The prescription of contraception: Negotiations between doctors and patients

Abstract

Maria, an Anglo woman, age 26, married, with medium length brown hair, slightly plump, has a tired air about her which can quickly turn to animated interest if her lively sense of humor is aroused. She has four children ranging in age from 11 years to 6 months, and a varied contraceptive history. This history includes successful use of the birth control pill for several years, followed by a period of 1 year when she would forget to take the pill regularly regardless of how hard she tried. This problem arose at a time when her two oldest (and at that time only) children were starting school and she wanted another child. Her husband was against the idea. She changed contraceptive method to an IUD (intrauterine device) which was inserted painlessly but caused her intense pain with menstruation. After several months she had it removed. She and her husband are presently using condoms which Maria feels interfere with their sexual life as well as creating anxiety for her. She is presently anxious to avoid impregnation, whereas her husband would like her to be pregnant again.

Based on Maria's unsuccessful experience with the birth control pill, her dissatisfaction with the condom, and her mistaken understanding (and thus rejection) that the diaphram needs to be inserted right before intercourse, similarly to the condom, she feels her options for birth control are limited. Given her current fears of pregnancy she has come to her local community clinic to once again try the IUD. While this decision makes her nervous— she previously needed prescription pain pills with this method—she feels resigned to this choice.¹

Notes

Grateful acknowledgement is made to Sue Fisher, Rich Frankel, Hugh Mehan, Ron Ryno, Thomas Scheff and Will Wright for their helpful suggestions and comments.