Hana didn’t start using hormonal birth control until four years after she became sexually active. When she was in high school, most of her friends were already on the pill for a variety of reasons – to regulate their menstrual cycles, or to clear their acne – but not necessarily for contraception. Interestingly, Rachel Jones of the Guttmacher Institute reports that teenage girls are more likely to use birth control for non-contraceptive reasons than they are to use the pill as birth control. Of girls aged 15-19 who reported using birth control, 82% say they use the pill for some health benefit other than preventing pregnancy, such as reducing menstrual pain, regulating their period, to treat endometriosis, or to clear acne (Jones). Hana, however, at age 16, would only have used hormonal birth control to prevent pregnancy, but condoms worked just fine for her and her boyfriend at the time. Plus, Hana’s parents never discussed birth control with her, and neither did her doctor, so it wasn’t on her mind.
“If I have kids, [birth control] will definitely be a conversation that I make sure I have with them because I don’t think it hurts to have extra protection,” Hana said. “My mother’s not from this country, I don’t know what the conversation is around contraception [in Japan], if there is one, she just might not have known to bring it up. If [birth control] had been brought up at the time I would have been like, ‘Oh yeah, everyone else is on it, I want to be on it too.’ It’s like, everyone else is doing it, I’ll join the club.”
In retrospect, Hana believes it was slightly naive of her to rely solely on condoms to prevent pregnancy. In high school, she never seriously considered the potential repercussions of an instance where a condom might fail.
“I went to school in a middle class, privileged area, so teen pregnancy wasn’t something that was hugely on our minds,” Hana said. “There was one girl in high school who got pregnant, and she was the example. Everyone was like, ‘Oh poor her,’ ‘Oh did you hear.’ She was an outlier, so I never actually thought, ‘this could happen to me.’”
Hana started thinking about hormonal birth control for the first time when she was in college. In high school she had consensual, safe sex with her nice, loving boyfriend where both parties agreed condom usage was necessary – he was never threatening, he never tried to convince her otherwise. When Hana got to college, though, her sex life got dicier.
“I never felt like my boundaries were violated by anybody in high school, but then in college there’s a lot of people who, in the moment, try to pressure you,” Hana said. “I’ve been in some situations in college that weren’t good. I am a people pleaser, so when I was younger, if somebody tried to pressure me, I [didn’t always] have the wherewithal to say ‘no.’ There was [often] alcohol involved, so [I didn’t] have full control. It’s dark, but it’s the reality – I needed to protect myself with an extra layer of contraception because I wasn’t in a relationship where I trusted my partner. It was hookup culture.”
Hana felt she was taking a risk by engaging in hookup culture. She had been warned of sexual assault on college campuses – according to a 2015 survey of 150,000 undergraduate students across the country, one in every three female respondents were victims of a nonconsensual sexual act (Orenstein). Furthermore, Hana acknowledges that even in scenarios where she consented to sex, she still may not have had the confidence to ask a partner to use a condom and advocate for herself if he refused. Hana is not alone in this experience; in her book Girls and Sex, journalist Peggy Orenstein reports on the ways in which young women feel stripped of their power in intimate settings, and many feel an overwhelming unspoken pressure to “please” a man in some way while ignoring their own wants and needs in hookup culture (Orenstein). Hana began to think about hormonal birth control because she saw it as something that was fully within her control as she engaged in a culture that made her feel less in control of her body. To explain, wearing a condom is something that both parties in a sexual encounter have to agree on, and the decision to wear a condom has to be made again at the beginning of every sexual act even as the influence of drugs or alcohol impair judgment. The decision to use hormonal birth control, on the other hand, was a decision Hana could make independently and would not have to be made in the heat of the moment.
Hana got an IUD during her sophomore year of college because a girl on her rugby team recommended it – she said it was easy to get, it’s highly effective, it’s good for five years, and best of all, she no longer menstruates. Hana loved the pitch; she’d heard of girls experiencing unideal side effects from taking the pill – such as weight gain – but she’d never heard anyone complain of IUD side effects. After hearing about her teammate’s experience, Hana immediately made an appointment to have an IUD inserted at her school clinic.
“I think some people’s insertion experiences were not great, but I literally didn’t feel anything. It was so easy,” Hana said. “[The IUD] is amazing. I’ve used it ever since. It fits my lifestyle. [Before getting the IUD], I did not pay attention to when I was gonna get my period. It would always be a surprise when it came, it would be a mess, I’d have to do laundry. I literally don’t even have to think about [my period] anymore. I haven’t had any issues [with the IUD].”
Hana loved her IUD so much that one year later, she encouraged her sister to get one. After the 2016 election, they were concerned their access to birth control may soon be restricted, so the IUD’s long-term effectiveness was appealing. Thus, similarly to Hana, her sister made the decision to get the IUD in order to protect herself from a potential scenario that could render her less in control of her own body.
“Now, we need to protect ourselves [from pregnancy] with birth control so the government can’t force us [to have a baby], and even birth control sometimes isn’t enough to protect us,” Hana said. “We never grew up in a situation where we had to worry about access to [contraceptive care]. I know now what’s at stake.”
Now, Hana is 28 years old. Whereas when she was younger she may not have thought too hard about birth control, the older she gets, the more critically she thinks about contraceptive care and reproductive rights. She thinks more about the potential consequences of an unwanted pregnancy, she thinks about who has access to her body. It’s taken a lot to get to this point of understanding about her own health and autonomy. And though she’s always had a good experience with her IUD, she regrets that birth control has been solely her responsibility throughout the years.
“In my relationships in college, birth control was never discussed because I handled it,” Hana said. “In my current relationship, birth control is something we communicate about. There’s been this evolution – I used to be like, ‘I got it, don’t worry.’ I saw it as my responsibility because I can get pregnant. But this is a two way street, I refuse to fully shoulder this emotional burden anymore. It's another thing to do, it’s another thing to think about. But it's difficult because in one perspective [birth control] is me taking control of my own health, but I don’t want to be the only one [in a relationship] who has to think about it.”
Furthermore, she regrets that growing up, she did not learn about her body and her bodily autonomy; rather, birth control seems to have always been presented as an artificial substitute for women taking true control and ownership over their bodies.
“I was not taught to have that much of a connection to my body,” Hana said. “[Women] can grow up thinking our body is for other people’s consumption instead of our own. It was a journey for me to understand that’s not the case, that my body is mine. A lot of [women] are not taught to prioritize our own bodies and our own sexual health, and when we are taught that then it's like, ‘You should get birth control so you don’t get pregnant,’ like it’s all our responsibility. It’s kinda like how we teach women how not to get sexually assaulted instead of putting the responsibility on men to understand consent. It’s always the woman’s job to defend herself. You have to go through the world knowing that people view your body as not your own.”
Hana wishes she could have had more self-confidence earlier in life, and she thinks a lot about how, if she should have a daughter, how she might raise her to have a better understanding of herself.
“You’d need to hammer it into her growing up, like, ‘Your needs are important, your health is important, what you want is important,’’ Hana said. “But the world will always tell us differently. So how do you even teach that?”
Works Cited
Martinez, Gladys. “Sexual Activity and Contraceptive Use Among Teenagers Aged 15–19 in the United States, 2015–2017.” Centers for Disease Control and Prevention, United States Department of Health and Human Services, 6 May 2020.
Jones, Rachel K. “Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills.” Guttmacher Institute, Guttmacher Institute, Nov. 2011.
Orenstein, Peggy. Girls & Sex: Navigating the Complicated New Landscape. Harper, 2017.
*Interview conducted October 3, 2022 by phone