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Feature 07.12.2021 6 minutes

Birth Control Pilled

women hand golding birth control pills close up

The tide may be turning against hormonal intervention into women’s reproduction.

“The pill is prescribed carelessly and taken thoughtlessly.”

—Holly Grigg-Spall, Sweetening the Pill

It seems as though every few years, we experience a new wave of skepticism about hormonal birth control—not from the religious Right, but from feminists.

The first and maybe most pivotal example of this was back in 1970. Barbara Seaman’s book, The Doctor’s Case Against the Pill (1969), exposed serious and unpublicized side effects of ingesting high doses of artificial hormones. These included: blood clots, heart attacks, strokes, loss of libido, and clinical depression. To name just a few. The millions of women being prescribed the Pill were never so much as warned about these risks.

Seaman’s critique launched Senate hearings into the safety of the Pill, led by Senator Gaylord Nelson. Today Seaman is celebrated (posthumously) as a feminist hero—a fierce advocate for women’s health who wasn’t afraid to ask hard questions. But when she was alive, she was also referred to as “the Ralph Nader of the Pill.” She was painted as an alarmist and, in some cases, even blackballed. Some of her critics were medical professionals who had an obvious financial horse in this particular race. But others were feminists who saw her, and the Nelson hearings, as over-emphasizing the negative side effects of the Pill while minimizing what it had done in service of women’s liberation.

Seaman’s findings were not alarmist handwringing. Her work and the feminist health movement that followed it helped usher in a major victory—not just for potential users of the Pill, but for anyone prescribed any drug. The Nelson hearings ended in mandatory inclusion of patient-information inserts.

But the feminist presence at the Nelson hearings—and the questions that underpinned them—weren’t just about gendered patient advocacy or the abuses of pharmaceutical companies.

Larger, more important questions about the Pill’s so-called “liberating” potential were being asked. Why should contraception solely be a woman’s responsibility? Why should women’s health suffer so men can enjoy consequence-free sex? What did preventing unintended pregnancies mean for women’s bodies, or for their status? How liberating, exactly, was the practice of pumping women’s bodies full of artificial hormones to prevent ovulation?

And then, just like that, the criticism faded into the background. It was cordoned off to niche feminist health movements. Until, that is, the next wave. Rinse and repeat.

The Third Way

Each wave of feminist criticism of hormonal contraceptives seems to follow this template. There’s some controversy—usually anchored in serious medical concerns—and some subset of feminists speaks up. Maybe there’s a Senate hearing, maybe there’s a class action lawsuit on the horizon, like the one faced in Ontario by the pills Yaz and Yasmin. Then the conversation is quickly moderated by the media, by doctors, by other feminists, before it can become too incendiary: Yes, THIS hormonal contraceptive may have caused X, Y, and Z health problems in women, but let’s not panic. Let’s not be alarmists.

Any increase in likelihood of anything is quickly written off as marginal; from cancer to blood clots, from strokes to clinical depression. But what if the likelihood of a given side effect isn’t marginal? What if it’s both common and unpredictable with respect to whom it might impact? “Every woman’s journey with hormonal birth control is different, it’s a highly individualized process.” The foregone conclusion is always that birth control is a good thing. This necessitates just accepting that hormonal birth control is a never-ending guessing game, with no clear strategy for how to standardize it. We are required to assume that it is worth the risks and the cost.

There is also a strange tendency for the discussion to devolve into an unusual dichotomy: either women are on hormonal birth control, or they’re pregnant against their will. Criticism of hormonal birth control is often framed as tantamount to criticism of any contraceptive at all, and always heavily disclaimed. Articles that could have easily been neutral reports about risks are loaded with statements like, “It feels precarious to point out…” and “It gives me pause to criticize contraceptives….”

Even back in 1970, hormonal birth control was an extremely polarizing issue. Take this article from The New York Times, “Panic and Pregnancies Linked To Senate Inquiry on Birth Pill” (1970): “A New York obstetrician told a Congressional subcommittee today that publicity generated by its hearings on hazards of birth control pills had caused ‘panic’ among women using the drug and ‘dozens of unwanted pregnancies.’” The American College of Obstetricians and Gynecologists later issued a statement “deploring inaccurate or sensation reports concerning the drugs.”

But the question remains: Why is it that hormonal birth control is so inextricably linked to the status of any birth control method at all? What is special about making your body ready for unprotected sex at any moment via a pill, versus more intentional forms of contraception which may require more communication, like condoms or the rhythm method? These are questions that remain just barely answered, even within the safety of feminist spaces—some of them are even considered dangerous to discuss, depending on the company.

Some people, like the historian Elizabeth Siegel Watkins, have offered some helpful clues about why this might be. In the 1990s, marketing for hormonal birth control more explicitly promoted the treatment as a “lifestyle drug.” This framed the user of hormonal birth control as a particular type of person. We also saw an explosion of “off-label” use.

But there is a third way of looking at things—often treated as a footnote, but present nonetheless. Some argue that other forms of contraception are all well and good, but hormonal birth control is more than just birth control. The name is misleading—it’s a hormonal treatment that impacts ovulation, but there are myriad off-label uses that are vital for people’s well-being.

Proponents of this third view argue (correctly) that hormones can influence any number of health problems. The reason mood swings, acne, bad PMS, low libido, high libido, painful periods, anxiety, hair loss, and hirsutism all might invite a “Would you like to try hormonal birth control?” is because it’s the best option we have on the market right now.

It’s difficult to determine whether this speaks more to our relationship with birth control, or to how American medicine is wont to view our bodies: isolated pieces, divorced from a whole. But hormones are not just another “part.” They are an integral component that impacts every piece of how you work. You can’t dial up a woman’s estrogen in isolation without creating a ripple effect throughout her whole body.

The Turning Tide

There’s reason to believe that the tide might be changing though—that not only a new wave of skepticism, but maybe a totally different approach, is on the horizon. Maybe, just maybe, skepticism of hormonal birth control is on its way to becoming a mainstream position, one that fits squarely in the Overton window of what can be published without a million addendums, prefaces, disclaimers, and so on.

In 2018, The Cut published an article about how many women were beginning to question hormonal birth control’s impact on their bodies. In recent years, several articles in the same vein, including in the New York Times and The Lily, have also been published. They were overwhelmingly met on social media with women who felt like the experiences described resonated with their own. None of these pieces experienced the usual feminist diminishment as “alarmist.” They were not thought to have any particular agenda.

More recently, it’s been possible to discern a shift in how we’re talking about other forms of birth control. Phexxi, a hormone-free option, has been able to position itself well within educated, coastal circles—the same kinds of circles that might feel the need to whisper any sort of criticism against hormonal birth control, for fear the Religious Right might hear them and bring about some kind of Margaret Atwood-inspired dystopia.

Marketing materials and articles written about Phexxi have been quick to point out the growing number of women who are hesitant to take hormones; the New York Times has noted that it’s “an increasingly vocal contingent in a boom of wellness culture.” In this same article, they go on to say, “In recent years more people are asking questions about what they put into their bodies, embracing routines and products that feel more ‘natural’ to them and rejecting things they perceive as toxic.”

What’s striking—and important—here is how even-handedly these women are being described. Whereas even a year ago, particularly under the Trump Administration, these same women might have been described as tantamount to the much-maligned anti-vaxxers, the language around them has shifted. Skepticism of artificial hormones is now seen as just another “wellness perspective.”

Then there was the conversation sparked by the FDA’s decision to pause the J&J coronavirus vaccine, after it was shown to cause blood clots. Women, again, often self-identified feminist women, began asking, “Why aren’t we more concerned about hormonal birth control then?”

And now, a growing number of women on TikTok are asking, “Why aren’t we?” This trend might be the most revealing of all, as it’s fueled by the voices of average, everyday people. Type in “hormonal birth control” into TikTok or Twitter and you’re greeted with a wellspring of apolitical (and not, important to note, “New Age”) content about people who are concerned about the impact hormones have on their body. From the frivolous to educational, women are increasingly open about saying “No.”

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