Contraception in Context

Abstract

Over much of human history, heterosexual activity and reproduction have been inseparable. Although in the past people undoubtedly have accumulated systematic knowledge about herbal contraceptives and abortifacients, in many places fertility and child spacing have been governed by diet, physical activity, and frequency and duration of lactation rather than by conscious choice. This mode of regulation still operates in some foraging and other preindustrial societies.1 For example, among !Kung, who live as foragers in the Kalahari desert of southern Africa, births are spaced at approximately four-year intervals.2 This appears to be due largely to women's high activity levels and to their nursing their infants on demand as often as every fifteen minutes and for three years or longer.3 !Kung and other women who live in agricultural or more urbanized communities tend to conceive much sooner following childbirth. The value placed on having many children varies widely among different peoples, ethnic groups, and classes, as does the acceptance of limiting fertility. How acceptable the manipulations intended to enhance or reduce fertility are depends on how they fit into the range of personal and public options that govern our sexual and reproductive behavior. Personal choices about contraception are steeped in power relationships and in economics and politics. So, of course, are the governmental and corporate decisions that determine what contraceptives are developed and how they are made available. In the United States and the rest of the industrialized world, middleand upper-class people often frame decisions about childbearing in terms of responsibilitytoward society, themselves, and their children. Children are regarded as expenses, almost as commodities. People speak of being able, or unable, to afford them, and call others irresponsible if they have children they cannot afford. But children are a net expense only when they are expected to spend their days in school for eighteen years or more, without contributing to the household economy. In many societies children help produce food or cash income and therefore save, rather than cost, money.4 Even in our society, where children are usually a monetary expense, they can be a source of love, selfesteem, and social recognition that women may find hard to come by in other ways. We need to look closely at the contexts of work and family relationships in which people make their reproductive decisions before we presume to evaluate their choices. During the past hundred years, two social movements have concerned themselves with family size and contraception-the movements for population control and for