Birthcontrol strategies and contraceptive use are an integral part of heterosex forthe prevention of HIV and AIDS as well as women not wanting to get repeatedlypregnant. One important innovation introduced to prevent HIV and other STDs isthe female condom.
It has been accepted as an alternative or supplementalbarrier method to the male condom. However, no studies have tested the efficacy of a relationship-based interventionon the use of the female condom amongst women and their long-term male sexualpartners. On the other hand, some research has demonstrated an increase infemale condom use within stable and long-term relationships and female condomuse may be particularly effective for the HIV prevention in engagement withtheir male sexual partners.
Within heterosexual relationships,contraceptive practices are heavily dependent on the female partner. Eventhough condoms, as one of the limited available male options, that may be usedin the early stages of a relationship, these are set aside when therelationship starts getting serious (Flood, 2003; Willig, 1995). Condoms’visibility is portrayed as raising the attention of the risks of unprotectedsexual activity and as having the potential to question the ‘trustworthiness’of both male and female partners (Flood, 2003; Willig, 1995).
On the otherhand, the oral contraceptive pill and implant technologies are highly given a’default’ status, because of the potential side effects to women (Oudshoorn,2003). Therefore, the decision to use a contraceptive method in heterosexualrelationships or change a method is heavily dependent on the factors such asside effects e.g. weight increase, mental side effects, bleeding disturbancesor fear from the method itself. It may also be related to social and developmentalchanges related to a change in the individual’s personal life. These mayinclude the beginning of a new relationship, unplanned pregnancy or fear fromgetting pregnant, specific life changes such as an illness, a planned birth,ending of a relationship and cost.
It has become a culturally inscribedresponsibility for women to manage and deal with contraception use especiallyin long-term relationships for the reasons such as women are the ones who getpregnant, give birth, and take care of the child.On the other hand, The Women, Risk andAIDS Project (WRAP) (Holland et al., 1992a) interviewed young women aged 16 to21 in London and Manchester and concluded that heterosexual relationships are asite of inequality where women have less power than men to control the progressand content of sexual interactions. Their research revealed that young women’soptions regarding safer sex are constrained by the context of differentialpower relations in sexual encounters. However, there is little information asto whether these difficulties continue as women become older or whethermaturity and experience bring empowerment. There is a universal opinion thatolder people are more likely to be monogamous in long-term relationships andconsequently not at a risk of HIV infection.
However, where a long-termrelationship is not monogamous, and safer sex is not practiced, risks willevolve. In fact, estimates of extra-marital sex would appear to specify thatlong-term relationships are often not monogamous. Thompson (1983), reviewing 12surveys dating from 1948 to 1981, indicated that the reported incidence ofextra-marital sex ranged from 20% to 66% in male samples and 10% to 69% infemale samples. Additionally, he reported that an average of 72% of men marriedfor 2 years or more admitted to extra-marital sex (1981) and that 70% of womenmarried for more than 5 years had extra-marital relationships (1987).Furthermore, monogamy seems to be a more serious problem in cohabiting couples.
According to British National Survey of Sexual Attitudes and Lifestyles, 15.3%of cohabiting men and 8.2% of cohabiting women reported they had more than onepartner in the previous year. Moreover, only 21.8% of married women and 26.2%of cohabiting women used condoms as a form of contraception, in comparison with46.7% of single women. These statistics suggest that there is an increased riskfor those older age groups that are likely to be married or have steadyrelationships, particularly if safer sex is not performed.
Holland et al. (1990) reported thatwhere women insisted on sex being safe, they were mostly able to get men’sco-operation. However, they needed to be very assertive and this was often veryproblematic. Also, Boyle (1991) suggested that some women reported difficultiesaround their partners’ inferences that they would be responsible for causing areduction in men’s sexual satisfaction.Men’saccess to positive conceptions of an active, pleasure-seeking, embodied,masculine sexuality, put pressures on them to become ‘real men’.
Becoming a’normal man’ implies the exercise of power over women. Within this masculineheterosexuality, women’s desires and the possibility of female resistance arepotentially unruly forces to be disciplined and controlled, if necessary byviolence. (Ramazanoglu, 2004, p.12).
This point highlights a major issuewith the ignorance of women’s sexual pleasure and their victimisation in aheterosexual relationship. In fact, the way in which this competition formasculinity is played out, protects men from acknowledging fears of anindependent female sexuality and draws women into servicing men’s vulnerability(Ramazanoglu, 2004). Holland et al. (1998) suggested thatideas of ‘uncontrollable’ male sexuality keep on reinforcing women’s responsibilityfor contraception. Pollack (1984) has argued that whilst women have gained’responsibility’, this has been offset by a decline in male ‘responsibility’,therefore, women are now exclusively accountable for any ‘failures’. Also,Ringheim (1999) has argued that efforts should be made to increase men’s shareof responsibility to reduce the imbalance of gender inequality. However, if menare encouraged to be more involved in decisions over fertility this mayreinforce rather than decrease inequality since it has the potential to allowmen to be able to exert control over women’s bodies (Lowe, 2003).