During the COVID-19 pandemic, I developed what was commonly referred to as ‘mask acne’. My face got worse and worse over time, to a point where I no longer cared about what I looked like but rather, I wanted the itchiness and pain to stop. Upon consulting a dermatologist, she diagnosed me with Seborrheic Dermatitis. I spent a good year following her instructions and taking the medication she prescribed, not to mention it wasn’t cheap. Yet, I kept coming back to my dermatologist because my condition made no significant improvements. So, I did my own research. To my surprise, I saw that birth control was listed as an effective way to combat acne. Naturally, I asked her about it and her response somewhat shocked me.
Keep in mind that I had already spent thousands behind these consultations, blood work and medication, and I was desperate for some relief. Here’s how our conversation about birth control went:
Me: Ma’am, I read online that birth control can help manage Seborrheic Dermatitis and acne. Is this true? And could it work for me?
Doctor: …Well, yes. It is true. Birth control does in fact help with such acne. However, I’d STRONGLY advise against it for mainly two reasons. Firstly, this is obvious, you’re unmarried. Secondly, we’d have to do a bunch of hormonal tests. So, let’s not go that route. Anyways…
That was the last time I consulted with her. After all the time, money and blood work into investigating this issue already, what’s wrong with a few more hormonal tests? Why is me being unmarried a factor for my skin treatment? Is she assuming that I’m not sexually active (a question that I feel she should’ve directly asked me)?
In simple words and from my own experience, we’re not ready to talk about birth control. We simply don’t talk about birth control even if the other person broaches it.
If we can’t talk about it in circumstances that have nothing to do with being sexually active, how can we talk about it as a resource that should be available to women, married AND unmarried?
In Bangladesh, you’ll find pharmacies holding over-the-counter emergency contraceptives and birth control pills. But without the direction and prescription of a specialist, which birth control pill do you take? How often do you take it and when? Is it wise to prescribe it to yourself based on your own research? In the end, women are not able to find answers to these questions, and in dire circumstances, most end up choosing emergency contraceptives instead. However, emergency contraceptives, while effective in preventing unwanted pregnancies, take a massive toll on the female body, and cannot be considered as a regular form of contraception. It is not even common knowledge to many young women that you shouldn’t be taking emergency contraceptives more than once every three or four months. But again, what other options do these women have? What else would you do? Sometimes you find yourself in unwanted situations you can’t explain, and sometimes you give in to your impulse of the moment – why are these occurrences met with ignorance, guilt, and victim blaming at the cost of our health?
But not all hope is lost.
There are some clinics and NGOs which will give you the help you need. But there’s a catch.
These birth control pills (or even abortion pills) are often disguised as medication that will help keep your menstruation cycle regular. Tactful, isn’t it? These organizations don’t question your marital status and in fact, in their consultation, your married or single life isn’t their headache. But like anything good and useful, it’s tricky finding such organizations under the veil of stigma that surrounds pregnancy outside wedlock or an unmarried woman having an active sex life in Bangladesh.
A June 2021 report by The Daily Star examined the hypocrisy that pervades among Bangladeshi sexual and reproductive health clinics. According to this report, despite the fact that birth control is widely subsidized by Bangladesh’s Ministry of Health and Family Welfare (MoHFW) and services are available in all divisions of the country, it doesn’t stop medical practitioners from taking the conservative route. The MoHFW also collaborates with national and international partners to ensure that as many Bangladeshis as feasible have access to contraception services. This makes contraception affordable and accessible in Bangladesh, which is a heartening realization and would promise a heartwarming outcome if such sentiments were actively implemented.
While oral contraception pills (birth control pills and emergency contraceptive pills) are accessible over the counter to prevent unwanted pregnancies, medical practitioners are required to provide services for IUDs and implants. This is an acceptable rule to enforce, but why inquire about your marital status and refuse to provide contraceptive and family planning consultation and services? This not only adds a layer of humiliation for women, married and unmarried, by depriving them of autonomy over their own bodies but also enforces the notion that women are guilty or are to be blamed for getting themselves in the situation to need such services in the first place. This in turn is a silent statement about how we still perceive rape culture in Bangladesh but that it another conversation we’re not ready to have for another day.
The conservative approach medical practitioners take enhances the likelihood of greater aggregate abortion rates in a country where abortion is prohibited and stigmatized.
The stigma is just as bad for married women who choose not to have children. Because — Isn’t that what marriage is? Why get married in the first palace if you don’t want kids? Indeed, the conversation about birth control is never limited to only providing a necessary medical resource to women. After all, when you talk about women and their bodies, strict social values and untold rules, conservativeness, and a little dash of humiliation and degradation always have to come into action.
When this stigma and conservativeness prevents a medical practitioner from providing an ethical, sensitive, and confidential medical consultation, it indicates a larger problem—that doctors’ behavior actively discourages and discomforts patients from seeking sexual and reproductive health services that could potentially affect their lives, fertility, and social security.
This underlying conservative mindset is inherent in South Asian cultural fabric. It is no secret that discussions about sex, sexual and reproductive health, and contraception still remain taboo and stigmatized in Bangladesh. And you won’t even have to step into a clinic to understand that. Just ask your mother about birth control or one of your male friends.
In my opinion, we’re not ready to talk about birth control.
But we’re not also ready to talk about many other crucial issues, such as workplace harassment, LGBTQ+ rights, or women having property rights. Nor are we ready to talk about the lack of legal steps taken to protect ethnic and religious minorities, the situation in hill tracks, and so much more. Yet right here you reading this article is a start, isn’t it? So, we’re already talking about things that we’re not ready for. Why hold birth control back from the table?