The McGill Daily — Montreal (CUP)
“Alesse made me stop wanting sex.”
This is scrawled in black Sharpie on an ad for the popular brand of birth control, in a stall of a women’s washroom. 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 the fear of pregnancy potentially inhibit their desire to do so?
Laura McMahon, a philosophy and English major at McGill University, has her own horror story about Alesse. She credits the 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 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 is adamant that hormonal birth control will never again be an option for her. Yet McMahon’s story, as well as that of the anonymous bathroom scribe, are two among many. Birth control is intrinsically linked with the “free love” movement of the ‘60s, 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 only experience positive results from hormonal forms of fertility control. However, a growing minority of women and men are emphasizing the need for a more vigorous debate surrounding the pill’s safety, distribution and efficacy. Underlying this is a fear that criticism of the pill labels one as anti-feminist or paternalistic. But this concern only contributes to the lack of critical analysis and discussion.
“The pill has a really deplorable history in terms of eugenics,” says Jocelyn Porter, who works as a health facilitator at Head and Hands, a not-for-profit organization that promotes physical and mental well-being for youth.
Porter emphasizes that birth control has been tested primarily on marginalized populations who had very little control over the process. Most trials for contraceptive drugs were done in poor nations in the Global South.
A birth control pill, for example, was tested 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 United States 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 for 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 United States. Margaret Sanger, founder of the American Birth Control League (which later 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 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 often wanted them used to curtail specific populations — a side of birth control that often gets overlooked.
Many women recall their experience going to the doctor to discuss birth control for the first time feeling rushed and uncomfortable, as if taking the pill was 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. “[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 recalls lasting on the pill for only six months until she became ill. “The whole time I was on it, I was a total nutcase,” she says.
Ideally, women should learn in high school about birth control options to 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 titled “Learning About Birth Control: The Challenges and Opportunities.” She interviewed 12 McGill students about their experiences learning 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. She found that women often value information from their peers over 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 ‘60s, curricula adjusted to address the rising rates of unplanned pregnancies, while in the ‘80s they began to concentrate on the growing AIDS crisis.
While many Canadian schools currently offer comprehensive sexual health education, including instruction on different birth control methods, studies consistently report that these programs are deficient. One study found 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.
There is an information gap concerning non-hormonal birth control options among university students, Feigenbaum says. This is coupled with what she calls a “complaining discourse” surrounding condoms.
“There are limited alternative information sources, particularly ones that have funding and infrastructure,” she laments. “It’s time to expand our definitions of sex.”
Despite these misgivings, the pill remains the most widely used method of birth control for women under 30. 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 of 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 reveal themselves as the first generation of users develop symptoms. Few long-term controlled research trials have actually been carried out on the pill.
Hormonal oral contraceptives also put the entire onus of birth control on women. While this is reassuring for many, it eliminates 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, a Montreal mental health institute, 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.”
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.”
Howard also has concerns about chemically controlling women’s menstrual cycles. “I do think [hormonal birth control] is not the right choice for everyone,” she says.
For those hoping for better choices in the future, research and development on alternatives has been lacking, often due to cost and potential liabilities. Many pharmaceutical companies have completely withdrawn from research in pregnancy prevention, focusing instead on marketing.
“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.
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 the company sells. These guides 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 are in some way connected to their payroll.
“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.”
Critics argue 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.
McMahon says we can no longer pass the pill off as “something totally normal and benign.” 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.”
Avital Oretsky, an arts student, has been on the pill for almost two years and has not experienced any negative side effects, besides some initial nausea. Oretsky says she is happy with the pill, and plans to stay on it for the foreseeable future, though she too admits to a certain degree of uncertainty.
“I’m still kind of unsure how I feel about it,” she says, “even though all doctors reassure you that it’s totally safe and fine for your body.”