Coming of Contraceptive Age: An Interdiciplinary Analysis of Hormonal Contraceptives and Mental Health
Zettermark, Sofia LU
(2023)
In Lund University, Faculty of Medicine Doctoral Dissertation Series
- Abstract
- This thesis emanates from the discursive gap between a medical discourse and
experience-driven knowledges in mental health aspects of hormonal contraceptives.
The tensions and fractures between a medical discourse focusing on contraceptive
effectiveness and largely refuting any significant adverse outcomes, and experiencebased
narratives of commonplace detrimental, or at least unwelcome and unpleasant,
mental health effects, is apparent. Although hormonal contraceptives are widely used
and side effects on mood and mental health are often reported, little is known about
the link between hormonal contraceptives and mental health effects and, what is
more, the discourses, narratives, and experiences such a link... (More) - This thesis emanates from the discursive gap between a medical discourse and
experience-driven knowledges in mental health aspects of hormonal contraceptives.
The tensions and fractures between a medical discourse focusing on contraceptive
effectiveness and largely refuting any significant adverse outcomes, and experiencebased
narratives of commonplace detrimental, or at least unwelcome and unpleasant,
mental health effects, is apparent. Although hormonal contraceptives are widely used
and side effects on mood and mental health are often reported, little is known about
the link between hormonal contraceptives and mental health effects and, what is
more, the discourses, narratives, and experiences such a link is inescapably and
importantly enmeshed in.
Against this backdrop of increasing awareness of possible mental health side effects
of hormonal contraceptives, an interdisciplinary approach with four studies utilizing
different approaches to explore mental health aspects of hormonal contraceptives was
conducted. Two nationwide prospective cohort studies were carried out, the second
utilizing an intersectional multilevel approach, where significant associations
between hormonal contraceptive use and subsequent use of psychotropic or
antidepressant drugs was found. Two qualitative studies, one critical discourse
analysis of contraceptive information directed at the public, and one in-depth
interview with women using, or having used, hormonal contraceptives explored
discourses of contraception and reproduction that are being drawn upon and
reproduced in Sweden, along with experience-based narratives and knowledges. The
studies in this thesis show that 1) depressive and other mental health side effects are
likely more common than previously acknowledged, particularly among young
women; 2) these mental health effects are affected by interacting power dimensions
of oppression; 3) women are expected to choose and change (hormonal)
contraceptive methods for years and plan pregnancies perfectly; together with 4)
navigating often conflicting discourses on hormonal methods as either a simple and
effective solution to all reproductive issues, or exogenous hormones as unnatural
poison, obliging constant negotiation and self-surveillance.
11
Using reproductive justice as a jumping off point, this thesis argue that hormonal
contraceptive use is a form of modern fertility work dependent on biomedicalization,
and that mental health is at the core of this effort. I also show how hormonal
contraceptives and discourses thereof are not value-neutral, but act as normative
regulators of reproduction in a broader sense. Finally, I argue that hormonal
contraceptive effects can be conceptualized as neither purely biochemical nor purely
cultural, but rather as a contextual and interconnected result of different powerimbued
processes. While availability of hormonal contraceptives is one important
part of reproductive autonomy, it becomes clear that the medical discourse on
hormonal contraception often obscures the arduous and fundamentally gendered
fertility work, entrenched in a unequal society, that hormonal contraceptive use is.
A more explorative approach by the medical community, in patient contact and in
research on psychological side effects of hormonal contraceptives, could possibly start
bridging the divide created by the unfeasibility of reducing complex human emotion,
experience, and knowledge, to dichotomous variables. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/b6a7d19f-5ebf-4e82-a5ea-84dca769fe53
- author
- Zettermark, Sofia
LU
- supervisor
-
- Juan Merlo LU
- Diana Mulinari LU
- Carola Tilgmann LU
- opponent
-
- Professor Goicolea, Isabel, Umeå University
- organization
- publishing date
- 2023
- type
- Thesis
- publication status
- published
- subject
- keywords
- Interdisciplinary, Social Epidemiology, Gender Studies, Hormonal Contraceptives, Reproductive Justice, Intersectionality
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2023:131
- pages
- 198 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö. Zoom: https://lu-se.zoom.us/j/67400472759
- defense date
- 2023-12-01 13:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-473-5
- language
- English
- LU publication?
- yes
- id
- b6a7d19f-5ebf-4e82-a5ea-84dca769fe53
- date added to LUP
- 2023-11-10 14:02:15
- date last changed
- 2023-11-13 09:49:32
@phdthesis{b6a7d19f-5ebf-4e82-a5ea-84dca769fe53,
abstract = {{This thesis emanates from the discursive gap between a medical discourse and<br/>experience-driven knowledges in mental health aspects of hormonal contraceptives.<br/>The tensions and fractures between a medical discourse focusing on contraceptive<br/>effectiveness and largely refuting any significant adverse outcomes, and experiencebased<br/>narratives of commonplace detrimental, or at least unwelcome and unpleasant,<br/>mental health effects, is apparent. Although hormonal contraceptives are widely used<br/>and side effects on mood and mental health are often reported, little is known about<br/>the link between hormonal contraceptives and mental health effects and, what is<br/>more, the discourses, narratives, and experiences such a link is inescapably and<br/>importantly enmeshed in.<br/>Against this backdrop of increasing awareness of possible mental health side effects<br/>of hormonal contraceptives, an interdisciplinary approach with four studies utilizing<br/>different approaches to explore mental health aspects of hormonal contraceptives was<br/>conducted. Two nationwide prospective cohort studies were carried out, the second<br/>utilizing an intersectional multilevel approach, where significant associations<br/>between hormonal contraceptive use and subsequent use of psychotropic or<br/>antidepressant drugs was found. Two qualitative studies, one critical discourse<br/>analysis of contraceptive information directed at the public, and one in-depth<br/>interview with women using, or having used, hormonal contraceptives explored<br/>discourses of contraception and reproduction that are being drawn upon and<br/>reproduced in Sweden, along with experience-based narratives and knowledges. The<br/>studies in this thesis show that 1) depressive and other mental health side effects are<br/>likely more common than previously acknowledged, particularly among young<br/>women; 2) these mental health effects are affected by interacting power dimensions<br/>of oppression; 3) women are expected to choose and change (hormonal)<br/>contraceptive methods for years and plan pregnancies perfectly; together with 4)<br/>navigating often conflicting discourses on hormonal methods as either a simple and<br/>effective solution to all reproductive issues, or exogenous hormones as unnatural<br/>poison, obliging constant negotiation and self-surveillance.<br/>11<br/>Using reproductive justice as a jumping off point, this thesis argue that hormonal<br/>contraceptive use is a form of modern fertility work dependent on biomedicalization,<br/>and that mental health is at the core of this effort. I also show how hormonal<br/>contraceptives and discourses thereof are not value-neutral, but act as normative<br/>regulators of reproduction in a broader sense. Finally, I argue that hormonal<br/>contraceptive effects can be conceptualized as neither purely biochemical nor purely<br/>cultural, but rather as a contextual and interconnected result of different powerimbued<br/>processes. While availability of hormonal contraceptives is one important<br/>part of reproductive autonomy, it becomes clear that the medical discourse on<br/>hormonal contraception often obscures the arduous and fundamentally gendered<br/>fertility work, entrenched in a unequal society, that hormonal contraceptive use is.<br/>A more explorative approach by the medical community, in patient contact and in<br/>research on psychological side effects of hormonal contraceptives, could possibly start<br/>bridging the divide created by the unfeasibility of reducing complex human emotion,<br/>experience, and knowledge, to dichotomous variables.}},
author = {{Zettermark, Sofia}},
isbn = {{978-91-8021-473-5}},
issn = {{1652-8220}},
keywords = {{Interdisciplinary; Social Epidemiology; Gender Studies; Hormonal Contraceptives; Reproductive Justice; Intersectionality}},
language = {{eng}},
number = {{2023:131}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Coming of Contraceptive Age: An Interdiciplinary Analysis of Hormonal Contraceptives and Mental Health}},
url = {{https://lup.lub.lu.se/search/files/164726325/Coming_of_Contraceptive_Age_Zettermark.pdf}},
year = {{2023}},
}