The sixth most populous country, Pakistan's modern contraceptive use rate is just 25%. Of the multiple reasons for avoiding contraceptives, women cite side effects as a significant deterrent to contraceptive uptake. Efforts to understand these side effects are limited by overreliance on the biomedical framework, which typically dismisses some of women's negative experiences and explanatory models as misperceptions. Drawing on 13 months of ethnographic data from a village in Khyber Pakhtunkhwa, Pakistan, our study sought to provide an emic description of contraceptive side effects. Respondents’ described what we call “spiritual” and “somatic” side effects. While the latter included experiences such as irregular bleeding and leg pain, spiritual side effects had more severe implications ranging from job loss, birth defects, to child death. In a context of a firm belief that family planning was a sin, contraceptives were believed to negatively impact spiritual well‐being and invite God's wrath. Our data suggest these perceptions and experiences played a crucial role in contraceptive decision‐making. The spiritual and somatic experiences of contraceptive use described by respondents also demonstrate the importance of broadening dominant biomedical approaches to holistically understand contraceptive side effects and usage.

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针头不同意，药丸不同意：巴基斯坦帕赫图妇女使用避孕药具的经验

作为人口第六大国，巴基斯坦的现代避孕药具使用率仅为25%。在避免使用避孕药具的多种原因中，女性认为副作用是避孕药具吸收的重要障碍。过度依赖生物医学框架限制了了解这些副作用的努力，生物医学框架通常将一些女性的负面经历和解释模型视为误解。我们的研究利用巴基斯坦开伯尔-普赫图赫瓦省一个村庄 13 个月的民族志数据，试图提供避孕副作用的典型描述。受访者描述了我们所说的“精神”和“躯体”副作用。虽然后者包括不规则出血和腿部疼痛等经历，但精神副作用具有更严重的影响，从失业、出生缺陷到儿童死亡。在坚信计划生育是一种罪恶的背景下，避孕药具被认为会对精神健康产生负面影响并招致上帝的愤怒。我们的数据表明，这些看法和经验在避孕决策中发挥了至关重要的作用。受访者描述的避孕药具使用的精神和躯体体验也证明了扩大主导生物医学方法以全面了解避孕药具副作用和使用的重要性。