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How not to have children?

1In France, work on contraception and fertility control has long been marked by a “teleological vision of the history” of contraception (Pavard, 2012: 15), considered as a source of emancipation for women and as “Lever of male domination” (Héritier, 1999: 48). The weight of this approach, which links medical contraception and the liberation of women, has slowed the emergence of a critical sociological perspective on contraception, and it is rather demography and epidemiology that have taken hold of the subject in France, limiting birth control to a public health issue of reduction of voluntary terminations of pregnancy.

2It was not until the turn of the years 1990-2000 that French research underlined the restrictive nature for women of pregnancy prevention methods and the medical and social standards that govern their use. Highlighting a standard (Bajos / Ferrand, 2004) restricting contraceptive uses within a well-defined temporality and relationship maturity (male condom for punctual relationships or at the start of relationships, pill once stabilized, IUD when the desired number of children is reached) completes a whole reflection on the social control to which women are subject in reproductive matters and in particular birth control (Ferrand-Picard, 1982). For the past ten years, works have been trying to depart from this emancipatory vision of contraception and seek to reveal social inequalities (Bajos et al., 2012), the obstacles to its use or the invisible dimensions of responsibility. that women overwhelmingly endorse. These surveys seem all the more necessary today as an evolution of the French contraceptive model, in particular a reduction in the use of the pill, seems to begin following the “crisis of the pills” of 2012-2013 (Bajos et al., 2014).

1 If men are not absent from contraceptive work (Le Guen M. et al., 2015), taking care of (…) 3Preventing pregnancy covers a certain number of tasks and burdens which constitute work in itself for those who, for the most part, take responsibility for it: women. Being able to benefit from contraception implies in fact respecting certain stages: these are material, financial, time constraints which follow one another. Added to these different obligations is the “mental burden” (Haicault, 2000: 15) borne by women using contraception, which consists of the need to worry – continuously, and sometimes on a daily basis – about what intercourse are not fertile. If they are finally and an abortion is planned, it is always women who will have to manage it (days off, possible pain, etc.) and are likely to be stigmatized (Mathieu / Ruault, 2015 ).

2 Like certain parts of salaried work. In particular, this invisibility concerns (…) 4Or, this contraceptive work, which represents a section of reproductive work and is based on the empowerment of women, has been naturalized over time; its different dimensions thus seem to have gradually become invisible. The very conditions of possibility of this invisibilization – in particular the gender inequalities that found this work and are renewed through it, but also the medical staff that orders it – also remain to be thought about. To understand the naturalization of contraceptive work is therefore to wonder: who benefits from this invisible work of women? It is in fact at the crossroads of two types of power relations, which are not themselves distinct but rather rather nested one inside the other: medical power, on the one hand, which currently frames today in France the contraceptive practice of the majority of women; gender relations, on the other hand, which induce women to internalize their assignment to the domestic and reproductive sphere. The reduction of contraceptive work to female responsibility therefore refers to two types of logic which are mutually supportive: a logic of public health, where it is a question of thinking in terms of population management and control births; a gender logic, where it is rather a question of the possibility of a discharge of male responsibility (Spencer, 1999) and the consequences of this work.

3 The pill has since become the most widely used method in France: 40.6% of women affected by (…) 5This article will first analyze female responsibility for contraception, looking back at its origins since the legalization in France of the contraceptive pill in 1967 then on its progressive invisibilisation. It then aims to shed light on certain concrete dimensions of contraceptive work, by emphasizing in particular the efficiency imperative to which women are subject, as well as the resources required today for “choice” in contraception. Finally, he intends to come back to the most denied dimension of contraceptive work: that which concerns the effects on the body, emotions and sexuality of the methods used to not have children.

Methodology

This article is based on two doctoral research. A first thesis work, that of Mylène Rouzaud-Cornabas, focused on contemporary contraceptive policies, drawing on both institutional and press archives and on a corpus of 78 interviews carried out with health actors and actresses. (health professionals, user and feminist associations, public authorities). Taking into account the recent crisis of so-called new generation pills has also led to work on the data from the Fecond surveys (Fertility – Contraception – Sexual dysfunctions, Inserm / Ined, 2010 and 2013) about contraceptive practices and representations . The second thesis, that of Cécile Thomé, questions the effects of the spread and contemporary use of different contraceptive methods on sexuality and gender relations. It is based on a corpus of archives, the Fécond surveys as well as a corpus of 71 interviews on sexual and contraceptive life, conducted with women and men aged 20 to 84 and having exclusively or mainly heterosexual intercourse.

6The “Simon report”, the first major French survey on sexuality, conducted in 1970 by the FIFG under the direction of Doctor Pierre Simon, emphasizes that “formerly practiced almost exclusively by men – if not always on their own initiative – contraception today tends to become an equally feminine behavior ”(Simon et al., 1972: 334). From the 1960s, medical methods of contraception (in particular the contraceptive pill), managed by women, gradually replaced interrupted coitus as well as methods based on the determination of ovulation and abstinence (Ogino method, temperature method).

7If this medicalization of contraception is accompanied by its feminization, it is because the contraceptive pill is the main outlet for a whole section of scientific and industrial development of research on hormones. The discovery, in the 1920s, of so-called feminine and masculine sex hormones led to a biologizing interpretation of the masculine and the feminine, which reinforced the discourse on the difference of the sexes (Gaudillère, 2012: 58; Martin, 1987). By meeting a desire to locate the “feminine essence”, to understand and mark the distinction between the sexes, this endocrine turning point perpetuates gender representations associated with reproductive bodies (Oudshoorn, 2003). Due in particular to the ease of access and synthesis of estrogens but also to their profitability in what will become pharmaceutical products (Martin, 1987), research and development in this area mainly revolves around understanding the female hormonal system. (Löwy, 2006; Watkins, 2012), to the detriment of understanding male reproductive functions and, therefore, research on contraceptives for men.

8The distribution of the pill and then of the other hormonal contraceptives (injections, hormonal IUD, implant, patch, ring) is part of this process of feminization of contraception. The essentialization of female contraceptive responsibility is also to be seen in a relational approach, female work gradually allowing male disinvestment.

How not to have children? part of an

4 The condom was however rarely used on a regular basis, both because it was (…) 9It is, before the distribution of the pill, the withdrawal which was the most used preventive technique in France to avoid pregnancy. In 1970, 54% of men and 50% of women declared that they had already used it, far ahead of condoms (33% and 23%), the Ogino method (15% and 14%) and the temperature method (7% for both) (Simon et al., 1972: 331). Practiced by men, the withdrawal was their responsibility, as revealed by the words of Simone (retired researcher 79 years old) about the partners she had before her marriage: “Most of the time it was the man who said, ‘I’ll be careful’. If he was nice: “Don’t be afraid, I’ll be careful”.

10Men therefore had the mental burden of withdrawing – whether, as in the case of Simone, during relationships outside marriage, but also within the framework of the couple formed. If men had to do some form of work on their sexual desire and / or pleasure, this contraceptive responsibility remained relatively circumscribed, in particular because it did not belong to the medical sphere and was mainly played during the act. sexual – moreover, it was then women who had to bear the consequences of a possible male failure (Accampo, 2003). For their part, women were poorly informed about sexuality, which could prevent them from preventing conception themselves: the first medical means, in particular the diaphragm, indeed required familiarity with one’s own sexual organs which was often lacking (Fisher, 2000).

5 We find the same type of shift in responsibility with the male condom (Thomé C. (…) 11 But this should not mask a possible female investment in the work of fertility control: indeed “traditional methods, even when they are male, can be initiated or required by women “(Rusterholz / Praz, 2016: 14). This is of course the case with the Ogino method and that of temperatures, which are based on determination by the woman of her fertile period and necessitate reacting to the sexual desire of the partner. But it can also be that of withdrawal, a method however considered as masculine, as testified by Paulette (retired cook, 84 years old):

– So you were afraid of having sex or …?

– Oh well not even, not even, because I was careful. As soon as I saw that it started to be agitated, I went, pfiout. I backed away! [laughter].

12Here, it is Paulette who is concerned with the course of sexual intercourse: she “[pays] attention” to two, having learned to recognize the moment when her husband had to withdraw. She is also the one who, like many other women (Thébaud, 1991), experiences the fear of being pregnant on a daily basis, when her periods do not arrive (“When it did not come … I grumbled because I said to him ‘Bah, am I still pregnant !?’ “): another form of burden, an integral – and already feminine – part of an intimate and invisible contraceptive work. Thus, we note that the male contraceptive work linked to withdrawal, a work of management by the man of his desire and his pleasure, could be ensured or, at least, supported by women – what works over the period rarely underline, already obscuring women’s efforts for the sole benefit of male responsibility.

13The arrival of medical methods of contraception, then their diffusion, will however rapidly and profoundly change this situation where men were involved in contraception. Indeed, the male responsibility linked to the practice of withdrawal and ignorance by women of their bodies then seems to disappear very quickly, as evidenced by François, 31-year-old commercial director, interviewed in the mid-1960s by journalist Fanny Deschamps (who notably wrote, at that time, articles in the female press in favor of the pill):

Ten years ago, when I was making love with a minor, it was up to me to think that this poor creature does not catch children, it was not at all in the race. While now! … My wife knows ten times more than I do on this subject and when I make love elsewhere, this problem of not having children, I don’t even think about it any more. I tell myself that the person who is with me has managed, or when he will warn me. Finally, in short, if I am not made to think about it, I no longer think about it (Deschamps, 1968: 33).

6 Whose existence as a distinct specialty from obstetric gynecology appears to be a spec (…)

Whose existence as a distinct specialty of obstetric gynecology appears to be a specific (…) 7 Expression used during an interview by a French epidemiologist to qualify the training (…) 14The mental burden of contraception seems to be be carried over very quickly to women (even if some men can also get involved in it sometimes, for example by reminding their partner to take the pill). This postponement takes place thanks to the medicalization of only female contraception which generates, in addition to this mental burden, material work. Indeed, the legalization of contraception and its pharmaceutical development do not remove the moral issue associated with birth control, but it is the doctors who become the guardians of morality and the regulators of practices contraceptive. The fact that medical gynecologists, infatuated with “endocrinological rationality”, take contraception and at the same time proclaim themselves specialists in “women’s health” further contributes to locking up contraceptive work even more the female sphere. Furthermore, the feminization and medicalization of contraception does not, or very little, arouse criticism from French feminists, unlike their British, Canadian or American counterparts (Vandelac, 2004). The symbol of contraception – and a fortiori the pill – as a tool for the emancipation of women seems to take precedence over the constraints associated with this new responsibility (Löwy, 2005).

15Therefore, it is now very largely women who are concerned with the management of contraception and with the work that it represents (Le Guen et al., 2017). Today it is obvious for the majority of women and men who have sex: women have always thought about and organized contraception. This belief is based on a biological fact, because it is women who bear children. It appears in male discourse on contraception, as here in the case of Sébastien, 38, engineer in professional retraining:

How not to have children? which currently

– And your partner at the time, was she using contraception on her side? So that you can stop [the condom]?

– Uh … Good question … Uh … For her it was her first report. So, was she using it, was she taking the pill …? I think so … I’m more certain. […] She … If we stopped the condom, she had to put on the pill if she didn’t have it by then.

8 Here, letting go affects both the risk of unwanted pregnancy and contamination by (…) 16For Sébastien, the question seems almost incongruous: the burden of avoiding pregnancy seems to have been directly attributed to his partner, without questioning the underlying work. In the same way, punctual relationships can also give rise to a male letting go, as in the case of Domenico (30 years old, in charge of relations in an association) who declares about one of his partners “on vacation” (with whom he had intercourse without a condom): “I imagine that she was taking the pill, no doubt”. The question does not seem to have arisen for him before it was addressed to him during the interview. This naturalization of the female contraceptive duty is also found, moreover, in cases where contraception is carried out outside medical control: this is the case of the methods of self-observation, within the framework of which it is for the woman to do a regular examination of her body and to keep her partner informed of the fertility period. If men are not completely excluded from contraceptive work (Le Guen et al., 2015), their possible investment remains limited. One of the members of Ardecom, an association for the promotion of male contraception which was formed in the 1970s, notes that he is now, at 61, “the youngest” member of the association and underlines a lack of interest in the question on the part of the following generations:

If you don’t have an initiative from above saying “This is where you need to go” and if you don’t have popular validation to say “We want it, we want it”, it doesn’t work. Anyway, women were it, that is to say that the labs responded to a feminist push and proposed an answer and suddenly, it developed, but you need at least two elements that push . We don’t have any, we try to push from the bottom but there are four of us and from the top, it’s no.

17The advances in research on hormones – in particular the discovery of the contraceptive pill – but above all the representation of birth control as a female responsibility that followed, encouraged both by the medical sphere and by representations of contraception as a liberation tool for women, therefore allowed men to largely divest themselves of contraception – and therefore of related work. But if the contraceptive work carried out by women has gradually been made invisible, some of the tasks linked to it remain directly comprehensible. This does not mean, however, that they are considered to be part of reproductive work: largely naturalized, these everyday thoughts and actions, although visible, are often not considered to be part of a more global and systematic form of child labor. women.

9 The process of legitimizing contraception indeed echoes a new issue, both moral and (…) 18Understanding the medical dimension of women’s contraceptive work requires determining what is expected of them. It should first be emphasized that the legalization and dissemination of medical methods of contraception have resulted in a dual form of control over women: medical, due in particular to the medicinal nature of the new contraceptives, but also social, in order to ensure proper use of these products and thereby avoid abortions. Beyond the issues of emancipation and freedom of choice, contraception quickly turned into a true female responsibility:

Faced with the irresponsibility that abortion represents, modern contraceptive practices become the positive norm, the sign of a good social adaptation of women, the proof of their psychological maturity (Ferrand-Picard, 1982: 394).

19The idea that contraceptive coverage should extend to all women appeared gradually in the 1980s. However, it was not until the 1990s and when the use of abortion stabilized (unlike the expected decrease) that the public authorities should focus on contraceptive effectiveness as such.

10 The Pearl index is measured by the number of women who become pregnant while using it (…) 20At the turn of the 1990s, the distinction between theoretical effectiveness (measured by the Pearl index) and effectiveness appears convenient. This distinction highlights that the issue is not only contraceptive coverage, but also the compliance associated with contraceptive practices. Realizing that contraceptive failures, the primary cause of the use of abortion (Moreau et al., 2011), are due to compliance difficulties and tolerance problems, the authorities are gradually shifting the focus from socio-economic barriers individual determinants of contraceptive use. In a logic of calculation of the benefit-risk ratio more and more prevalent in the regulation of medicinal products, but also of dissemination of a “quality” approach in terms of medical prescription, contraceptive effectiveness and adherence then make l subject of all the attention of public authorities and prescribers (Kammen / Oudshoorn, 2002). Contraceptive work must therefore now be effective: we can see the outline of reinforced work for women here, who then assume all the more responsibility for failure and the associated sanctions (Mathieu / Ruault, 2015). The only contraceptive work promoted is actually effective contraceptive work – and it is women who have to (pre) take care of it.

21But ensuring this efficiency is in itself a job, including a form of mental burden, mainly borne by women insofar as it comes from the observance of their own body. The first aspect of this work relates to the obligation of medical monitoring. Indeed, medical methods of contraception, requiring a prescription or follow-up, today concern almost 70% of women (Bajos et al., 2014: 3): cognitive work is therefore associated with the need to have in mind the timing of contraceptive monitoring. This mental burden is coupled with a concrete obligation – that of going to the appointment – which is not always obvious, as evidenced by Carine (31-year-old lawyer):

For doctors, it’s … it’s not easy, my gynecologist if I want an appointment I have it in two months … As she works at the same hours as me where I work, that means that take an afternoon, so there you go, I’m not going like that.

22This excerpt from an interview highlights the confrontation that can play out between contraceptive work and paid work. This confrontation makes the contraceptive constraint visible, no doubt largely because it is opposed to so-called “productive” work.

23The refusal to be subject to this mental burden and the work represented by medical follow-up can also play a role in the contraceptive choice, as testified by Josephine, 32, who works in the performing arts: “This stop of the pill, etc., it was also a way for me to free myself from… that, not necessarily having to go to a doctor ”. Hormonal contraception can be seen as a bondage to medical power rather than a release. It involves time but also money, since all consultations with health professionals and prescribed contraceptives are not fully reimbursed. It is then the fact of stopping going to the doctor that constitutes a “release” from this contraceptive work.

24But women’s time management work is not limited to medical methods of contraception. Indeed, whether it is the pill or self-observation methods, effective contraception also means doing daily work: either taking a tablet at a fixed time, or observing of his body. This is for example the case of Maeva, a 26-year-old unqualified housewife who takes the pill:

So suddenly I found a tip, so I set my alarm to ring every day at 8:30 p.m. actually. Otherwise sometimes I forget it. Even now, I’ve noticed, since I set my alarm to ring there, if my cellphone wasn’t there to remind me, I think I would actually forget it. Sometimes with fatigue, and all that, well I would forget it.

25The need not to forget the pill thus gives rise to “tricks” which are all ways of trying to make the constraint of having to take a drug every day to promote the effectiveness of contraception easier. Self-observation methods also imply rigor of the same type: taking temperature at least during part of the cycle, regular monitoring of mucus, taking notes of observations, etc. Again, it is when it conflicts with salaried work that this work becomes more visible. This is what Marielle, a 35-year-old general practitioner, explains about the “natural methods” that she herself tried to practice:

It was nevertheless thought for a certain type of women … who can be … here, who have time to invest in that. And it was not thought for women who have a professional activity, a timetable where it requires … For example it does not work at all for women who work shift schedules.

26The requirement of strict observance of the method which follows from the injunction to efficiency causes not only a mental load, but also a material constraint which, again, is exposed because it comes up against so-called productive work. And, if male partners can sometimes help their partners manage their contraception (Le Guen et al., 2015), it is nonetheless mainly female and above all highly naturalized, as a 45-year-old doctor working in a family planning:

They will say: ‘No but I am not reliable, I have a small head, I will forget’. Rather, they will put themselves in a self-deprecating register and say that they are not capable. They are not in a militant thing saying: “I do not want to bother taking the pill every day”, it is rather “I am not able, I can not do”.

27These are therefore personal reasons which are cited by women to justify a breach of the contraceptive order, where they could question the very fact that this work is theirs. This self-depreciation stems from the fact that this task is not perceived as such – all the more so as in the case of contraception, women seem to have the choice.

28In 2013, a major scientific and media controversy arose following the discovery of an venous over-risk for users of new generation pills. Although essentially reducing the use of the products in question, this “crisis” more generally destabilized a French contraceptive model centered on the pill in favor of other methods: IUD (intrauterine device, also called IUD), condom, methods say “natural” (withdrawal, periodic abstinence). Beyond the health risk that motivated the evolution of contraceptive and prescriptive practices, it is the constraint and the lack of concrete choice that users have expressed by changing their ways of doing things.

11 Slogan of the first communication campaign on contraception from the Institut National de Prév (…) 29 This lack of choice may seem surprising: in fact, observance is associated with the acceptability of a method and, by Therefore, at her choice, women have been invited for a few years to choose the contraception that would suit them best (“The best contraception is the one we choose”) – without however being taken into account social differences between them that are likely to influence these decisions (Bretin, 1992; Bretin / Kotobi, 2016). But it is important to emphasize that the field of possibilities and what seems “medically” acceptable is in fact limited. Alternative methods (withdrawal, periodic abstinence, local methods), yet used by almost 10% of women affected by contraception (Bajos et al., 2014), are for example fairly systematically omitted in public health campaigns or considered not to be part of the panel of methods to be recommended by prescribers. This extract from an interview with a 67-year-old medical gynecologist attests to this contradictory injunction between choice and effectiveness:

– Contraceptive policies today are those that decrease the number of abortions. Is this the right marker? I do not know.

– Quel serait le bon marqueur selon vous ?

– Le bon marqueur ce serait que les femmes aient une contraception qui leur convient [sic]. Bien sûr que le taux d’IVG c’est important parce que c’est toujours quand même un peu traumatisant. Mais je pense que le bon marqueur c’est de dire que toutes les femmes aient une contraception qui leur convienne et une contraception efficace. Parce que de nos jours, on voit revenir des femmes qui font le retrait, qui font la méthode des jours et on sait comment ça se termine en général. L’ovule est volage et le spermatozoïde tenace. Vous voyez bien ce que ça veut dire. On ne va pas dire ‘non mais voilà, prenez vos risques !’ Qu’on ne dise pas que les méthodes naturelles sont efficaces. Notre slogan c’est de dire la vérité aux femmes et qu’elles choisissent.

30Si la contraception doit “convenir” à chaque utilisatrice, elle n’en doit pas moins être “efficace” selon les critères médicaux, qui ont tendance à dramatiser l’avortement et ainsi à stigmatiser les femmes (Divay, 2004 ; Mathieu/Ruault, 2015). Or, l’efficacité contraceptive n’est pas toujours le déterminant principal du choix d’une contraception et entre souvent en ba­lance avec d’autres priorités : problèmes de santé, coût, éloignement des structures de soins ou des prescripteurs/trices, choix du couple, sexualité, volonté de ne pas avoir d’intermédiaires, notamment médicaux, etc. Ce choix apparaît donc bien illusoire, voire contradictoire, dans la mesure où les utilisatrices sont contraintes à ce qu’il n’entre pas en contradiction avec la norme procréative du “bon enfant” au “bon moment”. Cela nécessite une méthode efficace, au moins pour les femmes qui n’ont pas le profil prescrit : stabilité relationnelle et financière, âge à la maternité socialement acceptable. Faire un choix éclairé nécessite alors une forme particulière de travail : la recherche et le tri de l’information.

31En effet, acquérir des savoirs contraceptifs demande de l’investissement et du temps. Si l’école représente une source de savoir mixte, c’est souvent via leur mère (Amsellem-Mainguy, 2006) ou des réseaux de pairs que les femmes s’informent et sont informées des différents moyens de contra­ception – démarche que les hommes ne font généralement pas, comme en témoigne, en entretien, le flou affectant leur description des méthodes disponibles. Ce travail cognitif passe aussi par le dialogue avec un·e médecin (gynécologue ou généraliste) ou plus rarement un·e sage-femme, dialogue qui s’inscrit dans un suivi médical voulu comme régulier (Guyard, 2010b ; Amsellem-Mainguy, 2012). Cet échange ne se limite d’ailleurs pas à l’en­trée dans la vie contraceptive, mais peut durer tout au long de celle-ci, au gré des changements de méthodes – et il peut conduire à des conflits avec les médecins. C’est par exemple le cas face à des praticien·ne·s refusant de poser des DIU à des femmes nullipares, contrairement aux recommandations de la HAS (Haute Autorité de Santé). En effet, ces recommandations peuvent être connues des femmes, dont le travail cognitif implique aussi un travail de recherche personnelle qui peut désormais passer par Internet (Bruchez et al., 2009 ; de Pierrepont, 2011). C’est d’autant plus le cas pour les méthodes qui ne sont pas recommandées par les médecins, comme les méthodes dites “naturelles” de contraception (en observant la glaire cervicale, la température et/ou le col de l’utérus pour déterminer le moment de l’ovulation). Émeline, auxiliaire de vie de 23 ans qui utilise depuis quelques années l’auto-observation (associée au préservatif masculin en période de fécondité), explique par exemple :

Et là [sur un forum] y’avait un topic [fil de discussion] qui s’appelait “Méthodes naturelles”, etc. J’étais avec ma pilule à ce moment-là, et j’avais commencé à en avoir vraiment marre. J’avais demandé à mon gynéco si il existait pas une méthode naturelle, tu sais pour… pour gérer sa fertilité quoi ! Parce que quand tu vas chez le gynéco, ils te disent ‘C’est soit le stérilet, soit la pilule’. Comment on fait ? ! Y’en a aucun qui me convient ! J’étais là : ‘Ah, OK, super ! Je suis pas la seule à me poser la question’.

32Face au refus de son gynécologue de répondre à ses attentes, Émeline décide de chercher par elle-même des informations grâce à un forum en ligne qui lui permet de découvrir que son problème n’est pas isolé. Ce travail de recueil et de traitement de l’information constitue un pan à part en­tière du travail contraceptif féminin – même si parvenir à accéder à des données ne garantit pas de pouvoir, ensuite, choisir véritablement sa contraception.

33Mais, que la contraception ait pu être choisie ou non, elle est susceptible d’entraîner des effets sur le corps et la sexualité : peut-on alors consi­dérer que la prise en charge de ces effets relève, là encore, d’une forme de travail invisibilisé ?

12 Effet sur la santé associé à un acte médical ou à l’utilisation d’un produit médicamenteux.

Effet sur la santé associé à un acte médical ou à l’utilisation d’un produit médicamenteux. 13 Ce qui se reflète aussi dans les représentations des prescripteurs/trices ( Ventola C., 2014). 34Un des effets de la centralité du corps féminin dans la recherche sur les hormones et le développement des contraceptifs tient dans la minoration, voire la dénégation des effets secondaires induits par la contraception hor­monale. Si le risque iatrogène associé aux contraceptifs hormonaux a fait l’objet d’une attention particulière et de développements visant à le réduire chez les femmes, le bénéfice (prévenir une grossesse) a toujours été jugé supérieur aux effets potentiels sur la santé et au bien-être des utilisatrices. A contrario, s’agissant des sujets masculins, l’acceptabilité du ris­que iatrogène a primé sur le bénéfice, ce qui a permis de justifier l’arrêt de tout développement à la suite des essais cliniques mettant en évidence des effets secondaires. Outre le moindre développement de l’intérêt pour l’ap­pareil reproductif masculin, qui explique la compréhension et la maîtrise plus tardives du mécanisme de production des spermatozoïdes, les effets possibles sur les fonctions sexuelle (désir sexuel, impuissance) et reproductive (réversibilité de la méthode) des hommes ont ainsi constitué des arguments majeurs pour ne pas développer des méthodes masculines qui auraient permis de partager le travail contraceptif entre classes de sexe :

14 Notre traduction. En plus de l’accord général quant à la nécessité de développer de nouveaux contraceptifs masculins, un consensus existe également concernant le fait que la non-interférence avec la fonction sexuelle (“libido” et “potentia”) est une dimension importante de l’acceptabi­lité contraceptive et doit être prise en compte au même titre que d’au­tres critères tels que la sûreté, l’efficacité et la réversibilité (WHO, 1982 :32 ).

35Chez les femmes, les incertitudes concernant les effets sur la santé n’ont pas été un frein au déploiement des méthodes hormonales ; les répercussions sur la sexualité n’ont tout simplement pas ou très peu été investiguées, les femmes étant renvoyées à leur fonction reproductive (Kam­men/Oudshoorn, 2002). Cette asymétrie dans l’acceptabilité du risque, qui a donc conduit à la féminisation de l’offre contraceptive, participe à la naturalisation de la dimension genrée du travail contraceptif, comme le souligne ici un expert britannique en santé sexuelle et reproductive âgé de 70 ans :

15 Notre traduction. La contraception restera toujours un problème féminin, principalement car ce sont les femmes qui tombent enceintes. Des discussions ont eu lieu, au cours de ces quarante dernières années, concernant le développement et la mise à disposition de contraceptifs masculins (notamment hormonaux) – les études sont claires, la contraception hormonale masculine est possible avec des effets secondaires faibles. Pourquoi ne pas la développer ? Les compagnies pharmaceutiques ne mettent pas d’argent dans la recherche, car elles pensent qu’elles ne pourront pas avoir de retour sur investissement. Les cliniciens sont souvent sceptiques et il y a un nombre considérable de mythes qui circulent : les hommes ne vont pas aimer ces contraceptifs, les hom-mes ne sont pas fiables, etc. Tous ces mythes sont faux. Il y a eu beaucoup de travail ces dernières années pour s’assurer qu’il y ait plus de ‘participation masculine’ en santé sexuelle et reproductive. Est-ce que cela a amélioré les choses ? Rien n’est moins sûr .

36L’existence d’effets secondaires liés à la contraception hormonale est donc connue depuis l’apparition de ces méthodes, mais seules les femmes ont eu à les subir et ils ont rapidement été invisibilisés.

37Les gênes susceptibles d’être occasionnées par le contrôle hormonal de la fécondité sont nombreuses : elles peuvent concerner le corps – prise de poids, migraines, saignements intermenstruels, jambes lourdes, etc. –, mais aussi l’humeur, voire le désir (fluctuations du désir sexuel). Lors des entretiens, la majorité des femmes interrogées témoignent avoir, à un moment ou à un autre de leur vie, éprouvé des effets secondaires considérés comme négatifs (ce qui les a parfois incitées à changer de méthode). Selon l’enquête quantitative Fécond 2013, parmi les femmes concernées par la contraception, 36 % déclarent ressentir des effets secondaires avec la méthode qu’elles utilisent – proportion qui tend à augmenter avec l’utilisation de méthodes hormonales, notamment de la pilule contraceptive (43,4 %). Ce constat peut alors conduire à un changement de contraception. L’en­quête montre par exemple que 45 % des femmes qui ont arrêté leur pilule entre décembre 2012 et juillet 2013 l’ont fait à cause des effets ressentis. Nolwenn, étudiante de 23 ans qui a pris la pilule quelque temps avant de repasser au préservatif masculin, explique quels peuvent être ces effets :

Et en fait c’est quand j’ai vu que mon cholestérol avait doublé en six mois, je me suis dit ‘Non, là c’est pas possible ! ’. Puis cette prise de poids soudaine […] m’a choquée, et j’ai vu mon corps changer, vrai­ment, et du coup c’était trop. […] Et… et je me sentais quand même assez perturbée, je sentais que mes émotions… Enfin, je sais pas, ma libido j’avais l’impression qu’elle baissait, après c’est peut-être que je devenais parano hein, mais… J’avais l’impression que j’étais beaucoup plus à vif, enfin j’avais des transformations de comportements aussi.

38Nolwenn a dû s’accommoder de ces changements consécutifs à la prise de la pilule, qui ont constitué pour elle un “choc” dans sa perception de son corps, de son désir et plus largement de son comportement. L’impor­tance de ces effets secondaires est cependant souvent niée ou minimisée par les membres du corps médical, qui les considèrent comme normaux, sans importance et devant donc être supportés par les femmes. Cependant, s’y confronter et chercher à les atténuer représente pour les femmes un tra­vail en soi, sur leurs corps et leurs émotions, qui n’apparaît en filigrane que lors de prises de conscience, comme pour Nolwenn, ou lors de l’arrêt de la contraception, comme dans le cas de Mélanie, éducatrice spécialisée de 35 ans (qui prenait la pilule et l’a arrêtée lorsqu’elle a débuté une relation avec une femme) : « Non. Non non, non non, j’ai jamais eu d’effets secondaires… À part des maux de tête. […]. Par contre j’ai rencontré des effets hyper positifs quand je l’ai arrêtée ». Ici, la situation vue comme nor­male par Mélanie est celle de son corps “sous pilule”, ce qui met bien au jour un travail d’invisibilisation des effets secondaires. Cette invisibilisation des changements provoqués et des ajustements requis par le travail contraceptif peut ainsi être le fait des femmes elles-mêmes.

39Un autre aspect du travail contraceptif féminin sur le corps concerne plus précisément la sexualité. Certes, les hommes aussi peuvent ressentir l’influence de certains modes de contraception (préservatif masculin, retrait) sur leur sexualité. Cependant, le préservatif masculin comme le retrait demeurent, en France, des méthodes de transition ou de court terme (Beltzer/Bajos, 2008), contrairement aux autres méthodes de contraception (Higgins/Smith, 2016). Or, ces effets sur la sexualité des femmes sont rarement pris en compte (Guyard, 2010a). C’est seulement au prix d’un travail sur les émotions (Hochschild, 2017) et sur leurs désirs que les fem­mes peuvent adapter leur sexualité aux contrecoups de la contraception – par exemple en s’attachant à ne désirer un rapport sexuel que lorsque c’est le moment adéquat dans leur cycle.

40Le travail le plus invisibilisé que la contraception – hormonale (Grino, 2014), mais pas uniquement – impose aux femmes est donc une activité dont elles semblent rarement conscientes et qui porte sur elles-mêmes : sur leur corps, leurs émotions, leur sexualité, voire leur perception d’elles-mêmes.

41La “crise de la pilule” de 2012-2013 a eu l’effet d’un électrochoc, amenant une femme sur cinq à changer de méthode contraceptive entre septembre 2012 et juin 2013 (Bajos et al., 2014). Si la pilule commençait déjà à perdre du terrain, mais dans une mesure toute relative (diminution de 4 points en une décennie selon Bajos et al., 2012), les changements observés entre 2010 et 2013 ont été majeurs et ont mis au jour une faille dans le modèle. Au travers des effets sur la santé, c’est bien la contrainte sur le corps mais aussi la charge mentale que celle-ci représente qui ont été remises en question. L’enquête Fécond 2013 montre pourtant que les représentations négatives à l’égard de la pilule n’ont guère évolué, son caractère contraignant ou ses effets supposés sur le corps n’étant pas plus évoqués par les femmes aujourd’hui qu’en 2010 (environ une femme sur trois est tout à fait d’accord avec l’idée que la pilule est contraignante et une sur quatre avec l’idée qu’elle fait grossir). Or, cette controverse a permis un changement dans les pratiques : comme si les utilisatrices s’étaient autorisées à dévier du modèle.

42Les scandales plus récents autour du DIU Mirena et de ses effets indésirables renforcent cette idée d’une remise en cause généralisée d’un modèle ayant invisibilisé le travail féminin, qu’il concerne l’organisation du temps, des savoirs, la charge mentale ou la prise en compte du corps. La médicalisation et la féminisation conjointe de la contraception ont en effet contribué à sa normalisation et à l’évacuation progressive des enjeux politiques autour du contrôle des corps reproducteurs. La publicisation des ris­ques et des effets secondaires participe ainsi d’un travail politique de désenclavement (Dodier, 2003) de la pilule et, de manière générale, de la contraception médicale, dont l’enjeu est d’opposer la transparence et l’in­formation à une vision émancipatrice des méthodes proposées, qui tend trop à occulter les dimensions du travail contraceptif. On observe, concernant la dimension contraignante de la contraception, une sorte de libération de la parole portée par les associations de victimes mais également par les usagères, ainsi qu’une « politisation du cabinet médical » (Quéré, 2016 :33) visant à remettre en question les asymétries de pouvoir dans les rapports entre corps médical et usagères.

43Cependant, deux grandes limites à cette remise en question sont à évoquer. D’une part, une différenciation entre groupes sociaux est observée (Bajos et al., 2014), les plus précaires choisissant de plus en plus des méthodes théoriquement moins efficaces (comme le retrait), les plus aisées se tournant vers des méthodes théoriquement plus efficaces et de long court (comme le DIU). Cette reproduction d’inégalités doit faire réfléchir sur les dimensions concrètes du travail contraceptif évoquées (capacité de négociation avec le prescripteur/trices et le partenaire, contrainte financière, degré d’information) et sur une division sexuelle de celui-ci qui peut s’a­vérer plus ou moins pesante pour les femmes d’une méthode contraceptive à l’autre, et donc d’un milieu social à l’autre. D’autre part, dans cette remise en cause du modèle français, le travail contraceptif reste majoritaire­ment féminin et l’asymétrie de genre est finalement assez peu posée. La norme procréative semble s’adapter sans jamais remettre en cause les fondements genrés du travail contraceptif, aujourd’hui encore considérés comme naturels et biologiques. Le travail politique en train de s’opérer n’a, en ce sens, pas encore investi le terrain des rapports entre femmes et hommes, pourtant structurants dans les modalités du travail contraceptif : la remise en cause de la contraception médicale ne sera positive pour les femmes que si elle va de pair avec celle des rapports de genre qui la sous-tendent.

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