Blog of the Society for Menstrual Cycle Research

Why Can’t We Criticize the Pill?

February 13th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall

On February 10th, the Washington Post published an op-ed piece by Rachel Maddow. In this she outlines how there are Republicans who don’t want birth control covered by insurance, they don’t want Planned Parenthood receiving federal funding, and they want an embryo to be considered as a person with rights. She highlights that this last issue threatens the legality of hormonal birth control. In the final paragraph she states:

“Time will tell on the political impact of this fight, but the relevant political context here is more than just a 2012 measure of Catholic bishops’ influence on moral issues. It’s also this year’s mainstream Republican embrace of an antiabortion movement that no longer just marches on the anniversary of Roe v. Wade to criminalize abortion; it now marches on the anniversary of Griswold v. Connecticut, holding signs that say “The Pill Kills.”

Discarded Pill Package Photo by Beatrice Murch // CC-BY-SA 2.0

I was somewhat perturbed by Rachel’s slightly misleading description of how hormonal birth control works which suggested she has no more of an understanding than the Republicans she is railing against. However, I like her and I am loathe to criticize her — but I must. The thing is — the pill does kill. I’m not talking unborn children, I’m talking teen and adult women who are definitely considered persons.

As I wrote about for Ms. magazine last week, the FDA recently ruled to keep the oral contraceptives Yaz and Yasmin on the market despite the fact that it was discovered these drugs hold a 50% to 75% increased risk of causing blood clots than other birth control pills. Even though they are only as effective as other pills in preventing pregnancy, an FDA advisory board weighted with people with financial ties to Bayer Pharmaceuticals decided the benefits outweighed the risks. There are 10,000 lawsuits against Bayer — women who have been seriously injured by the embolism, stroke, or heart attack that resulted from a blood clot and the families of women who have died. I spoke to a lawyer working on many of these cases who told me one of his clients is a 20-year-old young woman who was training to be an Olympic skier when she started taking Yaz. She developed a blood clot, had a stroke, and is now permanently injured.

Now, I’m British and so where I’m from birth control is free under the National Health System. If you want to use the pill for contraception the doctor draws a little ‘female’ sign on your prescription and the pill is given to you, any brand and as often as you need it, for free. If you want it for, say, acne or endometriosis treatment, you pay the same prescription rate as you would any other drug — around $12. The NHS has even piloted schemes to make the Pill available over-the-counter. So, I’m coming from a very different background and therefore when I started criticizing Yasmin — and then the pill as a whole — through my blog, Sweetening the Pill, I was perplexed to find I was accused of siding with the far and religious Right. I’m pro-choice. I used the pill for a decade. Now I use a combination of condoms and spermicide together and the fertility awareness method. I don’t want children. I have no problem with abortion. I’m not Christian. Somewhere around half of the British population do not see themselves as part of an organized religion, significantly more than in the US.

From this standpoint, to me it seems as though the fight over sustaining access to birth control is preventing women speaking honestly about the pill, and hormonal contraceptives in general. 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 (like Mr. Rick Santorum) 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 – feminists, activists for reproductive rights and the women’s health movement. The silencing of honest discussion is letting many women suffer unnecessarily as a result of using the Pill.

How many women out there have not heard about the new Yaz/Yasmin research? How many have, despite the leg pain and swelling they’ve been experiencing, decided to keep taking Yaz? They keep taking it because they are told by the likes of Jezebel that pregnancy holds a much higher risk so it’s better to be on it than not. We can’t blame this on women not reading the insert. Not when there is so much propaganda for the pill, enough to drown out the wordy, deliberately evasive and cautious details on that slip of paper. But since the Nelson Pill Hearings we’ve been acting like the insert marks the end of the discussion.

These women don’t know they have other non-hormonal options or how to use them properly because we are too busy talking up the pill, raising its pedestal higher in the hope that we can stop it being taken away entirely. ‘Positive’ research is seized upon – such as that claiming the Pill prevents period pain – even though the majority perpetuates false information about how the pill works. Statistics are circulated on Facebook that proudly state that 31% of women use the Pill to prevent menstrual pain, 28% to regulate their periods, 14% to treat acne, 11% other and 4% for endometriosis. Consider this with the FDA ruling on Yaz/Yasmin: Do the benefits of the drugs’ use for regulating periods outweigh the risks? The majority of women taking the pill — taking Yaz/Yasmin specifically, if you like — are not sick. The pill is not keeping them alive. It isn’t, for most, easing pain that could not be eased via other less intrusive methods that don’t involve taking a drug every day, for years. There are non-hormonal methods of birth control that are just as, if not more, effective. They have no side effects. This is the point from which we need to start a discussion about the pill.

What the Yaz debacle should tell us is that we are being lied to and in response we should increase our vigilance when it comes to hormonal birth control. I think it is safe to assume if Bayer could hide research and weight an advisory panel, pay magazines to subtly promote Yaz in features, plant false news stories on local TV news and pay ‘experts’ in women’s health to advocate for their drugs in books and lectures, then there’s a distinct possibility that the lies don’t stop there, with just these brands of pills from this one company. It is too important to continue to be naïve about this. I think trying to silence critical thinking and honest discussion is abusive of the trust women are putting in certain groups of people to advocate for them. At this time it seems like these groups are trying to keep women on the pill at any cost, whilst the Right is trying to get women off the pill at any cost. The pharmaceutical industry must be loving all the free advertising they’re receiving from feminists. Why do we believe pharmaceutical companies are working for our good?

From my standpoint the whole debate is based on faulty foundations — that the richest country in the world expects a sick person to pay for medical care is, to me, barbaric. But, moving on — what would the best course of action be for women faced with expensive birth control pills costing them around $60 a month or, let’s say, for women faced with a ban on birth control? I think we need to support education on non-hormonal alternatives and encourage the development of body literacy.

Using a non-hormonal alternative method — such as condoms and spermicide combined — and establishing an understanding and awareness of your own ovulatory cycle would be a great position to take at this time. There’s also the diaphragm, the non-hormonal IUD and the Today sponge to consider.

Yes, I know, the Catholics are all for a similar method that they call ‘natural family planning.’ Except NFP is considered by Catholics to be “a way of following God’s plan for achieving and/or avoiding pregnancy“ and the fertility awareness method has nothing to do with God. NFP advocates promote “ecological breastfeeding – a form of child care that normally spaces babies about two years apart.” Basically, NFP is very much a pro-baby making method. The Catholic Church doesn’t agree with any other forms of contraception, including barrier methods.

With the fertility awareness method, some women I know use condoms (or another barrier) and spermicide when they’re ovulating and nothing when they’re not; and some women have no penetrative sex during the time they are ovulating and use condoms and spermicide the rest of the month. Body literacy is a good addition to any form of contraception – it will increase its effectiveness. This is the flip side of criticizing the pill, as many women who educate themselves about how their bodies work no longer want to use hormonal contraceptives. They feel that they can not experience optimum health when they are suppressing ovulation for years at a time. Some of them, like me, find that this choice is life-changing – and not because they get accidentally pregnant. This step puts the action back into the term ‘activist.’

Occupy yourself. Every new cycle spurs action. A revolution – in every sense of the word.

  

15 Responses to “Why Can’t We Criticize the Pill?”

  1. I went off the pill 10 years ago, tired of putting hormones into my body every day and spending so much on prescriptions every month. I switched to condoms and then as I approached 50, did away with contraception all together. That might not be the best choice for everyone but it’s working for me.

    When I was first becoming sexual in the 80s and thinking about birth control, the big scary monster was IUDs. And to this day my peers shy away from it despite the fact that it’s a totally different animal than it was back then. They cling to the pill, no matter what the news brings. Even my gynecologist couldn’t talk me into the IUD a few years ago. I consider myself pretty aware but these old ideas stay with you.

  2. Thank you for this great article about ‘pill politics’. I did not realize that you are from the U.K. Holly. The Daily Mail posted a couple of articles that were quite distressing last week – not about the pill but about Nexplanon (sounds like ‘Implanon’) implants being inserted into 13 year old girl’s arms at school without parental consent or knowledge.

    Parents furious as 13-year-old girls given contraceptive implants at school without their knowledge
    http://www.dailymail.co.uk/health/article-2097662/Parents-furious-girls-13-given-contraceptive-implants-school-knowledge.html

  3. There are additional reasons besides political why no one criticizes The Pill (as I will call combined oral contraceptives) and I speculate that they are pharmaceutical. Some years ago I studied bone density at baseline in a population-based study of about 500 women ages 25 to menopausal. The results showed that women who had ever used The Pill (3 or more months) had significantly lower bone density in the spine and the trochanter part of the hip. It took me over three years to get that paper published. The Pill is a major cash cow for drug companies and, through skillful marketting to women and physicians, has become a sacred cow.

    Women need to know that there are many, safer and equally effective ways to prevent pregnancy. These should be covered by medical plans and health insurance schemes. My personal preference (supported scientifically in this CeMCOR article) is a barrier method plus vaginal spermicide–http://www.cemcor.ubc.ca/help_yourself/articles/contraception. What I most like about non-hormonal methods is that they do not disrupt the production of our own essential cyclic menstrual hormones and ovulation. Non-hormonal (copper) or progestin-containing IUDs are also a good contraceptive choice and they also don’t alter our own cycles and estradiol and progesterone.

    What I want to know is how to get young women to question use of The Pill, not just for contraception (where use has justification and is proven effective). I think it is foolhardy and wrong to use The Pill to treat problems of the menstrual cycle since for each of the following problems, scientific evidence shows better effectiveness and safety for an alternative choice:
    1) cramps (ibuprofen works much better),
    2) irregular or absent periods (dealing with stresses, eating enough to cover our needs and cyclic progesterone work much better),
    3) unwanted facial hair and acne in Anovulatory Androgen Excess (also called PCOS), cyclic progesterone and spironolactone work much better; and
    4) heavy flow, ibuprofen and cyclic progesterone are more effective.

    When will The Pill no longer be a sacred cow for industry, for physicians and for women?

  4. Laura Wershler says:

    It’s time we moved beyond the idea that the pill, or other forms of hormonal contraception, are the “gold standard” for birth control. I’ve been concerned for a very long time that these medications are becoming the “standard of care” for being a girl. It’s got to stop!

  5. Geraldine says:

    We have addressed the issue of Coming Off the Pill in a booklet that is useful for those wanting to restore menstrual cycle health through complementary medicine approaches. http://www.justisse.ca/ComingOffThePill

  6. Jacqui says:

    You have to hand it to the pharmaceutical companies: they are that good at what they do. We have been and still are sliced and diced by these guys. They have the entire game stitched up so that they make the rules, they effectively control the so-called independent bodies that are supposed to regulate them, and with only a small percentage of doctors reading independent medical literature – 10% is the statistic in Switzerland – and presumably only reading what the pharmaceuticals send them, it feels like EVERYONE is on Team Pill except the few people like Holly speaking out. And the worst thing is, they’ve managed to get women and the feminist movement onside!! We are being sold down the river in the worst way, and my fear is that we haven’t even begun to pay the price for our supposed ‘freedom’.

    So if speaking out against giving carcinogens to our daughters to avoid pregnancy, acne and facial hair puts me on the same side as the Religious Right, you know I think I’m going to grin and bear it.

  7. I completely agree that the power of the pharmaceutical industry is a major factor in this issue. Doctors are massively influenced by money, research and advertising by the workings of this industry. Its primary aim is not to save lives or alleviate suffering – but to make money. Saving lives and alleviating suffering are essentially by-products of this drive. The concept of suffering and illness is stretched and manipulated in order to create voids that can be filled with profit-making medications.

    The Pill has a huge market – all women that are fertile and want to avoid pregnancy and now these days all women who are fertile and want to avoid acne, moodiness for a few days a month, bloating before their period, periods in entirety….

    I frequently consider other pills that have been revealed as dangerous and the reaction there was to them. I compare and contrast, and see that SOME pills are considered critically. But often the machine makes it seem like we have a need that is more pressing than potential side effects.

    I recall Seroxat/Paxil – the anti-depressant that can make young people more depressed and suicidal – and there the debate went along the lines of…well how do we know if it’s the drug doing this or if it’s just the person’s natural state? Even when a mildly depressed person suddenly wants to jump off a cliff. And when people complained that when they tried to come off of the drug they had horrible withdrawal symptoms – and people were committing suicide – the answer given by the industry was – well, don’t come off it then! This all seems very similar to the Pill – it makes women depressed, anxious, it makes them have flu-like symptoms, adrenal fatigue – well, how do we know? They’re taking it for much of their fertile lives, so maybe this is just normal changes that would happen anyway. And they have withdrawal symptoms coming off of the Pill? Well, don’t come off then! – until you want a baby and then we as an industry can send you in the direction of infertility drugs, and they’ll sort you out.

    Just like with drugs for psychological disorders there are some people who really, truly benefit from taking them – it totally stops them suffering and turns their lives around – but for a big middle section of people (those with mild depression, grieving, issues that need to be helped through therapy – or for the Pill say, those with slightly heavy periods, some pain, those who just have light, regular periods) drugs that you take every day are not the answer – but they ARE the answer for an industry looking to increase its market. I understand, for example, that some people with, say, ‘attention deficit disorder’ really benefit from a drug (I assume they do) – but there are tons of adults, and children, who have mild concentration issues, are not being attended to at school properly, are doing a job that doesn’t satisfy them, who are going through a difficult phase, for which drugs are not the right choice. The industry’s aim is to open up markets, open up markets and find new customers.

    Yet I see a lot more critical thinking out there in regards to psychiatric medications than in discussion of hormonal contraceptives. So there’s more at play here. The threat of the Religious right, yes. But more than that. As I write about in my blog – acceptance of the Pill, enthusiasm for the Pill, I believe comes from ingrained historical and social concepts of women and women’s bodies, and from the resulting willingness of women to change and behave in certain ways in response to these concepts.

    • Heather D says:

      Agreed, Holly, there are larger gender issues involved here. I like how in the end here you link this to larger issues of women being accustomed to molding themselves for others’ gazes and purposes. Therefore this is about large-scale ideological forces as well as large-scale economic and political forces.

      • Elizabeth Kissling says:

        I agree, Heather — it’s sexism deeply entrenched with economics and politics. The selling of Sarafem (fluoxetine for PMDD) has become a case study in marketing classes, much like the history of deodorant and razors, of how a company can create a product and then create the need.

        And Holly, it’s quite interesting to make the comparison to other drugs. Does anyone else remember fen-Phen and how quickly it was pulled from the market after a comparatively smaller number of women experienced heart valve damage or death?

  8. Jane Bennett says:

    Thanks for a great article and thanks everyone for a great discussion. Many important points have been raised and I’d like to add a little bit here.

    It has become clearer and clearer to me of late that while we have the rhetoric from big pharma, peak health bodies and most health professionals that hormonal contraception is the ‘gold standard’, as you say Laura, this is clearly in conflict with the wellbeing, and capacity to make an informed choice, of an individual woman. There are a whole bunch of reasons that hormonal contraception is promoted so heavily and many of those doing the promoting genuinely believe this is the best thing – for individual women, for society, for the national health budget, for tidy statistics, for shareholders … (I’m in Australia and contraception is partially federally funded here.)

    It would seem a simple, logical, dignified and respectful thing to do – to educate and support women and girls, as well as their partners, in a clear, non-commercially influenced understanding of a range of contraceptive methods so that for the decades they are needing contraception they can make choices based on their health, wellbeing, life-stage and relationship needs. In other words women could make truly informed choices about what is best for them.

    We are clearly a long way from this approach and there are many ‘interests’ and conscious and unconscious barriers to this, many mentioned above. However, from what I know of the women whose comments appear above, and a great many others as well, there is a powerful and articulate groundswell and many many women are responding as if finding an oasis in the desert. I believe change is stirring and while I can’t say I know what the process will look like or where it will land I am heartened by the growing chorus.

  9. http://inamerica.blogs.cnn.com/2012/02/15/contraception-denigrates-me-as-a-woman/

    Laura sent this column to me this morning. It is fascinating. A Catholic who is anti-contraception but doesn’t seem to differentiate between hormonal contraceptives and non-hormonal. Her statements suggests she means hormonal – like this:

    “My fertility is not a disease. It does not need to be repressed, manipulated, or rejected. It ought to be accepted and respected accordingly, by individuals and by society as a whole. And if that means exercising a bit of self control now and then, well, that’s a hell of a lot more dignified than saying, “Eh, we got this pill that makes self control unnecessary. I want pleasure now. Let’s get it on!””

  10. Elizabeth Kissling says:

    Also check out the Edith Stein Foundation. I just learned about them yesterday — some of their supporters/members are advocates of NFP, and also supporters of re:Cycling. They seem to be opposed to all forms of contraception, if I understand correctly.

  11. Right, they, like most everyone, use the term ‘contraception’ and ‘the pill’ interchangeably. Just goes to show how dominant hormonal contraceptives are. It’s like they’re the only viable method. Economically viable, I suppose. Diaphragms, IUDs – they last too long, involve only one-off payments. FAM – free. Condoms – well:

    http://www.laweekly.com/2012-02-09/art-books/condoms-suck-HIV-vaccine-sexually-transmitted-infections/

  12. Cynthia says:

    We can and should criticize the Pill and its manufacturers, when warranted, and it appears that Bayer and its products, Yaz and Yasmin, definitely need to be further investigated. However, we should also also understand that for many on the religious right this is just not about the Pill. It’s about restricting women’s sexual autonomy and making sure that they return to the home, their “natural” sphere.

  13. auh says:

    ‘NFP advocates promote “ecological breastfeeding – a form of child care that normally spaces babies about two years apart.” ‘ I was unaware of the Catholic church’s stance on ecological breastfeeding. I can say this falls in line with very much with the AAP and WHO’s guidelines for nursing an infant: On demand breastfeeding, no formula supplementation, exclusive breastfeeding until at least 6 months of age. I did not begin ovulating until my child 9 months old by exclusively breast feeding. Great article though!
    http://www.llli.org/nb/nbsepoct06p196.html

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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.