances (e.g., her health, sexual relationships, economic situation); the societal conditions affecting her sexual and reproductive choices; the availability and quality of health and family planning services; and the mix of fertility regulation methods currently available and her perceptions of, and experience with, them.

3. What is known about a particular contraceptive method, its benefits, and its drawbacks? Here the dilemmas are quite complex:


Transcending Separate Worlds: The Challenges of Collaboration

Scientists and women's health advocates live and work in almost entirely separate worlds. They have very little information about one another and very few opportunities to communicate. As a consequence, many women's health advocates in both Northern and Southern countries have justifiably concluded that principles of women's rights and variations in the realities of women's sexual and reproductive lives have had little impact on contraceptive research agendas, or on population programs and policies. They have most often found themselves in the position of reacting to what researchers and policy makers do. Because of their isolation and lack of sufficient information, they often react ineffectively and inappropriately. This inevitably fosters distrust and criticism on both sides rather than creative collaboration and a search for shared values. Hence, more constructive exchanges are needed.

During the past several years there have been several fruitful attempts at dialogue between women's health advocates and the "population establishment," including contraceptive and demographic researchers, physicians, and family planning program planners and policy makers. Before the mid-1980s, such dialogues were simply not possible. Today they are, perhaps because social movements have matured, scientists have become more sensitive to the concerns of women, some donors are more aware, and the demand among women for participation is growing around the world. Although all aspects of the debate between women's health advocates and scientists are unlikely to be resolved, interactions such as these can clarify the terms of debate and, in so doing, delineate areas of common ground on which to build.

Divergences between women's health advocates' perceptions of contraceptive technologies and those of scientists and population planners are highlighted here in the belief that dialogue and collaboration are possible only if the persons involved try to understand their differences. The challenge facing us all is whether we can:



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