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Issues in Interdisciplinarity 2020-21/Power in Contraception

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Introduction

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The contraceptive pill, the revolutionary invention playing a significant role in female sexual liberation and gender equality, may not be as feminist as we thought. As a divided issue, its research in pharmaceutical sciences and portrayal in the history discipline offer a varied and interdisciplinary perspective on this controversial issue. Their contrasting scientific and subjective approach highlight varied ways we approach the issue of power. When combined, they offer a more comprehensive view on the causes and impacts of power in the issue of contraception.

Power in History

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History as a discipline is written and re-written by historians' selectivity of primary sources aiming to provide the most accurate account of events possible. However within History, there is an enduring gender bias within the discipline that sees a lacking female presence in reading lists, source syllabi and conference panels that discuss the specifics of what is taught within the curriculum; history in academia remains largely male.[1] In the UK there are only 20.8% female history professors.[2] In another example, a Stanford applied history conference featured 30 executives, exclusively white males. What if primary sources were the result of a western-male centred authority on what has been chosen to be told and the way it has been told? History relies on people's perceptions and society's way of experiencing and recalling events[3], but in a society where the prevailing perception is a male one, it is difficult to be completely objective.

History as a discipline allows us to look at how we view the chronologies of contraception in a way that shapes our contemporary view on the subject. Yet as we use History for understanding, unequal balances of power within the discipline distort how the history of contraception can be understood. There is an indirect, institutionalised form of power [4] within History, held by certain groups of people, which unconsciously stifles the voices of minorities and potentially generates a lack of collective truth and accuracy. In studying the history of contraception, the male majority gives less space to women's voices and perspectives. The curriculum then bases more on facts and events rather than personal narratives, and subject these narratives to a generalisation of all women and the women's movement.[5] A female perspective on the subject allows more diversity of thought as their positionally brings along with them an experiential connection and understanding rather than just an academic one.

Fortunately, there have been efforts to dismantle these gender biases within the discipline, where more women are encouraged to pursue research and be present during discussions.[6] In this sense, we can say that the gender disparity is improving as contemporaries are more aware of this institutionalised bias. For example, in Reproductive Rights and Wrongs, the Global Politics of Population Control and Contraceptive Choice, Betsy Hartmann tackles the, until then, undiscussed issue of the pressure that can be put on some women in several countries and socio-economic groups by powerful figures that provide them contraception 'often in an unsafe manner, for their own objectives, which are fundamentally disempowering of women and of poor people generally.' [7]. However, this indirect coercion will continue if the industry remains dominated by men who hold the most senior positions, thus those in higher positions of power have greater control over the academic narrative.

Power in Pharmaceutical Sciences

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Side Effects in Female Contraception Methods

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Power in pharmaceutical science is present in research related to the contraceptive pill. Women are often responsible for the burden of contraception (evident in the vast variety of female contraception drugs available), yet are subjected to various side effects associated with contraception. [8] These include, but are not limited to, headaches, nausea, mood swings, and more serious effects such as blood clots and breast cancer. [9] One study on the use of hormonal contraception by women found that it positively led to use of antidepressants. [10] Why has further research not been done in the half century since the birth of contraception to reduce these side effects and make contraception safer for women? [8]

The issue lies in the sex bias present in the discipline of pharmaceutical science. Especially in drug research, most are conducted and carried out on men, without regard for how the two sexes might react differently. [11] Because of this, the recognition of health problems, from a drug specific to women, has been slow. Nancy Krieger posed this question: ‘Why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already shown, three decades earlier, to be carcinogenic?’ [12] This lack of knowledge can also be seen specifically in contraception. The Pearl Index was created in 1933 by Raymond Pearl, a male biologist, to calculate the effectiveness of contraceptive drugs in preventing pregnancy. Still used today, the Pearl Index uses equations not accounting for the side effects women experience taking the drugs. [13]

Research in Male Hormonal Contraception

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Meanwhile, results in research on the male contraceptive pill indicate that hormone regimens that induce azoospermia, the lack of viable sperm in the semen, prove to be effective in pregnancy protection, comparable with the female contraceptive pill.[14] Given the erratic nature of the pill’s side effects for women, it is questionable why research in male oral contraceptives has not further progressed. A WHO study testing one male hormonal contraceptive found that androgenic common adverse effects included acne, mood changes, and abnormal liver function tests — all of which homogeneous to side effects in the female pill. Yet, this product was then deemed unacceptable to users. [15] There are claims implying further testing has not been done due to the risk that may accompany long-term use, although the first large scale human trial on the female pill was carried out by Gregory Pincus in 1950s Puerto Rico before it was approved in the U.S., in which three deaths occurred. [16]

It is consequently not presumptuous to view the power imbalance in gender in the field of pharmaceutical sciences as partly responsible for this issue. The underrepresentation of women in STEM indubitably leads to the implicit bias towards androcentric scientific studies — a form of indirect and direct coercion rooted in the social identity theory.[17] The male agentic nature of scientific research has led to an invisible advantage for male scientists and reticence in female; therefore, the evident bias towards progressive studies in female contraceptives, rather than male, exists despite the extensive opposing justifications. [18]

Conclusion

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Interdisciplinarity is vital to the future of contraception. With a more objective approach from historians, the impartial truth of the implicit power imbalance in contraception is elucidated to the public. This change in authoritative historical influence hugely impacts the contemporary perspective that is fundamentally prevalent in scientific research — what has been written before will affect what researchers decide to study — which, in turn, transforms subsequent research, and therefore the field as a whole.

In a world where the supply and demand model is profoundly influential, this collective shift in view can also lead to an increase in unbiased research in contraception as the public advocate for more female representation in the scientific community. Progressive pharmaceutical science research can therefore be done to equalise the responsibilities of the two sexes in regards to contraception, thus ultimately advancing gender equality within this domain.

References

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  1. Hawkesworth ME. Feminist Rhetoric: Discourses on the Male Monopoly of Thought. Political Theory. 1988;16(3): 444-467. Available from: https://www.jstor.org/stable/191581 [Accessed 13 December 2020].
  2. Royal Historical Society. Report of Council Session 2015 – 2016. Available from: https://files.royalhistsoc.org/wp-content/uploads/2016/11/17210009/RHS-Annual-Report-2015-16.pdf [Accessed 13 December 2020].
  3. Kundra S. Objectivity in history. The Fiji Times. 2017. Available from: https://www.researchgate.net/publication/314113409_OBJECTIVITY_IN_HISTORY [Accessed 13 December 2020].
  4. Bachrach P, Baratz M. Power and Poverty: Theory and Practice. New York: Oxford University Press; 1970.
  5. Banner L. Review: On Writing Women's History. The Journal of Interdisciplinary History. 1971;2(2): 347-358. Available from: doi:10.2307/202850.
  6. Blain K, Wulf K. “Women Also Know History”: Dismantling Gender Bias in the Academy. Colombian College of Arts & Sciences. 2018. Available from: https://historynewsnetwork.org/article/169254 [Accessed 13 December 2020].
  7. Hartman B. Reproductive rights and wrongs, the global politics of population control and contraceptive choice. New York: Harper & Row; 1987.
  8. a b Liao PM, Dollin J. Half a century of the oral contraceptive pill. Can Fam Physician. 2012;58(12): 757-760. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/ [Accessed 12th December 2020].
  9. NHS. Combined Pill. Available from: https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/ [Accessed 12 December 2020].
  10. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception with Depression. JAMA Psychiatry. 2016;73(11): 1154-1162. Available from: doi:10.1001/jamapsychiatry.2016.2387.
  11. McGregor AJ. Sex bias in drug research: a call for change. The Pharmaceutical Journal. 2016;296(7887). Available from: doi:10.1211/PJ.2016.20200727.
  12. Chilet-Rosell E. Gender bias in clinical research, pharmaceutical marketing, and the prescription of drugs. Glob Health Action. 2014;7. Available from: doi: 10.3402/gha.v7.25484.
  13. Trussell J, Portman D. The Creeping Pearl: Why Has the Rate of Contraceptive Failure Increased in Clinical Trials of Combined Hormonal Contraceptive Pills? Contraception. 2013;88(5): 604-610. Available from: doi: 10.1016/j.contraception.2013.04.001.
  14. Gava G, Meriggiola MG. Update on male hormonal contraception. Ther Adv Endocrinol Metab. 2019. Available from: doi:10.1177/2042018819834846.
  15. Abbe CR, Page ST, Thirumalai. Male Contraception. Yale J Niol Med. 2020;93(4): 603-613. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513428/ [Accessed 13 December 2020].
  16. Roberts WC. Facts and ideas from anywhere. Proc (Bayl Univ Med Cent). 2015;28(3): 421-432. Available from: doi:10.1080/08998280.2015.11929297.
  17. Handley IM, Brown ER, Moss-Racusin CA, Smith JL. Quality of evidence revealing subtle gender biases in science is in the eye of the beholder. PNAS. 2015;112(43): 13201-13206. Available from: https://doi.org/10.1073/pnas.1510649112.
  18. Roper RL. Does Gender Bias Still Affect Women in Science? American Society for Affect Women in Science. 2019;83(3): 18-19. Available from: doi:10.1128/MMBR.00018-19.