Artikel
The battle of the pill: injunctions and resistance in gynaecological consultations
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Autoren
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Céline Miani
- School of Public Health, Bielefeld University, Bielefeld, Germany
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Mary Ouma
- School of Public Health, Bielefeld University, Bielefeld, Germany
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Anita Alaze
- School of Public Health, Bielefeld University, Bielefeld, Germany
| Veröffentlicht: | 6. September 2024 |
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Gliederung
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Background: Despite a “pill crisis” in several high-income countries, gynaecologists continue prescribing the contraceptive pill as the main tool for birth control. This practice may lead to tensions or confrontations with patients who question the systematic use of the pill and long for alternative models of contraception. In this qualitative study, we investigated the injunction and resistance experienced by young patients of gynaecological care in Germany.
Methods: We conducted 15 qualitative interviews with patients aged 16-25 who narrated their first consultations and experiences of gynaecological care in Germany. We analysed the data thematically, focussing on the dyad of injunction and resistance, in order to elicit power relations and negotiations around the contraceptive pill.
Results: Patients tended to first consult a gynaecologist in relation to their (first) periods or to the need for contraception. The contraceptive pill was therefore a central topic in most interviews, as a regulator of menstrual symptoms or a birth control tool. To the patients, gynaecologists’ explicit push for the use of the pill appeared unjustified, inappropriate, or too aggressive. Several felt that their physician was reluctant to engage in an informed conversation about the pill or, more broadly, about period management and birth control methods. Patients resisted those injunctions through different strategies, from concealed resistance (e.g. taking the prescription but not complying with it) to overt rejection -opposing gynaecologists’ expertise with experience and information from other sources.
Conclusions: Our study shows a clear pattern of power relation in medical practice, structured around the injunction to take the contraceptive pill versus various forms of resistance. It also highlights the entrenched positions of both parties in the patient-provider relationship and the difficulties to establish real, informed dialog around sexual and reproductive health management.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
