Tag Archives: hormonal birth control

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.

Birth Control: Have It Your Way

Debbie says:

We humans are just so ridiculously good at telling each other what everybody should be doing, when we really mean, “Hey! I found out what I should be doing!”

Jill at Feministe provides the latest example. Holly Grigg-Spall, for whom birth control pills were A Bad Idea, has written a book called Sweetening the Pill: or How We Got Hooked on Hormonal Birth Control, in which she apparently argues that birth control pills (and other varieties of hormonal birth control, such as contraceptive implants) are a capitalist/patriarchal plot. Lindsay Beyerstein’s review in Slate describes Grigg-Spall’s argument as

… that the so-called liberating force  of the pill has been illusory. She claims that the pill keeps women in the thrall of patriarchal capitalism and destroys their health in the process. The addiction allusion in the title is not a metaphor—Grigg-Spall is convinced that the pill is an addictive drug. …

You might assume that women take the birth control pill for, well, birth control, but Grigg-Spall thinks she sees a more sinister agenda. “Women do not choose … hormonal contraceptives because these things are necessary or convenient for them or because they consciously need or want to,” she asserts. Instead, according to the author, “Women are encouraged to suppress their monthly ovulatory cycle in order to not miss any days of work or so as they can remain sexually available or experience only one-note moods.”

Sweetening the Pill frames hormonal contraception as a societywide assault on ovulation and menstruation orchestrated by the capitalist system and its handmaidens in the medical establishment and feminism. Grigg-Spall ascribes the pill’s popularity to a misogynist culture that expresses its contempt for the female body by squelching its natural cycles with artificial hormones.

Beyerstein knows more than enough to put this claim into perspective, starting off with birth-control pioneer Margaret Sanger‘s dream “of a ‘magic pill’ that would put women in charge of their own fertility.”

At Feministe, Jill relates her own dissatisfaction with the Pill and then says:

… one friend feels like she gets in her best shape by running, another by doing Barre classes and Pilates, whereas I prefer yoga. Shocking news: People are different, and our bodies work differently! The Pill works really well for a lot of women. It works less well for others. It’s intolerable for some.

Like Jill, I didn’t spend a lot of time on birth control pills, though I’ve never fully understood why I stopped. I just literally woke up one morning in my early 20s, saying, “I don’t take birth control pills any more,” with complete unshakable conviction. I’ve often wished I could make other decisions that clearly. I used barrier methods ever since, and of course, once the age of AIDS came along and the issue was not just preventing pregnancy, the pill became a single-use tool in a multi-need context.

Jill and Lindsay both make useful points about statistics, and the important role of doctors in health care decisions, but neither of them zeroes in on Grigg-Spall’s willingness to judge other women’s choices.

The world is chock-full of groups, forces, and movements that want to take agency away from women, want to take agency away from all marginalized groups, even want to take agency away from mainstream non-marginalized affluent white men. Some of them want to turn us into blind consumers, others into dutiful uncomplaining workers, others into followers of this or that or the other political/religious/cultural set of beliefs. Some of them overlap.

When she says “Women do not choose … hormonal contraceptives because these things are necessary or convenient for them or because they consciously need or want to,” Grigg-Spall is saying that women as a group do not know what’s good for us, that those of us who don’t see things her way are misguided tools of the capitalist system, the medical establishment, and misogynist culture.

Somehow Grigg-Spall differentiates her own recognition that the pill was doing her harm from another woman’s possible understanding that the pill offers her freedom, or makes her feel good, or is simply what she chooses to do. Grigg-Spall is, either unwittingly or uncaringly, dividing the world into Smart and Aware Women (who do not take the pill) and Blindly Following Women (who do).  I find it fascinating that, at least in the discussion in the blogosphere, actual concerns regarding unwanted pregnancy take a back seat to conceptions of the role of women in the workplace, sexual availability, and libido.

 

As feminists, as supporters of agency in everyone, we undermine our work whenever we attribute a woman’s (a human’s) decision about their own body as caving to outside pressure. Like Lindsay and Jill, I wholly support Holly Grigg-Spall’s right not to take birth control pills–and to write about what she believes the dangers of hormonal birth control to be, and to share her fears with the widest possible audience. I only wish she would acknowledge that what’s right for her (and Jill and me) is not right for every woman; that we can make conscious, aware, informed choices that are not the same as the ones made by the woman next door, the woman in the next cubicle, let alone the woman in a different racial, socio-economic, or cultural group.

Have it your way, Ms. Grigg-Spall. Just, please, encourage everyone else to do the same.