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.