Contraceptive behaviour: a psychoanalytic point of view
E.P. Spandau
AASSER (Argentine Association for Sexual and Reproductive Health), Buenos
Aires, Argentina
Since modern contraception (MC) developed, acceptability became a tool to
seek an answer to what goes on in the ‘black box’ of contraceptive decisions:
why a particular method is chosen; to use, not use or to misuse a contraceptive;
why failures in compliance happen, etc.. Social scientists and the medical world
complain that there has been little progress in the last decade to understand
contraceptive behaviour. Here we introduce the psychoanalytic point of view to
enhance the comprehension of this behaviour.
Some case studies show how well informed women often choose unsafe
contraceptive methods or have failures with highly effective ones. There are
also fantasies and fears about contraception that are alike in very different
settings and cultures. We’ll try to understand these 3 f’s (failures,
fantasies and fears) searching for unconscious (ucc) meanings and conflicts
activated by contraception.
Modern contraception successfully separates sex from reproduction. Sexual
pleasure only for its own sake, without consequences, not allowed by unconscious
and ancient social repression, may release ucc feelings of guilt and (self)-punishment
that often lead to unhealthy contraceptive behaviour.
Pregnancy can be a drive (Trieb, pulsion) or the final stage of gender
identification with the own mother or have many other meanings. But to give up
this ucc desire to conceive, there has to be a resignation, a often incomplete,
never ending mourning, that may appear as contraceptive failure.
The modern psychoanalytic and gender position, sees a conflict in the
psychosocial construction of motherhood as a central value of a woman’s self
and the free exercise of sexuality.
The woman’s body has the capability to achieve the basic feminine self –
ideals: attract the male and get pregnant. The unconscious mental picture of the
own body is different in every person.
The unconscious ideas of how the body interacts with gadgets or devices in
the genital tract or incorporating drugs, are absolutely personal and very far
from our biomedical way of seeing the body. It may unleash fantasies and fears
of harm related to the conflictive repressed sexual behaviour.
To include contraception usefully in life depends on how the self developed,
the relationship with the own body and the meaning of sex-life. That is why
reproductive health, in fact, is embedded in human development, in social and
educational change. In counseling in MC one should always bear in mind the
ambiguity, the contradiction between what is consciously asked for and the
unconscious trends and drives. Contraception may seem simple, but it awakens
often complex behavior and psychic conflict.
