Birth Control: Women vs. Men, Then vs. Now

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Debbie says:

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Bethy Squires, writing at Broadly,  pulls together historical and current information about “The Racist and Sexist History of keeping Birth Control Side Effects Secret.”

In September, JAMA Psychiatry published a Danish study that found a correlation between the use of hormonal birth control and being diagnosed with clinical depression. The study tracked hormonal birth control use and prescription of antidepressants over six years for over a million women. They found that women who were on hormonal birth control—be it the pill or a hormonal IUD or vaginal ring—were significantly more likely to be prescribed antidepressants.

The study found a particularly strong correlation between teenage birth control users and depression: there was an 80 percent increase in risk for teens taking birth control to start taking antidepressants after going on the pill. This statistic is particularly troubling, especially as many teen girls are prescribed the pill before they’re even sexually active—sometimes to treat acne or severe menstrual symptoms, and sometimes just as a general, preventative measure. “It was seen as an essential thing to do,” says [Holly] Grigg-Spall [author of Sweetening the Pill, “It was more of a rite of passage.”

Even if you are a hardened cynic, the history of female birth control will disturb you. In the 1950s and the 1960s, women in mental asylums in Massachusetts, women in medical school in Puerto Rico, were forced to try the Pill with no information, including what it was for. Later, women in the slums of Puerto Rico took it voluntarily after being told what it was supposed to do, but without being told they were part of a clinical study. The emphasis on Puerto Rico is, of course, racist. No women on the Pill were told about any risk of side effects, and the first version was released into the marketplace despite the director of the Puerto Rico Family Planning Commission concluding that the side effects were too extreme.

There’s a lot more in Squires’ piece, including how much we owe early birth-control activists for what we are told about drug side effects today. And then there’s this tidbit:

Incidentally, [biologist Gregory] Pincus et al. had originally looked at hormonal birth control for men. “It was rejected for men due to the number of side effects,” says Grigg-Spall, “including testicle shrinking.” It was believed women would tolerate side effects better than men, who demanded a better quality of life.

So here we are in 2016, and Susan Scutti, writing for CNN, relates the state of a promising male contraceptive trial:

A new hormonal birth control shot for men effectively prevented pregnancy in female partners, a new study found.

The study, co-sponsored by the United Nations and published Thursday in the Journal of Clinical Endocrinology and Metabolism, tested the safety and effectiveness of a contraceptive shot in 320 healthy men in monogamous relationships with female partners. Conducted at health centers around the world, enrollment began on a rolling basis in September 2008. The men, who ranged in age from 18 to 45, underwent testing to ensure that they had a normal sperm count at the start.

The procedure worked very well, but:

 … due to side effects, particularly depression and other mood disorders, the researchers decided in March 2011 to stop the study earlier than planned, with the final participants completing in 2012.

Scutti also mentions the Danish study and the connection between female hormonal birth control and depression.

So, more than 50 years after a drug went to market despite large numbers of test subjects reporting depression and serious physical symptoms, we’re seeing a clinical trial being cancelled because some participants are reporting depression (and there was some decrease in fertility).

Depression is important, real, and deserves attention. A finding that a drug causes depression is a fine reason to re-evaluate a clinical trial. FOR EVERYONE. It’s impossible to say whether the UN study was halted because the participants were men, or because we live in a different world, with more respect for people in clinical trials, than we had all those decades ago. (If it is even partly because of the different world, that’s due to the work of the early women birth control activists, and the later great work of AIDS patients advocating for their voices in study design.)

Neither author quoted here raises a key question about male hormonal contraception: would you trust a man who told you he wasn’t fertile? Why? There are good feminist reasons to want birth control (other than condoms) to remain the domain of women. There are good health reasons to prioritize barrier methods over hormonal ones. And everything has risks.

Looking at these two stories together tells us that we need transparency in drug trials; we need patient voices in decision-making (“nothing about us without us”) and we need to know the truth about what we’re putting in our bodies, and what the trade-offs are.