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The new pill politics

Naomi Lightman examines the troubling past and alarming side effects of the contraceptive that changed the world

“Alesse made me stop wanting sex.”

This is scrawled in black Sharpie on an advertisement for the popular brand of birth control, in a stall of a women’s washroom in Redpath Library. Simple and shocking, it hints at the contradictions that surround women’s attempts to control their fertility. Why does a drug that allows women to have sex without fear of pregnancy also potentially inhibit their desire to do so?

Laura McMahon, a U3 Philosophy and English major, has a horror story about Alesse. She credits this pill with what she calls a “completely, all-consuming bout of depression” which lasted for an entire year of high school.

“It never occurred to anyone – not my mom, my boyfriend, my friends, or even my therapist – that there was a link between my taking the Pill and my depression,” she says.

The malaise temporarily ended McMahon’s relationship, caused problems with her friends, and left her feeling somehow inadequate. Only through a combination of travel, new circumstances, and, most significantly, using a different form of contraception, did McMahon manage to fight the depression and get back on her feet.

Today, McMahon resolutely says that “[hormonal] birth control is no longer an option, and never will be again in my life.”

Yet McMahon’s story, as well as that of the anonymous bathroom scribe, are just two among many. Birth control is intrinsically linked with the “free love” movement of the sixties, second-wave feminism, and women’s liberation. While some women rely on chemical or hormonal forms of birth control, such as the Pill or the patch, others rely primarily on barrier methods, namely condoms or diaphragms.

Many women experience only positive benefits from hormonal forms of fertility control. However, a growing minority of women and men are now emphasizing the need for more vigorous debate surrounding the Pill’s safety, distribution, and efficacy.

Underlying this is an understandable fear that criticism of the Pill necessarily labels one as anti-sex, anti-feminist, or paternalistic. But this concern only contributes to the lack of critical analysis and discussion. Birth control options must be located within their broader social and political context, where misogyny, heteronormism, and corporate interests often outweigh the needs of individual women.

A troubling genesis

“The Pill has a really deplorable history in terms of eugenics,” says Jocelyn Porter, who works as a Health Animator at Head and Hands, a not-for-profit organization in NDG that promotes the physical and mental well-being of youth.

Porter emphasizes that birth control has been tested primarily on marginalized populations, who had very little control over the process. Significantly, most trials for contraception drugs were done in poor, “underdeveloped” nations in the global South. The Pill, for example, was tested most extensively on thousands of poor women in Puerto Rico in 1956 before it was approved for use in the United States in 1960.

Norplant, a long-lasting birth control implant (which was discontinued in the U.S. and Canada in 2002) was tested on women in Chile in 1972. Depo-Provera, which uses tri-monthly injections of progesterone, was tested for decades on Mexican and Thai women to establish whether it was acceptable for use by North Americans. Native American women, especially those with mental disabilities, were also used as test subjects by Depo-Provera.

“Not only were impoverished women in developing nations used as guinea pigs, but if we look at where it’s been given out for free or for really cheap, it’s also tinged with racism,” says Porter, adding that sometimes injections of Norplant were tied to welfare benefits in poor, primarily black areas of the U.S.

Margaret Sanger, founder of the American Birth Control League (which eventually became Planned Parenthood), is often considered the original spokesperson for birth control. While Sanger’s goal of introducing a simple, widely accessible, and cost-effective pill form of birth control was admirable, she was also a eugenics proponent. This movement aimed to decrease the fertility rate among genetically “disadvantaged” populations.

“Birth control was marketed as a way of controlling the ‘population of the unfit,’ like poor ethnic populations,” Porter says.

Sanger fed off white, upper-middle class fears about a “race suicide” of the “fit,” and uncontrollable population growth of the “unfit.” Those who promoted the Pill and other hormonal methods of contraception used them to curtail specific populations.

Today, this history is not common knowledge. While it is unlikely to affect women’s present-day fertility choices, it is important to acknowledge the racist and classist origins of birth control drugs.

Where are the teachers?

Many women recall going to the doctor to discuss birth control for the first time, feeling rushed and uncomfortable, as if taking the Pill was really the only viable option.

“You go in there, you’re young, and you’re usually scared because something is wrong,” says Anna Feigenbaum, a McGill graduate student and an instructor in Communication Studies.

“They [doctors] think you’re stupid and incapable of using any form of birth control that is non-chemical, and you don’t think to question it unless you start feeling sick.”

Feigenbaum herself recalls lasting on the Pill for only six months until she became ill, and says that “the whole time I was on it I was a total nutcase.”

Optimally, women would learn in high school – in a relatively neutral, non-judgemental manner – about the array of birth control options and then make informed decisions for themselves. However, according to recent McGill Arts graduate Theresa Howard, sex education in North American schools often falls short.

Howard’s undergraduate thesis was entitled “Learning About Birth Control: The Challenges and Opportunities.” In it, she interviewed 12 McGill students about how they had learned about birth control.

“A lot of women felt like their doctor and teachers didn’t have enough time, or weren’t willing to give them enough time, to sit down and really go through the different options,” Howard says. As a result, she found that women often value information from their peers over that of medical professionals or educators.

Formal sexual health education in Canadian schools began in the early 20th century due to anxieties about venereal disease. In the 1960s, curriculums adjusted to address the rising rates of unplanned pregnancies, while in the 1980s they began to concentrate on the growing AIDS crisis.

While many Canadian schools currently do offer comprehensive sexual health education, including instruction on different birth control methods, studies consistently report that these programs are deficient. One study discovered that only 15.5 per cent of Bachelor of Education programs at Canadian universities had mandatory sex-ed training, and 26.2 per cent had optional sex-ed courses.

Additionally, due to severe cuts to social programs and education budgets, the quality – as well as the very survival – of sexual health programs is threatened across Canada. In Quebec, sex education was essentially cut from high schools in 2005. This came at a time when the rates of sexually transmitted infections (STIs) were – and remain – alarmingly high among Canadian youth.

Overall, Feigenbaum says that, even among university-aged people, there is an information gap concerning non-hormonal birth control options. This is coupled with what she calls a “complaining discourse” surrounding condoms, forcing a heteronormative focus on penetrative sex.

“There are limited alternative information sources, particularly ones that have funding and infrastructure,” she laments. “It’s time to expand our definitions of sex.”

Medicalizing bodies

Despite these misgivings, the Pill remains the most widely-used method of birth control for women under 30. Just the fact that we refer to this hormonal contraceptive as “the Pill,” when there are countless other tablets and capsules, is indicative of its dominance in public discourse about contraception.

The known list of hormonal birth control’s potential side effects range from minor to fatal, including depression, weight fluctuations, decreased libido, and a risk of blood clots for smokers. However, as a relatively new drug, long-term side effects of the Pill are difficult to determine. They will only begin to be revealed as the first generation of users develop symptoms. Troublingly, there have been almost no long-term controlled research trials on the Pill.

Hormonal oral contraceptives put the entire onus of birth control on women. While this is reassuring for many, it also completely eliminates any male accountability. As a consequence, it becomes women’s sole responsibility to obtain, pay for, and take the Pill – as well as to suffer its physical or emotional side effects.

Sam Mackenzie, a researcher at Douglas Hospital and a McGill Neuroscience graduate, says he has “serious reservations” about hormonal forms of birth control.

Mackenzie’s concerns began during a course on endocrinology, the study of hormones in the brain. He learned that levels of estrogen naturally fluctuate in a woman’s body, but that hormonal birth control eliminates these fluctuations.

“It can lead to really elevated levels of estrogen across the entire cycle,” he says, explaining that estrogen plays a role in the serotonin level and in memory. “So if there’s a natural cycle, it gives me pause to tinker with that…. I’m not convinced that the Pill has no effect on the long-term health of those systems.”

However, Howard says she hesitates to use the word “natural” in discussions on birth control. “That word gets thrown around a lot. People will say that something is ‘natural’ and therefore it’s the way it’s supposed to be.”

Yet Howard also admits to having doubts about chemically controlling women’s menstrual cycles. “I do think [hormonal birth control] is not the right choice for everyone,” she says.

Conflicts of interest

For those hoping for better choices in the future, research and development (R&D) on alternative, safer oral contraceptives has been lacking. This is likely because of cost and potential liabilities. Many pharmaceutical companies have completely withdrawn from R&D in pregnancy prevention, focusing instead on marketing.

As a result, most recent industry-funded research only focuses on improving existing methods. For example, the patch and the ring both release the same hormones as the Pill into the bloodstream, via the skin, or in the case of the latter, the vaginal wall.

“It seems like they’re always coming up with something new, but it’s always a variation on the same thing,” says Porter. She also notes that non-contraceptive benefits of hormonal birth control, such as acne treatment or relief of menstrual cramps, are also often used to lure younger users.

Additionally, birth control pamphlets and guides for selecting the right contraception are often sponsored by Pill manufacturers, who have a vested interest in women “choosing” what they sell. These guides also often frame the Pill as “the” contraceptive.

“These supposed information pamphlets are actually advertisements,” says Howard. “And birth control pills are also sometimes given free to doctors by pharmaceutical companies as a promotion. This can influence what doctors prescribe, either because the product has been really sold to them by the company, or because that’s just what they happen to have on hand.”

Feigenbaum notes that sometimes doctors who are quoted in these information sources are also on the boards of the pharmaceutical companies that make the product, or in some way connected to their payroll, as a type of conflict-of-interest.

“Of course, it won’t say that when you open up your web page,” she says. “It’ll just say, ‘Great new drug for you,’ with doctor recommendations. Then, it turns out – through usually not too many clicks – that the doctor works for the lab.”

Overall, critics argue that pharmaceutical companies are consciously drawing attention away from non-medical methods of contraception. “It takes attention away from barrier methods which have the highest efficacy-to-safety ratio, and I think are really fantastic,” says Porter.

Healthy skepticism

It’s clear that every woman ought to have the option of using oral contraceptives and other hormonal forms of birth control if she so desires, and at reasonable cost.

However, the consensus seems to be that a healthy degree of skepticism is warranted concerning safety, and there need to be unbiased information sources readily available about alternative methods.

McMahon argues that we can no longer pass the Pill off “as something totally normal and benign.” For herself, she says she has learned over time which condoms work best for her and afford the maximum pleasure and safety.

“I’d way rather take real, visible, and exterior precautions on principle,” she says.

However a U0 Arts student that has been on the Pill for almost two years and has not experienced any negative side effects, besides initial nausea. She says she is happy with the Pill, and plans to stay on it for the foreseeable future. However, she too admits to a certain degree of uncertainty.

“I’m still kind of unsure about how I feel about it,” she says, “even though all doctors reassure you that it’s totally safe and fine for your body.”