Coming of Contraceptive Age: An Interdiciplinary Analysis of Hormonal Contraceptives and Mental Health

Sammanfattning: This thesis emanates from the discursive gap between a medical discourse andexperience-driven knowledges in mental health aspects of hormonal contraceptives.The tensions and fractures between a medical discourse focusing on contraceptiveeffectiveness and largely refuting any significant adverse outcomes, and experiencebasednarratives of commonplace detrimental, or at least unwelcome and unpleasant,mental health effects, is apparent. Although hormonal contraceptives are widely usedand side effects on mood and mental health are often reported, little is known aboutthe link between hormonal contraceptives and mental health effects and, what ismore, the discourses, narratives, and experiences such a link is inescapably andimportantly enmeshed in.Against this backdrop of increasing awareness of possible mental health side effectsof hormonal contraceptives, an interdisciplinary approach with four studies utilizingdifferent approaches to explore mental health aspects of hormonal contraceptives wasconducted. Two nationwide prospective cohort studies were carried out, the secondutilizing an intersectional multilevel approach, where significant associationsbetween hormonal contraceptive use and subsequent use of psychotropic orantidepressant drugs was found. Two qualitative studies, one critical discourseanalysis of contraceptive information directed at the public, and one in-depthinterview with women using, or having used, hormonal contraceptives exploreddiscourses of contraception and reproduction that are being drawn upon andreproduced in Sweden, along with experience-based narratives and knowledges. Thestudies in this thesis show that 1) depressive and other mental health side effects arelikely more common than previously acknowledged, particularly among youngwomen; 2) these mental health effects are affected by interacting power dimensionsof 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 andeffective solution to all reproductive issues, or exogenous hormones as unnaturalpoison, obliging constant negotiation and self-surveillance.11Using reproductive justice as a jumping off point, this thesis argue that hormonalcontraceptive 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 hormonalcontraceptives and discourses thereof are not value-neutral, but act as normativeregulators of reproduction in a broader sense. Finally, I argue that hormonalcontraceptive effects can be conceptualized as neither purely biochemical nor purelycultural, but rather as a contextual and interconnected result of different powerimbuedprocesses. While availability of hormonal contraceptives is one importantpart of reproductive autonomy, it becomes clear that the medical discourse onhormonal contraception often obscures the arduous and fundamentally genderedfertility work, entrenched in a unequal society, that hormonal contraceptive use is.A more explorative approach by the medical community, in patient contact and inresearch on psychological side effects of hormonal contraceptives, could possibly startbridging the divide created by the unfeasibility of reducing complex human emotion,experience, and knowledge, to dichotomous variables.