In Our Control (2 page)

Even as I continued working and eventually writing with Barbara, I stayed on the Pill. When I found myself in a new and increasingly serious relationship with the man who is now my husband, it seemed like the natural choice. But this time, the minor inconveniences that had whispered their presence in years past began to shout at me. My moods
became erratic and overwhelming. My breasts swelled unrecognizably, and I shuddered to put on a bra, let alone have them touched by my partner. Most upsetting was that I began to spot each month, right around the middle of my cycle. When I spoke to my gynecologist, she suggested I switch from a low-dose to a regular-dose Pill. (I have since spoken to friends and other women in my life and have learned that an extremely high number of women spot on low-dose hormones, despite what company material suggests.)

Things weren’t much better for me on the regular dose. I began putting on weight and my moods were worse than ever, to the point where it was affecting my relationships. I felt like I was standing outside of myself, watching a body that used to be mine and that was now occupied by an emotionally charged, easily angered monster. Every time I spoke to my doctor, her answer was the same: try another Pill. And so I gradually went through five different varieties, each of which brought new problems.

Why didn’t I go off? Mostly, if I am honest, because I was scared. Not scared that I would get pregnant using another method, but scared that going off the Pill would change my sex life in a negative way. I liked the freedom the Pill gave me. And I had heard horror stories from friends about other methods.

The truth was (with the notable exception of Barbara) I was surrounded by amazing ignorance on all sides. None of my friends used anything but the Pill and condoms and none had even considered that there were other possibilities. When I began to ask about diaphragms, I couldn’t find a single girl among my friends who had used or tried one. Nor had they tried female condoms or IUDs (intrauterine device); they hadn’t even tried other hormonal alternatives, like Depo-Provera. This wasn’t because my friends were all happy with the Pill—on the contrary, most had complaints that ranged from minor to more severe—but none considered that they had other acceptable options. When people encountered problems, their response (prompted by their doctors) was, like mine, to try another brand. It wasn’t just that doctors had only one answer to the birth control problem; it was that they didn’t even like the question.

The last straw came when, on my third Pill variety in a year, I stopped bleeding altogether. I know some women might like this “side effect,” but for me it was scary. Each month, I wondered if I was pregnant. I felt terrible,
like my body desperately wanted to bleed and just couldn’t—yet I still had side-splitting cramps. It was at this point that I marched into my gynecologist’s office and said, “I want to get off the Pill!”

My gynecologist, a lovely, bright young woman, wasn’t thrilled about my new conviction. She told me again that I probably just needed to try another brand. But I had finally realized that when doctors switch brands, they are enlisting you in an experiment. Prescribing the Pill is not like prescribing an antibiotic. With antibiotics, it is known which variety effectively treats specific bacterial strains. With the Pill, it is simply guesswork: if you do poorly on one progestin, try another. If you spot on one dose, try a higher one. You can try a dozen brands, but at what point do you say enough is enough?

When I asked for a diaphragm, my doctor looked at me as though I had requested a chastity belt. “Well I
guess
we can fit you for one,” she said reluctantly. “But it’s not as reliable.” She pulled a dusty brochure out of a bottom drawer in her office and handed it to me. Almost embarrassed, she said, “This is a little old … but I don’t think anything has changed.” When I went to pick up the diaphragm—your doctor writes you a prescription, just like for any drug, which you fill at a pharmacy—the man behind the counter rolled his eyes and told me in an exasperated tone that they would have to order it for me, and it would take a couple of days. But when it came, I was glad to have it.

I don’t share this experience to talk women out of using the Pill. I believe that oral contraception is the right choice for many women, and I would never tell a friend who is happy on the Pill to get off it. Our birth control choices are private, and we as individuals dictate which factors—safety, efficacy, expense, ease of use, degree of sexual interference, and so on—are most important to us when we make our decisions. But it is important to realize that these decisions are not independent from the social forces that have directed the contraceptive conversation since it began. When it comes to contraception and sexual health, there is no magic bullet that works equally well for everyone—but that is not the message we receive. We are told that doctors, scientists, and experts know what’s best for our bodies, and we are discouraged from seeing our own experience as a source of legitimate knowledge. We are often closed to the idea of trying
different methods, a problem that seems to have more to do with the success of pharmaceutical marketing and the alliance of doctors with drug companies than with the safety and efficacy of alternatives. To be informed consumers, to truly exercise our freedom of choice, we must trust ourselves. And to build that trust, we must understand how our birth control works in and on our bodies; research the available contraceptive options independently of advertisements and doctor’s visits; and take into account the complicated, sometimes disturbing, history of how birth control came to exist as it does today.

How can we talk about contraception in a way that ensures women have as many options as possible? First, we need to make the conversation intergenerational. As we move through our lives, what we want and need in a contraceptive changes. Our priorities, relationships, economic and vocational situation and biological realities are very different at age eighteen than they are at twenty-five, and different still at forty. For example, at eighteen, the single most important thing in contraceptive decision-making may be pregnancy prevention. By the time you are thirty, even if you aren’t planning children, you may not weigh this benefit as strongly against other risks. At forty, the health risks of the Pill are different than they were at eighteen, making this option less appealing. Too often, we act is if birth control is a subject for young women just initiating sexual intercourse. It needs to be an evolving, dynamic, multi-decade discussion.

Your particular health profile impacts pregnancy prevention options. Whether you are under- or overweight, whether you have a history of blood clotting or migraine headaches, even the size of your vagina and whether you have had a baby can change the safety and efficacy of different methods. And class factors into the equation, too: whether or not you have health insurance will have a significant impact on your contraceptive choices. You may not be able to pay out of pocket for expensive methods and may have other barriers to getting the birth control you want on your terms.

When women fought for the right to legally use birth control in the twentieth century, they saw contraceptive access as the answer to women’s social problems. Second-wave feminists made the right to abortion and birth control central goals of their activism. Many feminists in the 1970s
didn’t want to hear that the birth control pill was unsafe, because it meant facing the hard truth that the drug wasn’t simply something that enhanced women’s power. But decades of experience have taught us that gaining reproductive rights is not a simple answer to the bigger problem of ensuring reproductive justice for all women. The authors of
Undivided Rights
, a comprehensive and instructive study of reproductive justice groups organized by and for women of color, note that all too often “mainstream movements for contraception and abortion … have been unable to see how what may be reproductive freedom for them is reproductive tyranny for others.”
¹
In American history, reproduction has always been a place where racial inequality has been institutionalized, where the control of women by men has been constantly reaffirmed, and where middle-class and wealthy women have been valued over the poor.

Putting women in control of reproduction means addressing these social issues. Building reproductive freedom, including the ability to make contraceptive decisions, means working to give
women
—not the many cultural forces and people in positions of power around them—the ultimate right to make individual choices about pregnancy.

Letting people make up their own minds often means accepting other women’s values even when we don’t share them. If we are open to understanding others’ choices, we can benefit from the unique wisdom that various communities bring to our collective knowledge. Katie Singer, a writer and teacher of the Fertility Awareness Method (FAM) of birth control, learned the technique from leaders of Catholic family groups near her home in the American Southwest with whom she had serious ideological differences on many fronts. But Singer was open to what they could teach her, and with their help she has worked to bring technical knowledge of how fertility works to a wider secular community of women. If Singer had dismissed the information that Catholic leaders had to offer because she disagreed with their position on, for example, extramarital sex, she would never have found her ideal contraceptive method, and she would never have been able to share it with other women.

Limiting access to contraceptive knowledge is as dangerous a form of coercion as preventing physical access to methods. Young women today sit at the epicenter of many cultural battles, and their access to knowledge about all their birth control options is often foreclosed by those arguing
that abstinence—not having sex—is the only acceptable form of pregnancy prevention for young adults. Programs insisting on abstinence-only education have been gaining huge amounts of political and financial support for close to three decades in the United States and abroad. Besides seeking to prevent young people from becoming educated about contraceptive health, these programs promote religious values in public schools, decline to address the needs of students with diverse sexual identities, and insist on dangerous essentialist ideas about women and gender. Simply put, they instruct young people that “gender is your destiny.”
²
In addition, laws and policies that insist on parental consent to obtain certain types of health care and threaten to limit confidentiality for young women seeking reproductive services violate the civil rights of young women and reinforce a dangerous double standard. Women—even young women—should be given the respect and knowledge needed to make their own decisions.

Women in the twenty-first century have the best birth control in history. They can use methods that promise to work more than 99 percent of the time. And yet, since the hormonal innovations of the 1950s and 1960s, little has changed on the contraceptive landscape. In many ways, female consumers can’t win when it comes to birth control innovation. If we insist on safety, it discourages pharmaceutical firms from advancing new and potentially dangerous methods because they are afraid of lawsuits. If we embrace innovation, it often means taking big safety risks. It means accepting that we won’t always get comprehensive information from companies with an economic stake in concealing the dangers of undertested and profitable methods. Understanding the ways that protecting consumer safety has prevented birth control innovation can help us to open up the important question of why, after half a century and countless scientific advances, there are no truly new methods of pregnancy prevention.

The obvious gender inequities in birth control are also important to explore. Why is it that—other than condoms, withdrawal, and vasectomies—all methods of contraception involve women’s bodies? In what ways has scientific innovation and sexism in medicine prevented the development of male options, and to what extent do women fail to involve male partners in the choices and responsibilities of pregnancy prevention?

Looking at birth control through these many lenses isn’t easy. It means asking questions that often breed more questions than answers. It means challenging ourselves to reconsider our choices and to think outside our comfort zones. It means dealing with painful cultural histories and sometimes standing up to doctors we respect, partners we love, and a culture that can make us feel like we aren’t in charge. Let’s move forward in this difficult but valuable journey together, and work to place contraceptive health firmly in our control.

Chapter One
Past Tense: Contraceptive History Before the Twenty-first Century

Some things that happened for the first time
,
Seem to be happening again
.
—Lorenz Hart, “Where or When”

Slowly the girl shuffles into the drugstore. It is cold, even for February, and she unwinds a plaid scarf slowly from around her neck as she waits at the pharmacy counter. She is twenty-two years old, and she carries a prescription for low-dose birth control pills in the pocket of her jeans. As she waits, she notices rows of products aimed at consumers for promoting sexual health. There are condoms, female condoms, contraceptive sponges, film, and spermicidal jelly. Some products openly exist to promote pleasure, not just pregnancy prevention: lubricants in alluring purple wrappers and flavored condoms sit alongside more practical products on the store’s shelves. When the girl finally gets to the front of the line and hands her script to the pharmacist, she watches as he checks for her particular brand of pill alongside a plethora of other hormonal options, including patches, rings, and even chewable tablets.

It wasn’t always like this. Flash back one hundred years to 1910 and the scene would have looked very different for our young woman. While we have dealt with some serious gaps in birth control innovation in the second half of the twentieth and early part of the twenty-first century, we now live in a world that, contraceptively speaking, would have seemed almost unthinkable to our great-great-grandmothers. How it got that way is a story worthy of Hollywood, packed with villains, heroes, and many people who fall somewhere in between. It is a story worth knowing, especially for women, because elements of this narrative keep on repeating. As Albert Einstein famously said, insanity is doing the same thing over and over again and expecting different results. Understanding and owning
their reproductive histories is the only way for women to stay sane and gain control of their reproductive choices.