New Methods of Family Planning: Implications for Intimate Behavior

Journal of Sex Research, August, 2000 by Lawrence J. Severy, Jeffrey Spieler

The "long, long drought is easing" and new methods of family planning "are in the pipeline now" and "should be available in the next few years" (Burnhill, 1999, p. 1). Perhaps due to an environment in which product liability assumes priority over scientific advance, on top of antiabortion politics, industry has been very slow in developing new contraceptive technology and, hence, the United States Food and Drug Administration has not approved a new method of family planning since the female condom in 1993. Alternatives are becoming available in Europe, leading experts such as Stewart to observe that "the idea that the United States could be so many years behind other countries is pretty astonishing" (Stewart, 1999, p. 1).

The intent of this paper is to review some of the new methods in the pipeline and to ask a basic question: "How might these methods of family planning impact on my intimate behavior with my partner?" Our goal is not to provide a review of the use effectiveness of these contraceptive approaches. Rather our assignment, and intent, is to address the intimate behavioral implication of the family planning methods currently in the pipeline. Automatic acceptance of innovative technology in the field of contraception is anything but a foregone conclusion. As Snowden (1996) argued, most couples would really rather not have to use anything for family planning. Similarly, Severy and Silver (1993) suggested that couples often make choices based on the "least bad alternative" (p.225). It is not surprising that for Severy and Thapa (1994) the question became which methods couples were willing to tolerate. This negative spin on contraceptive use presents a daunting challenge for product developers and innovators. Innovations in contraceptive technology will have little, if any, impact if the new methods are not used. And, why should money be spent for development if no one will be purchasing the products? Marshall (1977) and Keller (1979) suggested that all new methods must meet a simple rule: that technology be developed to fit people, rather than requiring people to change in order to accommodate technology.

There are those who have concentrated on the positive side of the ledger. Marshall (1977) suggested that, in brief, acceptability is a quality that makes an object, person, event, or idea attractive, satisfactory, pleasing, or welcome. As will become obvious shortly, it is also our position that more positive and provocative features of contraceptive methods should be critical components of the methods and their marketing to potential consumers/users. In this regard, it is important to distinguish among several types of acceptance. In 1990, Cleland, Hardy, and Taucher differentiated among hypothetical, initial, and experiential acceptability. The first of these refers to a couple's assessment of the desirable/undesirable features of a potential new method. The second refers to their willingness to try the new method. And, the third--which some may term satisfaction--measures what actually happens when the couple uses the method. It is perhaps this third aspect--impact on behavior, especially intimate behavior--that is the primary focus of our attention here.

Recent research has finally recognized that "it takes two to tango." Although couples research has been conducted for many years (Miller, Shain, & Pasta, 1991, 1993; Rainwater, 1965; Severy, 1982; Severy & Silver, 1993), the importance of considering data from both partner's perspectives has become increasingly clear. Grady, Tanrer, Billy, and Lincoln-Hanson (1996) conclude that men play important roles in decisionmaking about sex, contraception, and child rearing. Becker (1996) argues for a focus on both partners, and demonstrates that behavioral predictions and family planning interventions are better when both partners are involved. Finally, Thomson (1997) demonstrated that partner's desires are not additive, that data from one partner can not serve as a proxy for the other, and that they carry approximately equal weight. Therefore, discussions of acceptability of new methods must pay attention to both partners in a sexually active relationship.

We have saved our most controversial introductory comment for last. Specifically, it has long been our position that family planning methods do not preclude elements or features that might enhance, stimulate and make more pleasurable the sexual experience. Developers and marketers need to think of procedures and products that might simply make sex more fun--while at the same time providing for contraceptive and/or STD preventative actions. Perhaps if conceptualizations of new methods started from the framework of "sex toys" and then also provided contraceptive action, use and sales rates might dramatically increase. Another related perspective, one that will not be developed further in this paper, relates to the other health benefits of new contraceptive technology. If temporary infertility were to be a side effect of a new health technology, and the primary effect is another important health benefit (e.g., a pill or injectable that prevents breast cancer or prostate cancer), then the paradigm for delivering and using contraception would change dramatically and positively. The following review of new methods is designed to hold open the possibility that these methods may have interesting implications for couple's intimate behaviors. Thus, is it possible that new methods can be more than nondysfunctional, can they actually enhance pleasure?