Access Versus Safety: It’s Not Either Or
In February 2012, five years ago to the week, I wrote:
“In the US women seem too scared to criticize the pill as they think anything less than zealous enthusiasm will be seized upon by the Right and used as fodder in their bid to ban birth control. This situation means there is very little accurate information getting through to women about the risks of hormonal contraceptives — from the quality-of-life-threatening to the truly life-threatening. Those on the Right that are looking to ban birth control or limit access are manipulating information, this is true, but so are those who claim to be working for women, who claim to have women’s best interests at heart. The silencing of honest discussion is letting many women suffer unnecessarily as a result of using the Pill.”
This statement was part of an article for the Society for Menstrual Cycle Research’s blog, re: Cycling. My book, “Sweetening the Pill,” was still in the proposal stage, yet to find a publisher. However, as I’d written for a few major publications by that time, I was asked, by a reporter at the Washington Post, whether I thought the political debate around access to birth control was “distracting from” discussion of the side effects and safety of hormonal contraceptives. The article became an extrapolation of my answer.
In the same week, I published an article with Ms. Magazine about the serious and life-threatening risks associated with newer, drospirenone-containing, oral contraceptives. One of these kinds of birth control pills, Yasmin, I had taken for over 2 years and my experience set me on the path to becoming a “birth control critic” (as the Washington Post then labeled me, in 2016). Due to a misleading marketing campaign, Yasmin became one of the most popular and profitable brands in the mid-2000s. Yet, drospirenone-containing pills had significantly higher risk of blood clots than older brands of pill (a fact known to the pharmaceutical company). This was not front page news, nor taken up as a feminist cause – which is why I was writing about it.
Politicians Putting Safety On Sidelines Again
Five years later, at the start of 2017, has the situation changed? Well, no, and yes. Last week I received this email in regards to the upcoming “Sweetening the Pill” documentary, which will look at the safety and side effects of hormonal contraceptives and issues of informed consent. This woman voiced her concern:
“I wanted to get a sense of your thoughts about releasing it in this rather terrifying new political climate, and all it means for women’s rights. Of course, I’ve long been in favor of looking at the downsides of the pill—and I still am—but there was always a small concern in the back of my mind about unintentionally aiding the right-wing agenda.”
Reading this, I felt a sense of déjà vu and disappointment. In the past year or two, people had stopped asking me this question. More women were talking about side effects and more support was being given to those women, including myself. When my book came out, it was not well-received by all, to put it mildly, but I’d seen the tide change and talking about the problems with the pill had become mainstream. 2015 was the “year of the period” (as decreed by NPR), increased honesty around menstruation was leading to body literacy, including a reexamination of the impact of medicalizing menstruation and fertility. Now, it seems, that this developing conversation might once again be hushed up.
The political climate the email-er was referring to, is, as you likely know, that Donald Trump’s administration looks to defund Planned Parenthood and dismantle the Affordable Care Act, both of which have made some birth control methods accessible to more women. While he hasn’t explicitly said that he doesn’t agree with the use of contraceptives as a whole, as Rick Santorum did back in 2012, it’s clear the result of his proposed policies will be less accessible, less affordable hormonal contraceptives and devices. On top of that, Trump has stated a desire to further limit access to abortion, even outlaw the procedure.
And We’re Falling For It
In the wake of Trumps’ election the internet was flooded with articles demanding women seize the opportunity to get a subsidized or “free” IUD, with headlines quite literally stating, “Get An IUD Before It’s Too Late.” None of these articles mentioned side effects to watch out for, few distinguished between the IUD options (hormonal or copper), or mentioned alternatives for preventing pregnancy.
Access concerns were centralized, side effects and safety issues were relegated to the sidelines – along with any concern for the informed consent of the women who would inevitably take action. In fact, Planned Parenthood widely publicized a 900% jump in IUD requests. We can assume a significant number of those women did not want an IUD, but felt they had to get an IUD. The suggestion that the IUD is the one-size-fits-all fix to the problem of access is a willful avoidance of many complexities – from the high discontinuation rates associated with IUDs, to the serious side effects, to historical and current experiences of coercion, especially for women of color and women of lower economic status. Getting the IUD was presented as the responsible, politically-aware, thing to do. Of course, there was no headline stating, “Men, Now’s The Time To Get A Vasectomy” or “Men: Commit To Condoms For The Next Four Years.” If the majority of women want their IUD removed before the expiration date, I hope health practitioners are ready for this.
Demand Access and Safety
Faced with an attack on access to birth control and abortion, the response from liberals, Democrats and feminists is understandably, to fight for access. The equation is drawn that less accessible birth control means more unplanned pregnancies; higher rates of unplanned pregnancy without access to abortion means more unsafe abortions and/or more women having those unplanned children. While five years ago the emphasis was on the pill, now the emphasis is on the IUD – effective birth control that is inserted and removed by a health practitioner, bypassing the autonomy of the woman almost completely.
My own response to an attack on access is the same today as it was five years ago. I believe in taking an offensive and not a defensive position (pun intended). I support full access to all forms of contraception – pharmaceutical drugs and devices, and non-hormonal methods, by which I mean OBGyns trained in diaphragm-fitting, accessible classes in fertility awareness, and insurance coverage for fertility monitors. As a British person, I’m obviously an advocate of a nationalized healthcare system. But I also, simultaneously, believe we need to address head-on the real problems with the pill and other hormonal contraceptives, otherwise we cannot claim to truly care about women.
Allowing politicians to dictate whether we can discuss side effects and safety issues benefits the pharmaceutical industry, which funds representatives on both sides of the aisle. Bayer AG, the makers of both Yasmin and the hormone-based IUDs (Mirena, Skyla), is one of the top contributors to senators and political campaigns. Bayer AG recently merged with Monsanto, another high level backer of politicians. We cannot let the conversation be co-opted by the men, or women, of any political persuasion, but that’s what can happen when we keep quiet.
One month after I published my piece for re: Cycling, I co-wrote (with Laura Wershler) a “guide to coming off hormonal contraceptives.” The introduction went:
“As politicians, pundits and priests whip the nation into a frenzy over access to birth control, it’s understandable that women of every political affiliation may have had just about enough. If women are fed up with this furor over contraception, this daily demonstration that their rights to sexual and reproductive self-determination are vulnerable, then maybe now is the time to do something about it.”
The answer was to seize the means of reproduction. Dependence on decision makers, or making choices from fear, is not the way forward. What we needed then, as we need now, is a birth control rebellion.
“One way to take back power from those who would deny, bully or browbeat you is to not need what they are fighting over.”
That guide can now be updated with the many more resources that have become available in the past five years for women who want to reject pharmaceutical birth control.
Encouragingly, I see sparks of this rebellion today – in women sharing books wherein this perspective originated, like “How To Stay Out Of The Gynecologist’s Office” and “A Woman’s Book of Choices;” in renewed interest in herbalism and plant medicine; in women sharing knowledge of fertility awareness, and those teaching informed consent and body literacy. This is the kind of grassroots movement that could bring about important change for future generations of women.
We need to take back control of the conversation from those who will happily kick this political football down the field for decades to come, always centering their agenda and not women’s health or autonomy.
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