The violence of reproductive injustice : reflections on birth control and its medical epistemics

Abstract

Background

The widespread promotion of oral contraceptives raises concerns about side effects, informed choices, and contraceptive coercion, which contribute to gynecological violence influenced by systemic factors. The link between gynecological violence and oral contraceptives is understudied and rarely examined through systemic violence theories. Methods

To address this gap, we explored how a continuum of symbolic, structural, and slow violence manifests in the physical body by drawing on qualitative online interviews with 19 former oral contraceptive users and six gynecologists in Germany. Data were analyzed using reflexive thematic analysis informed by symbolic, structural, and slow violence theories. This process involved iterative coding, theme development, and discussions within the research team. Results

Using the conceptual framework of gynecological violence, we show how the dominance of medical and pharmaceutical knowledge, systemic neglect of contraceptive counseling, and prioritization of oral contraceptives over other methods of contraception contribute to a cycle of symbolic and structural violence, ultimately harming users through slow violence. Conclusion

To promote more equitable and inclusive contraceptive counseling, we recommend advancing gender-responsive research, expanding the rights-based and psychosocial counseling offered by different health professionals (and not just physicians), and enhancing gynecology training programs to better prepare gynecologists for contraceptive counseling. Ultimately, these measures aim to transform contraceptive care into a more equitable, informed, and patient-centered practice.