Written by: Abigail Francis

Edited by: Anya Pan

Historically, through media and science, female fatigue has often been pathologized into personality. In these settings, the woman is emotional, moody and overwhelming: these are simply the intrinsic traits of existence as a woman. Yet, recent studies in fatigue, like ones done by Jonathan Sterne, point to something else: female tiredness can in fact reflect the demands placed on an individual by their exterior social world. Nowhere is this sentiment more reinforced than in the reproduction landscape. From the hormonal disruptions of birth control, the logistical planning of fertility management, to the economic cost of preventing or terminating pregnancy, women are expected to spend unfathomable time and money upholding a system of reproductive vigilance. The typical (hetero) sexually active American woman will spend three decades of her life trying to avoid pregnancy and will rely on prescription hormonal contraception to do so. The physical, emotional, and financial weight of this contraceptive choice on a sexually active woman is often framed as personal responsibility, rather than a product of patriarchal design. This reality is most evident in today’s gender-based inequality in contraceptives; men participate in contraception with relative ease through the prevalent use of condoms, with only 6.8% of heterosexual men opting for the physiological method of a vasectomy. For women, fatigue from the practice of birth control isn’t a fleeting condition or a sign of personal weakness; it is a chronic structural phenomenon produced through patriarchal sexual norms. Hormonal contraception thus positions women as the regulators of this system of injustice, making women’s ongoing exhaustion a necessary feature of capitalist modes of productivity.

In the Body: Biological Fatigue from Birth Control

Despite global advances in gender equality, women ongoingly retain the burden of hormonal contraception in the body, sparking physical and mental health-related challenges. According to a report published by the American Journal of Obstetrics and Gynecology, 46% of women discontinue hormonal contraception due to  the severity and persistence of physiological side effects. Studies conducted in both the United States and Europe reported that these alarming side effects include nausea, irregular bleeding, headaches, weight gain, and hair loss. These effects significantly disrupt women’s lifestyles, impacting sleep, appetite, and overall wellbeing. As such, the gendered asymmetry in contraceptive design intensifies a notion of biological fatigue among women. While almost all methods for female contraception rely on hormonal manipulation, no male method on the market involves altering men’s hormonal systems. As a result, women absorb the physical consequences of regulating fertility, while men remain structurally insulated from a comparable risk of bodily disruption. 

 As women experience intense side effects from hormonal birth control, they engage in what sociologists Wigginton et al. described as the search for “contraceptive fit”: a process of continual self-surveillance and bodily management in which they cycle through contraceptive options in hopes of finding one with limited side effects. This is yet another way in which women exhaust themselves in order to satisfy an ostensible reproductive duty. Women can exercise contraceptive choices amidst a market saturated with female-centric methods, but the expectation to find a right “fit” reinforces the idea that the responsibility lies within the woman’s body, rather than in the gendered dynamics of contraceptive technology itself. Even as women explore various market options, quitting hormonal birth control altogether is rarely considered an option in the view of being reproductively responsible. Altogether, the biological implications of hormonal birth control is a physical manifestation of women’s systemic fatigue, imposed upon by an oppressive gendering of contraceptive technology.

In the Mind: The Psychological and Emotional Burdens

The emotional burden of reproductive labor extends far beyond the daily management of contraception and into the profoundly stressful decisions surrounding unintended pregnancy. Because patriarchal norms construct women as the “sexual managers” responsible for preventing pregnancy, they also bear the psychological fallout when contraception fails in a way men do not. Even with a male hormonal birth control, male bodies would not sustain the same proximity and thus urgency towards an unwanted pregnancy. As a result, women must navigate the trauma of choosing whether to obtain an abortion, locate and finance the procedure, confront stigma, or alternatively, carry an unintended pregnancy to term which is often at the cost of education, work, and long-term economic stability, especially when a stable partner is absent. This reinforces the sense of duty imposed upon women to use sustained forms of contraception.

Emotional pressure also extends from a side effect that accompanies many hormonal contraceptives; women describe feeling “crazy,” angry, or depressed when using birth control. While women often feel dissatisfied with these side effects, a desire to avoid nonnormative displays of emotion and having their emotions labeled as irrational often leads them back to the laborious task of finding an alternative. Another aspect of birth control fatigue is fear. Many women express fear of pain with long-term methods like an IUD placement or implant insertion, all of which require invasive procedures, some of which are still being debated in the medical field regarding the need for appropriate pain management, such as local anesthetic or sedation.  Furthermore, women spend more time than men in clinic visits, obtaining medications and managing insurance coverage. The cumulative effect of the methodology of contraception is a multilayered psychological fatigue, in which women must manage the discomfort of side effects, the anxiety of procedural affairs, and the fear of potential pregnancy, all under the moralized weight of sexual responsibility.

In the Wallet: Economic Fatigue and Unequal Burden

The economic dimensions of fertility management reveals yet another layer of the overlooked and unequal labor women are expected to perform in the name of reproductive responsibility. In countries without universal healthcare, there is a huge recurring financial cost to hormonal birth control, as women pay for all appointments, devices, treatments for side effects, and even sleep aids recommended to combat fatigue caused by hormonal disruption. This cost only builds over years into another form of economic exhaustion unequally imposed onto women. Pharmaceutical markets have also been structured around women as primary consumers because women bear the burden of contraceptive responsibility, leading to a contraceptive framework where male methods remain underdeveloped. This profit model ensures female contraception is reinforced as the only long-term option, keeping women economically bound to sexual responsibility by participating in methods of female birth control. Furthermore, the risk of unintended pregnancy carries its own profound financial risks: lost wages, medical bills, and child care costs. This reinforces how the economic model of contraception disadvantages women disproportionately and intensifies the fatigue that comes with added financial costs.

Patriarchy, Capitalism and Reproductive Responsibility

The burden of contraception is deeply rooted in gender inequities, sustained by heterosexual norms that frame reproductive prevention as a responsibility inherent to women. This is a logic that has only been increasingly propagated after the widespread normalization of the birth control pill. These dynamics are also emphasized by cultural constructions of gendered sexuality, in which men are given a position of being sexually impulsive and entitled, while women are forced to be sexually rational and responsible. Female contraception fits into this paradigm, as it does not interrupt the male right to sex, threaten the perceived “naturalness” of heterosexual sex, or compromise male pleasure. Within this discursive landscape, female contraceptive developments are framed as potentially empowering, yet in reality, reproduces expectations that women manage pregnancy prevention and service men’s sexual needs. Hegemonic masculinity further entrenches these dynamics. Men often rely on women to navigate contraception, emergency contraception, and abortion access. When they attempt to participate in reproductive labor, they must negotiate tensions between sharing responsibility and respecting women’s autonomy. The result is an unequal distribution of reproductive risk. Fatigue becomes a mechanism through which women’s energy is continually redirected toward maintaining heterosexual stability, allowing men to remain unencumbered. From a feminist standpoint, this exhaustion is a structural condition as well as evidence of a system that normalizes draining women’s bodies in order to sustain male privilege.

Marxist historian Anson Rabinbach argued that fatigue has been historically tied to the regulation of labor power under industrial and late capitalist systems. Tiredness becomes a measure of how much energy can be extracted from a body before productivity starts to break down and therefore allows the capitalist to exploit the worker to their limit.Viewed through a Marxist lens of the worker, women’s alienation and exploitation in the reproductive sphere produces the exhaustion that capitalism runs on. Furthermore, the necessity and exhaustion for women to rearrange their lives to take advantage of the labour market leaves women with limited capacity to resist, reinforcing the broader feminization of reproductive labour within heterosexual relationships. To parallel patriarchal oppression with its architect of capitalism, the dominant reliance on the pill in reproductive labour has thus entrenched a system where women’s fatigue becomes structurally necessary to sustaining a gendered hierarchy.

What Can We Do?

The unequal distribution of contraceptive responsibility reinforces gendered power dynamics, leaving women to bear the physical, emotional, and financial burdens of preventing pregnancy, manifest in an all-consuming fatigue. Men’s reproductive responsibilities are also diminished by ceding major forms of contraceptive duties to women. In a feminist ideal, men should share contraceptive responsibilities because pregnancy impacts both partners; yet, current social and medical structures largely shield men from the fatigue of both risks of unplanned pregnancy, as well as the process of hormonal birth control. Although condoms are often raised as an alternative, they do not address the gendered imbalance in contraceptive responsibilities. Condoms are one of the few contraceptives that men use commonly, but they are less effective than hormonal methods and have a more limited usage in the short-term, placing the burden of consistent, reliable long-term prevention back on women. With the emergence of new contraceptive technologies, a re-evaluation of our reproductive practices should consider that sharing long-term contraceptive responsibility would not only alleviate this disproportionate burden on women but also foster more equitable sexual relationships. This would challenge societal assumptions about gender, pleasure, and accountability within the power dynamics of reproductive health.

Bibliography

Image source: http://www.sxc.hu/photo/103942.