Note to the Reader Exerpt: Dumping the Pill in Bangladesh Exerpt: The Puerto Rico Pill Trials Kathryn's Personal Testimony Note From J Jessica's Personal Testimony Pill History Hearing from women Resources

Note to the Reader [back to top]

"I honestly believe that I would have had a wholly different teenagehood if I had never gotten on the pill."

--Ariel Gore, from an interview with Michelle Tea for the SF Guardian.

I couldn’t believe my eyes: Ariel Gore was the first person to say something I’d been feeling for a while but felt “too dramatic” to utter. It took six years on the birth control Pill—between the ages of 17 and 23—to consider how the birth control Pill might have affected me during some of my most formative years. But it only took me a few months after my decision to go off to realize how happy I was to be free of it.

I am part of a generation of women for whom the Pill is more of an assumption and a right than a new symbol of sexual freedom. Though I’d had countless informal conversations with women about their experience with the Pill, I decided to more formally open up a dialogue with other women. For this ‘zine, I asked my girlfriends to contribute their thoughts and feelings about the Pill, regardless of whether they were ever on it or are on it currently. Then I asked my good friend Jessica Barnes to help with compiling, processing, and editing.

For some of us, the Pill was regarded as a necessary evil—we all knew that the Pill had gotten mixed reviews, but it was the kind of “sacrifice” a woman made to have sex with a man without a condom and be protected from pregnancy. For a few years, or longer, many women “dealt with” or continue to “deal with” the emotional and physical side effects of the birth control pill because it’s the easiest method of prevention. But knowing how much it affected me, I wonder if I would have made the same choice if I had been better informed as a teenager. Well-informed young women today may already know some of what it took me being on the Pill to discover. Or do they?

It was important to me to open a discussion, no matter how small, simply to hear from other women candidly about their experience with the Pill. Was I alone in my misgivings? I wanted to simply have the discussion and share the results, partly in order to get more information out about the effects of the birth control Pill and partly to challenge its widespread use. I want to share this information without challenging either the notion of pregnancy prevention or the notion of women’s choice as it relates to their bodies and sexual practices. It’s no secret that the Bush Administration is working to dismantle women’s reproductive rights. I don’t want any discussion of the Pill to contribute to the growing attacks on important family planning programs, and I don’t want to undermine the importance of birth control—or STD prevention. As my aunt Lisa reminds me, condoms should always be worn during sex, even within committed partnerships.

I realize that as a feminist, talking about the Pill with any critical eye brings with it some conflicts. Our mothers fought for birth control as a means of sexual freedom and its development in that context was extremely important. Questions about using the Pill are not the same for all women in all circumstances, not least because many women do not have access to it at all. The decision, for example, that an American teenager with healthcare makes about which birth control method, of several choices, she should choose, is vastly different from the decision a woman living in a developing nation makes when the only method of birth control available to her, if any, is the birth control Pill. At the same time, to act as though the side effects associated with the Pill (or other method of birth control) aren’t important for women with less choice available to them, is irresponsible and racist.

Like any scientific discovery, the birth control Pill wasn’t developed in a vacuum—its development and testing was affected by a variety of interests and philosophies. It didn’t take much research to find how birth control has been a vehicle for women’s sexual liberation as well as a vehicle for racist international policy. An article published in the November/December 1979 issue of Mother Jones (“The Charge: Gynocide, The Accused: The U.S. Government,” by Barbara Ehrenreich, Mark Dowie and Stephen Minkin) describes in detail how the United States “dumped” the Dalkon Shield, the first birth control pills, and Depo-Provera on the poorest parts of the world in order to test them prior to approval for the U.S. market:

“In July 1979, we interviewed Dr. R. T. (Ray) Ravenholt, the head of AID's Office of Population from 1966 to mid-1979 and the man who most represents the government role in contraceptive dumping ... He explained: “You don't really know anything until you have a very, very large number of people who have used it. You might have one kind of impression from 10,000 people, another from 100,000. You might need a million -- 10 million -- before you really know.” You might, in other words, need a few medium-size nations to experiment on.”

“Ray Ravenholt is a man with a cause, and that cause is ultimately no different from the one that motivates every other hard-working professional in the State Department. “Population explosions, unless stopped, would lead to revolutions,” he told the St. Louis Post-Dispatch in an April 1977 interview. Population control is required to maintain “the normal operation of U.S. commercial interests around the world ... Without our trying to help these countries with their economic and social development, the world would rebel against the strong U.S. commercial presence. The self-interest thing is the compelling element.’“

One would think these are “outdated” standards of operation for the U.S. government and that the overpopulation argument would no longer be used to sterilize women or limit population size specifically within non-Western or non-white communities. As Mother Jones reminds us, “More liberal population controllers argue that economic development, health services and an expanded role for women are needed to motivate people to reduce family size.”

But the fact is, birth control development and propagation has continued to be disproportionately tested on women of color, not only internationally, but even within the United States. The Committee on Women, Population, and the Environment report:

“The Philadelphia Inquirer ran an editorial suggesting that Norplant might be a useful tool for "reducing the underclass." Judges have even required women convicted of child abuse or of drug use during a pregnancy to use Norplant. The Native American Women’s Health Education Resource Center has found that Indian Health Services (IHS), which routinely injected Native women with Depo-Provera before it was even approved by the FDA for use as a contraception in 1992, still lacks adequate and uniform informed consent procedures for Norplant and Depo-Provera.”

The fact that the development of birth control has been tied to what I think of as racist policy does not mean that birth control in general, or the Pill specifically, is the wrong choice for women. Rather, its history reminds me that the Pill is not only a source of conflict within my body, but it rose out of and continues to operate within political conflict. There is no possible way, given all the parties interested in the money to be made from distributing the Pill, that my body is of primary concern. That’s why it’s up to me to gather as much information as I can and to make an informed decision. Unfortunately, these lessons are learned in retrospect.

At times I find myself thinking that the “problem” with the Pill is one of human nature. Most of us introduce or have introduced unhealthy substances into our bodies that affect how we function—nicotine, alcohol, caffeine, and chemical substances. Most of us learn or decide in retrospect, if and when we do, that it’s time to stop, that it’s time to put less pressure on our bodies. Some of us regret ever having introduced these substances into our bodies in the first place, but many of us, I think, are interested and curious about the effects of various substances on our bodies and do it anyway.

Whatever the “problem”—or not—with the birth control Pill, what’s most important is to talk about birth control, to understand it, to get birth control information into the open, and to work to create an environment where STD prevention, birth control, sexuality, and all sexual practices can be widely discussed. The birth control Pill is a substance that affects everyone but requires that women, not men, shoulder the burden. I have talked to far too many women who have had negative experiences with the birth control Pill, have decided in retrospect that the Pill has been unhealthy for them, and/or no longer believe the Pill is the right choice for their bodies, not to talk about it.

Dumping the Pill in Bangladesh [back to top]

[Excerpt from “The Charge: Gynocide The Accused: The U.S. Government,“ By Barbara Ehrenreich, Mark Dowie and Stephen Minkin (Mother Jones, November/December 1979)]

No woman can insert her own IUD, but -- the theory was -- if you can chew gum, you can swallow a pill. In Bangladesh, site of an intensive AID inundation program, pills are sold, usually at nominal prices and without any semblance of medical supervision, through local shops, alongside cigarettes, bananas and betel nuts.

From the beginning, AID's inundation program in Bangladesh had the markings of a biological disaster. The average Bangladeshi woman weighs 92 pounds and suffers from chronic malnutrition. Even in a 135-pound American woman, the pill is known to deplete the body's supply of vitamins A, B-6, D and folic acid (hence the special vitamins sold in the U.S. as supplements to the pill). Furthermore, no less than 90 percent of the Bangladeshi women who accepted the pill were breastfeeding. According to a study by the International Planned Parenthood Federation, babies nursed by pill-users grew at an average rate that was only two-thirds that of babies nursed by non-pill-users. Ending world hunger is the most common rationalization for the top-down approach to population control, but in Bangladesh, AID was creating its own kind of chemically induced famine.

All this preceded anything that could, strictly speaking, be called a dump. AID was, after all, distributing a pill that had been judged safe for American women. Not all birth control pills are the same, however, and in 1970 the FDA had advised physicians to prescribe only those with the lowest possible estrogen dose -- at that time, 50 micrograms. Sales of high-estrogen pills began to sag. AID had at first been following the FDA's advice, buying 50 microgram pills from G. D. Searle, Wyeth, and Parke, Davis. Then, in 1973, AID took its business to the Syntex Corporation and started buying up high-dose, 80 microgram pills. AID explained the switch as a response to "market conditions." Simply put, the high-dose pills were cheaper. According to sources at the George Washington University Medical Center (which was under contract to AID to publish the bulletin Population Reports), Syntex offered AID a better deal -- a discount on the domestically discredited, high-estrogen pills. Ravenholt bought up millions of dollars worth of Syntex's stock of 80 microgram pills -- for overseas use only, of course.

The dangers of estrogen overdosing don't dismay AID's inundation strategists. Dr. Malcolm Potts, director of the International Fertility Research Program and a key inundation planner, even sees a bright side to one pill side effect -- swollen breasts. In a paper presented at the 1977 Tokyo International Symposium on Population, Potts and two colleagues suggested as a catchy slogan for rural pill promotion: "It makes your breasts more beautiful and is good for everyone -- including the tailors who have to make bigger brassieres."

The Puerto Rico Pill Trials [back to top]

Exerpted From PBS American Experience, the Pill

Puerto Rico Trials

After the success of the preliminary Boston trials for the Pill in 1954 and 1955, John Rock and Gregory Pincus were confident they had honed in on an oral contraceptive. But without large-scale human trials, the drug would never receive the FDA approval necessary to bring the drug to market. Given the strong legal, cultural and religious opposition to birth control in America in the 1950s, the prospects for this crucial next step appeared dim.

A Perfect Location

In the summer of 1955, Gregory Pincus visited Puerto Rico, and discovered it would be the perfect location for the human trials. The island, a U.S. territory, was one of the most densely populated areas in the world, and officials supported birth control as a form of population control in the hopes that it would stem Puerto Rico's endemic poverty. There were no anti-birth control laws on the books, and Pincus was impressed with the extensive network of birth control clinics already in place on the island. There were 67 clinics dispensing existing methods of birth control and a large group of women used their services.

Poor, Uneducated Women

For Pincus, the island offered a pool of motivated candidates, and a stationary population that could be easily monitored over the course of the trials. Pincus also knew that if he could demonstrate that the poor, uneducated, women of Puerto Rico could follow the Pill regimen, then women anywhere in the world could too. Pincus hoped that by showing Puerto Rican women could successfully use oral contraceptives, he could quiet critics' concerns that oral contraceptives would be too "complicated" for women in developing nations and American inner cities to use.

Rio Piedras

The base for the first trial was a clinic at Rio Piedras, a brand new housing project complete with running water and sunny balconies just outside of San Juan. The worst slum on the island, El Fangito ("the little mud hole"), had been razed to build clean, white seven-story buildings, and the new residents were eager to continue to improve their standard of living. Many American companies were building factories on the island, and plenty of factory jobs were available for local women.

Many Trial Subjects

Puerto Rico Trials The Rio Piedras trials quickly got off the ground in April 1956. In no time, the trial was filled to capacity, and they expanded the trials to additional locations on the island. Although Puerto Rico was a predominantly Catholic island, people were far more concerned with the struggles of daily life than Church dogma, and did not follow Rome on matters of birth control. At the time, most women relied on sterilization or abortion to limit their family size, and the Pill was a welcome alternative.

Initial Dosages

The pharmaceutical company G.D. Searle provided the pills for the trial. Rock selected a high dose of Enovid, the company's brand name for their synthetic oral progesterone, to ensure that no pregnancies would occur while test subjects were on the drug. Later, after discovering Enovid worked better with small amounts of synthetic estrogen, that active ingredient was added to the Pill as well.

100% Effective

Dr. Edris Rice-Wray, a faculty member of the Puerto Rico Medical School and medical director of the Puerto Rico Family Planning Association, was in charge of the trials. After a year of tests, Dr. Rice-Wray reported good news to Pincus. The Pill was 100% effective when taken properly. She also informed him that 17% of the women in the study complained of nausea, dizziness, headaches, stomach pain and vomiting. So serious and sustained were the reactions that Rice-Wray told Pincus that a 10-milligram dose of Enovid caused "too many side reactions to be generally acceptable."

Dismissing Side Effects

Rock and Pincus quickly dismissed Rice-Wray's conclusions. Their patients in Boston had experienced far fewer negative reactions, and they believed many of the complaints were psychosomatic. The men also felt that problems such as bloating and nausea were minor compared to the contraceptive benefits of the drug. Although three women died while participating in the trials, no investigation was conducted to see if the Pill had caused the young women's deaths. Confident in the safety of the Pill, Pincus and Rock took no action to assess the root cause of the side effects.

Deceit and Exploitation?

In later years, Pincus's team would be accused of deceit, colonialism and the exploitation of poor women of color. The women had only been told that they were taking a drug that prevented pregnancy, not that this was a clinical trial, that the Pill was experimental or that there was a chance of potentially dangerous side effects. Pincus and Rock, however, believed they were following the appropriate ethical standards of the time. In the 1950s, research involving human subjects was much less regulated than it is today. Informed consent standards were minimal and only the most basic toxicity tests were required for human trials.

Questions Linger

To this day, questions linger over whether Pincus and Rock overlooked serious side effects from the original high dosage Pill during trials, in their rush to bring an effective pill to market. The dosage of the Pill has since been dramatically lowered and the incidence of serious side effects has been greatly reduced. Still, the Puerto Rico pill trials remain a controversial episode in the history of the Pill's development.

Kathryn's Personal Testimony [back to top]

Most of what I know about the pill I learned in retrospect. I could say that I would have done things differently if I had known better, but the truth is that mixing sex, financial decisions, and health, all for the first time, is bound to cause anyone to make a few decisions they regret later, especially if they are more or less doing it on their own.

I know now that as a teenager I wasn’t particularly in touch with my body, despite the fact that I was constantly using my body physically. I was an extremely active child and teenager, participating in swim team, gymnastics, dance, and crew. I built most of my upper body strength before I was ten years old during gymnastics and I was used to pushing my body to its limits through physical training. In fact, sports may have in some ways distanced me from knowing my body intuitively because, as we know of gymnasts, for example, extreme physical training at a young age has an amazing effect on developing bodies and can throw normal cycles a bit out of whack. In some ways my body was a little machine that I didn’t quite understand, I just utilized, and did so with fervor. For instance, I didn’t realize until many years later (probably not until I was 21 years old) that I had broken my hymen when I was nine years old in a gymnastics injury—falling on the high beam. All I knew at the time is that I was bleeding.

Fast forward to age 17 … there is a line in my diary that reads, “[my boyfriend] wants me to go on the pill.” That’s not to say that I felt coerced into going on the pill. As I recall, we used condoms, but he and I had unprotected sex when I was on my period and we both preferred it. The pill seemed just as “easy” as condoms, so I decided to get a prescription. I knew that I needed my parent’s help in order to go to my primary care physician, and I didn’t feel comfortable talking to them about sex, so I decided to go to Planned Parenthood for my first gynecological exam and to get a prescription for the pill. This turned out to be much more of a fiasco than I’d planned, because at the last minute, I found out that my mother needed the car the day of my appointment. Since I felt that I couldn’t tell my mother why I needed the car so badly, and especially since I was supposedly just going to be at work all day, I had to figure out how to borrow another car. I was working on an organic farm in Virginia that summer, in fact, I had just started to work there. It was early June. The day before my appointment I asked a fellow employee at the farm if I could borrow her car and she said yes, but then when I showed up for work the next day, the day of my appointment, she told me that her dad had said no, it was his car and he didn’t want anyone else using it. I spent the morning working, nervously, trying to decide what to do. Then, about an hour before my appointment, I told my boss that I had to go to the doctor and I had no way to get there and I really needed to borrow one of the trucks from the farm.

Now, I knew that this was a really far-fetched idea, since the farm trucks were the oldest, most unreliable trucks in the world; they had nasty old clutches and they stalled often. When I asked my boss last minute for the truck, which, granted, was part of the tactic, she was clearly angry with me and felt she had been put on the spot—which she had. But, thankfully, they let me use one of the trucks. I went about 45 miles an hour, tops, down the highway in that old beat-up pickup truck, so completely nervous and thankful that I was actually on my way. I had never had a gynecological exam before and had no idea what to expect.

Somehow that truck got me there and I sat in the Planned Parenthood waiting room. I remember my overwhelming feeling being terror that they would take a blood test; I had fainted earlier that year when I tried to give blood at my high school. I figured this time wouldn’t be any different. When they finally called my name, I walked into the examination room and I remember the doctor looking at me as though she couldn’t figure out why I was there. She asked me if I’d thought about my decision to start having sex at my age and had I really thought about my decision to go on the pill? I almost burst into tears. All I could think was the fact that I’d gotten away with no one knowing about where I was going, gotten the money together for the appointment and three months worth of pills, managed to borrow a car, risked my job to do it, and showed up at the appointment—how could this doctor ask me about how much I’d planned to go on the pill?

The truth is I had thought about my decision to start having sex pretty carefully. My boyfriend and I, both virgins, had discussed sex for over a year before trying it, even though our hormones were raging and we were curious as hell. As for going on the pill, we’d been having sex for close to year before we considered it. Planning on going on the pill meant nothing more than I had been sexually monogamous for nearly a year and I didn’t want to continue to use condoms. As far as I can tell, that’s as much as most women think before deciding to go on the pill. And why shouldn’t they? They are told by most doctors—many I have visited since have told me the same—that the pill has little or no effect on a woman’s mood, that it actually helps to prevent breast cancer, and that it helps regulate one’s periods, not to mention helps to diminish major flow and/or major cramps. To some degree they were right: After I went on the pill, I was overjoyed when my skin became manageable again—and I was more than pleased about larger breasts. What a wonder drug … About three years ago, ORTHO TRI-CYCLEN even began advertising its “skin-clearing” side effect. Now if that’s not targeted to teen girls, I don’t know what is.

Basically, I mumbled “yes” to the doctor at Planned Parenthood and got my first prescription for ORTHO CYCLEN. I stayed on that pill for close to six years—though I took about a three-month break after I was no longer sleeping with my first boyfriend. I went on again because I began sleeping with someone else. When I was about 20 or 21, I began to notice that I became nauseous every time I took the pill, whether or not I had food in my stomach. I was also becoming more aware of my depression, something I believe that I’d been experiencing since the age of 15 or 16 though less conscious of. Around age 21 and 22, my depression became a serious problem. I felt like the pill was contributing, even though I couldn’t quite explain how. My emotions were extremely foggy, zoned out, and distanced from my body.

My depression and mood swings became more pronounced when I was forced off my original ORTHO CYCLEN and onto another pill, Zovia, because of a change in healthcare policy. Zovia caused my period to cease completely for the three months that I was on it. During the times that I would have had my period, I was completely out of it and extremely depressed. I had already been thinking of quitting the pill, had already noticed what appeared to be side effects of the pill—the listlessness, the fact that I felt out of touch with my body, like I was living in a big haze or blur. None of this could I exactly put my finger on, since, granted, I was depressed, and had been experiencing depression for a while. I could think of countless reasons why I wasn’t feeling right in my body that had nothing to do with the birth control pill directly and much more to do with complicated feelings about sexuality in general. By the time I was 23, my feelings about sex had evolved and become complicated.

What I can say is that the pill seemed to be one thing that might be contributing to my depression, and it was one thing I could control. So I went off. And the truth is, my mood improved magnificently. My boyfriend at the time would testify to that. I also began to go to therapy and to focus on understanding and healing my body. I began to feel better. My face broke out in zits galore, and my breasts shrunk back down—but I began to feel more connected to my body. Heavy periods returned, irregularly for sure. One could say a whole series of things happened to me after this turning point: I quit my job that was making me unhappy, I went to school to become a writer, I started writing a book that was cathartic for me, I moved to a new apartment on my own, I started a new life.

This could all be situational. The pill could have absolutely nothing to do with any of this; I’m prepared to believe that. On the other hand, the pill might have been, as Ariel Gore has said, helping to create an entirely different reality for me between the ages of 18 and 23. When I started talking to more women, I heard rumor that if someone is prone to depression, the pill can make it worse. One friend told me that after many years on the pill her libido began to wane. I had been taking the pill for close to six years—who is to say how it affected me, especially since for a long time I wasn’t paying attention to the fact that it might have been affecting me. I do think that my body felt different when I was on versus off. I started experiencing higher highs and maybe even lower lows, but suddenly I could feel again.

Right before going off the pill, I talked to my doctor about other options for birth control. She didn’t seem to want to help me think of options besides the pill. We did try a low-estrogen pill, but I wanted to feel my body off hormones altogether, and I’m glad that I did. I tried the low-estrogen pill for two months, but by that time I had already decided enough was enough. My body was tired of making the adjustments, too, and didn’t react well.

I asked my doctor to fit me for a diaphragm, but unfortunately, it didn’t work well with my partner—he kept hitting the rim, so it was uncomfortable for him. When I told my doctor this, she implied that I was the victim to my partner’s unwillingness to use a condom—if I didn’t want to be on the pill then he should just use a condom. She denied the fact that I might also prefer sex without a condom. I didn’t even have time to explain that I didn’t feel victimized by my boyfriend at all; on the contrary I felt offended that she had implied such victimhood because, unbeknownst to her, I had worked so hard to feel powerful through my sexuality.

Unfortunately, I often felt rushed by this particular doctor. I became so flustered in front of her rushed manner that I would often forget the important things I wanted to ask her. I learned to write down my questions on a piece of paper and run through the list—but I always felt like a burden on her time. I’ve since switched doctors several times, but it’s been difficult to find any doctor who is really willing to engage with me on the problem of finding suitable birth control and maybe that’s because there just aren’t that many great options out there for women. Even the new IUD emits hormones, just the same as the pill or Depo. In any case, physicians only prescribe the IUD to women who have already had children or never plan on having them.

But what other methods are being developed? How reliable is, for example, the female condom and who knows about them and where can you get them in a hurry? I know about them from Good Vibrations, cause I lived in the sexual liberation capital of the country. But what about all the rest of the women in the world who don’t live anywhere near such a store.

It took me going off the pill to realize how many years I had been out of touch with my physical body. As a teenager I didn’t take into consideration what putting hormones into my body would mean. I know that I could have taken more care to seek out the information that I needed. I also know that I could have used a guiding hand. Sometimes I think, wouldn’t it be cool to go back to my high school with the voice of my older self and all the women I know who’ve learned from their experience with the pill and just airdrop our letters down into the hallways?!? What if someone had done that for me? Would I have read them, would I have taken notice, would it have made a difference?

Note From J [back to top]

A few months ago, Kathryn asked me to write my Pill history. The more I wrote, the more I remembered, and I found myself filling page after page with my own stories and experiences as well as those of my closest friends. What began as a simple narrative suddenly exploded into several running commentaries on the declining quality of health care, the huge (and alarming) role that health insurance plays in women’s experience of the Pill, gender roles and socialization of birth control methods, women’s health issues, sexuality education, and so on. The articulation of these larger sociopolitical problems forced me to come back to myself and take a closer at my own story. I had to ask myself questions about what I was really doing with and to my body. The end result, after considerable deliberation, was my decision to go off the Pill.

My reasons for going on the Pill were different from my female friends (I needed to regulate my periods; having sex without getting pregnant was a perk that came into play years later). Yet I still share the same ambivalence and “love-hate” relationship to the Pill that many women have described. Writing my history was a powerful experience for me – it brought up a lot of the question marks about the Pill that I had been trying to ignore. It reminded me of all the frustration, hassle, and potential damage to my body that I suffered at the hands of the Pill. Why was it so easy for me to forget these things? Because I liked the benefits more than the risks? Because there was no other viable/satisfactory alternative? Because I was afraid of change? Because I couldn’t find a doctor that could answer any of my questions? I know that many (if not all) of my female friends share these feelings, these question marks, this ambivalence regarding

the Pill. Many friends have switched brands several times in a desperate effort to find the one that will “work” for them without destroying their moods. Others have gone on and off the Pill multiple times over the course of their young adulthoods – giving up on it, then needing it again, attempting to reconcile its various effects in a seemingly endless cycle.

After writing my own history, I was hooked. I decided to collaborate with Kathryn on piecing together the stories we had collected. Some questions have been answered; some new questions and problems have been raised. It has been a learning experience for me and remains a work in progress. Every story I read provides me with new avenues for learning, researching, and writing.

Jessica's Personal Testimony [back to top]

My initial experiences with the pill were positive. I attribute this mostly to the fact that my decision to go on the pill was advised by a doctor I trusted and had absolutely nothing to do with my sexual history or my need for contraception. When I started taking it, I was one of the lucky women who experience only the positive side effects and none of the negative. It wasn’t until years later that I began to experience more negative effects and began to question whether I even wanted to be on the pill anymore and if I would ever find a trustworthy doctor again.

My periods had always been irregular… the first sign of irregularity being that I didn’t have a period at all. Until I was sixteen. And then I had just one cycle and didn’t see it again until I was seventeen. Doctors were unconcerned, citing my low weight and intensive gymnastics practice as explanations, telling me not to worry unless I turned eighteen and still wasn’t menstruating. In a way, my situation was nice: I didn’t have any of the socially traumatizing “I got my period all over my new white pants in front of my crush at the school pep rally” stories that line the pages of seventeen magazine. Still, I felt as though I was somehow missing out on some important aspect of womanhood; and even though I didn’t really want any embarrassing stories, I certainly felt left out when other girls were telling theirs.

Finally, my period began visiting me on a more regular basis… but it was still far from regular. It would come, usually for the full seven days, then it wouldn’t come for another six weeks, only to come again in another three. I would have no idea when it was coming, and I began to worry in earnest about those embarrassing moments that I couldn’t possibly be prepared for. In addition to being sporadic, it was heavy. And painful.

For the remainder of high school, I lived with the recurring anxiety that my period really could start at any moment. When I started college, I went to my first GYN exam. I wasn’t at all nervous; I was curious. Then again, this was back in the days when I trusted doctors. But it wasn’t so much about trusting doctors as it was about having a sense of accomplishment – completing a rite of passage, becoming a woman by doing something that “women” do, breaking into this mysterious world of womanhood and stirrups and speculums and questions about sex. No, I wasn’t nervous at all; I was excited.

My doctor was great, a tan, hippie-ish woman with long blond hair who reminded me of Joni Mitchell. She knew that it was my first exam and she was willing to take the time to explain things to me. She was gentle, she went through everything slowly and told me we could stop at any time if I felt uncomfortable or in pain. She even warmed up the lube under a heat lamp. (Looking back on this, it seems like such a luxury.) Most importantly, though, she didn’t miss a beat when I somehow managed to stammer out that I was having sex with girls and not boys. As I had only told one other person on the earth before this woman, her natural acceptance was an enormous relief. I almost hugged her. She had earned my respect and my trust. So when she later told me after blood tests that I had an iron deficiency – most likely due to my heavy periods – that could be easily remedied by taking the pill, I was already a captive audience. When she went on, explaining that it would also regulate my periods, making them lighter and less painful, I happily agreed.

When I got home with my new pills, I read the package insert compulsively, convinced I was going to develop a blood clot in my leg or have some sort of heart attack or any of the other frightening complications on the lengthy list of side effects. But I started taking them, and nothing bad happened. Only good. My skin cleared up, my tits got bigger, and I could predict the day my period would come, almost down to the hour. I didn’t have any negative side effects, something that also separates me from many of my female friends. I didn’t get depressed. No mood swings, weight gain, or decreased libido. And when I did start having sex with regular male partners, there was the added convenience of being protected against pregnancy.

[I know that I am lucky for the introductory experience I had with the pill, and I recognize that my experience was somewhat anomalous. For one thing, my decision wasn’t tangled up with thoughts and feelings about having sex and discussing sexual activity with a doctor, as it is for so many women. But I also know that this particular doctor was open to these discussions – she said, “are you sexually active?” and did not judge me for my response – and this is also rare. Most women I know had terrible experiences with their first exams, with their decisions to go on the pill, with their doctors and nurses making them feel somehow guilty for wanting to explore their sexuality and take responsibility for their bodies and their actions. My experience could have been just as traumatic, and I am grateful that it wasn’t.

On the other hand, I look back with amazement at how quickly and casually I made this decision. In essence, I did it because my doctor told me to. I didn’t ask a lot of questions or make an effort to research the issue. And I’m not criticizing myself for this – I was only eighteen years old. Granted, the pill may have been an appropriate prescription for me, given my painful, irregular cycle. But I know doctors all over the country are prescribing birth control pills to young women without advising them or really talking to them about what they’re doing to their bodies. And this is problematic and worrisome.]

For the next few years, my experience with the pill was fairly uneventful. I took it every day; it became part of my routine. When I finally settled down with a steady sexual partner, it enabled me to enjoy sex without condoms. I still had no negative side-effects. It was great.

When I moved across the country for graduate school, I ran out of pills. I called my new school’s health service to make an appointment; they couldn’t get me one for a month and a half. I told them that I had run out of birth control pills and was there any way I could see a doctor in the urgent care section or have some sort of brief consultation just to get my prescription renewed. (Keep in mind, this was a prescription I’d had for five years straight.) They seemed annoyed with me and told me there was nothing they could do, that they couldn’t give a prescription until I’d had an appointment. School policy. I didn’t have the time or the energy to deal with planned parenthood or any kind of clinic, so I remained passive and thought, well, then I’ll just stop taking them for a month. Big mistake. In the one month I was off the pill, my emotions went haywire. I became noticeably depressed, and it felt chemical, like a weight imposed on me with no reasonable explanation. I also had strange cramps, and then my period didn’t come. I called the same health service and explained the situation. They insisted that I come in immediately for a pregnancy test. I explained that I hadn’t even been off the pill that long and I had been using condoms with my partner. The same people who told me they couldn’t possibly get me any kind of five-minute appointment for someone to fill my pill prescription were insisting that I come in for an “emergency appointment” later that day, making me travel an hour in both directions before I was even allowed to speak with an advice nurse. So I went. I took a pregnancy test, which was an absurd waste of time, energy, lab supplies, and an appointment that could have gone to someone else. Of course I wasn’t pregnant. But at least I’d had an appointment and could now have my prescription filled… or so I thought. “No, ma’am, you’ll have to have your annual exam and your doctor will have to fill that.” When I finally did see my doctor, she told me that it was ridiculous that they told me no one would fill it and that the people who answer the phones must have just been confused. Though I can appreciate the fact that she apologized, it was much too little and much too late.

Since that experience, I have remained on the pill. A couple of years ago, I had an abnormal PAP smear. I had to go through the hell of scheduling and attending appointments for frightening sounding things like “colposcopy” and “biopsy”. Throughout the ordeal, no one seemed to understand why I would be anxious about these things, and no one did anything to answer my questions or alleviate my concern. The doctor who performed the test was cold and rushed. When I started crying during the procedure because I was so scared, she sighed and asked me, “does it really hurt that much?” In any case, all results were negative. Which was a relief, to be sure, but then no one seemed able to tell me what had happened to make my PAP abnormal. When I visited my doctor again and asked her this, she just said something like, “oh, that happens sometimes.” When I probed for a better explanation, she said, “it’s probably because you’re taking birth control pills. Sometimes we see cell changes in women who are on birth control. Nothing to worry about.”

Over the past year or so, I have been experiencing more spotting between periods and a heavier, thicker discharge. Because this is different from anything my body has ever done, I have consulted my doctors. I am told time and time again that this is just because I take birth control pills and it’s nothing to worry about. A somewhat curious explanation, considering birth control pills are touted for their ability to stop spotting between periods. When I have exams and they use the swab for the PAP smear, my cervix bleeds. I have been told by more than one doctor that this is because the cells on my cervix are rearranged – something that they often see in women who take birth control pills. The cells on my cervix are rearranged? And that doesn’t concern you? I even consulted a “specialist” about the recent changes in my reproductive health. Another big mistake. I worried about the appointment for weeks; she arrived twenty-five minutes late and rushed me through it. The entire time, she made me feel crazy and stupid and acted as though she was annoyed that I was wasting her time with my questions. She gave me the same answer as everyone else – “It’s very common in women who take birth control pills. Nothing to worry about.” Her behavior was so disrespectful that bursting into tears or screaming at her became realistic options. Instead, I succumbed to her attitude and gave up. I completely shut down and forgot all of my questions. I left her office furious, a sob stuck in my throat. At the end of the day, I went home and took my birth control pill and went to bed. I have not seen a doctor since and I am reluctant to do so.

Today, I have a strange relationship to my pills. I continue to take them, despite my confusion, my skepticism, and my fear that they may be harming me. My current insurance doesn’t cover them, so I’m paying a considerable amount to continue to regulate my body. I no longer have a regular sexual partner, so the need for them as contraception is not a factor. Still, I continue to buy them and I continue to swallow them every night. I think something in me is afraid to stop taking them, because it’s something I have done for seven years. I’m afraid to stop taking them because I like having the extra bit of protection from pregnancy when I do have sex. I’m afraid to stop taking them because the one time I did stop taking them was so horrible. I’m afraid to stop taking them because I don’t want my emotions to run amok again. I’m afraid to stop taking them because I like having a regular period and I don’t know what will happen to my cycle if/when I stop regulating it. I’d like to think that things will even themselves out, but I don’t know. These are all things I would like to discuss with a doctor, but I hesitate to do this because of the negative experiences I’ve had in the past and the negative experiences I hear about from friends on a regular basis. Doctors you can trust – doctors who really listen to your questions and give informed responses, doctors who care about you enough to sit with you until all your questions are asked, doctors who aren’t rushing you out the door or telling you to make an appointment with someone else or telling you to have this test done or take this medication – are few and far between. And I feel completely daunted by it all. It seems somehow easier to just keep doing what I’ve been doing.

As I reread that last paragraph, it scares me. My relationship to my pills sounds addictive and unhealthy. I don’t know if I want to be taking them, but I’m afraid to stop taking them because… I have questions but I don’t know where to go to have them answered because I’m afraid of how I’ll be treated... I wonder if they’re doing bad things to my body, but I won’t stop taking them just yet because… And how many other women feel this way? Ask these questions? How many young girls having their first annual exams head right to the pharmacy afterwards to pick up their first bag of birth control pills? Who tells them what they’re really doing to their bodies? Who can tell me what I’ve already done to my body?

“Nothing to worry about.”

*********

A few weeks after writing this, I made the decision to stop taking the pill. Although this was a decision inspired by curiosity and concern for my health, in the end it was my passivity that won out: I stopped taking my pills because I ran out of them. There was yet another problem with my pharmacy or my insurance or my doctor (this happens so often that I can’t even remember the specifics) and I took it as a sign. It’s three months later and I feel that I made the right decision. My cycles have been fairly regular, which has been a pleasant surprise. I’ll admit that they are heavier and a bit more painful, which will take some getting used to. It’s hard to know just how much my decision to stop taking the pill has affected me – and the power of suggestion can certainly be strong – but somehow I do feel better. Knowing that I’m no longer regulated by hormones makes me feel more in tune with my body. My emotional state was not really affected – if anything, I feel less depressed than I did three months ago. I’m free from having to negotiate pill side-effects, insurance coverage, appointments, and prescriptions.

Most of my female friends still battle birth control complications and hassles on a regular basis. I am frustrated and angry for them and wish that women had better choices, more choices, more information. I see my decision to try to live without the pill as an experiment that happened to turn out well. At the same time, I wonder what I will do in the future if I have a steady partner again. Will I keep going on and off of the pill? Can I really do that? How will my body react then? Will I have a doctor I can trust to help me with these decisions, or will she/he just be writing me the prescription while pushing me out the door? At this point, I can only wait and see.

Pill History [back to top]

The following timeline was compiled from: PBS American Experience, the Pill Official ORTHO website Web MD Health

1954

Testing of the first synthetic oral progesterone begins on a group of 50 infertility patients at Dr. John Rock’s clinics in Boston. Some patients were given the drug without direct consent. The drug was also tested on 12 female and 16 male psychiatric patients at Worcester State Hospital. Under today’s standards for informed consent and human subjects, these trials and tests would be considered unethical.

1956

Dr. Rock creates large-scale trials of the pill in Puerto Rico, where he felt there would be plenty of participants that would be eager to sign up and easy to monitor. Some of the logic behind these trials was that if the doctor could demonstrate that the “poor, uneducated, women of Puerto Rico” could follow the Pill regimen, then women anywhere in the world could too.

The pills for this trial were provided by Searle Pharmaceuticals and were given at extremely high doses to ensure that no pregnancies resulted while participants were on the drug. Granted, the pill was 100% effective, but 17% of the participants complained of severe and long-lasting side effects like nausea, dizziness, headaches, and vomiting. The doctors dismissed these negative effects, suggesting that they were psychosomatic and minor when compared to the drug’s benefits.

Three women died while participating in the trials, and the investigators were accused of deceit, colonialism, and the exploitation of poor women of color. However, no formal investigation of the trials was ever conducted.

1960

The FDA gives the Searle drug company approval for Enovid - the first birth control pill. Despite being 100% effective, this version of the pill has terrible side effects, including life-threatening blood clots. It was later realized that the dose was 10 times too high.

As soon as Searle completes the requisite field tests demonstrating the effectiveness of the Pill at lower doses, the FDA approves the drug for contraceptive use at 2.5 and 5 milligrams.

1963

Ortho Pharmaceutical introduces its first birth control pill in 1963

1963

2.3 million American women are using the Pill.

1964

One quarter of all couples in America using birth control choose the Pill.

1965

More than 6.5 million American woman are taking oral contraceptives, with Searle pulling in $89 million in sales of Enovid.

The Pill becomes the most popular form of birth control in the U.S.

1967

Over 12.5 million women worldwide are on the Pill.

1968

Sales of the Pill hit the $150 million mark.

American women can now select from 7 different brands.

1970

The FDA orders that all oral contraceptive packages must contain a patient information insert detailing possible side effects from the Pill.

1980s

The FDA reports that 10.7 million American women are on the Pill.

The modern, low-dose, two- and three-phase birth control pills become available.

2000-2002

Four new birth control products are approved by the FDA, including Ortho Evra, a birth control "patch" that slowly releases hormones through the skin and frees women from a daily pill.

2003

The first continuous birth control pill is approved, allowing women to suppress their periods and provide birth control. Seasonale schedules four menstrual periods a year.

Research is currently being done on other pills that would schedule one menstrual period a year.

Basically the way to think about oral birth control is that it tricks the body into believing that it's already pregnant. Birth control pills contain levels of the female hormones progesterone and estrogen that approximate levels during pregnancy. Progesterone is a hormone that is released by the placenta during development of a fetus, and it suppresses the development of egg follicles as well as their release (ovulation). Estrogen is the primary hormone produced by the ovary. Taking extra estrogen basically decreases the amount of sex hormones produced by the body, suppressing the activity of the ovary and further decreasing the development of an egg.

[from Dr. Drew Online]

The lower levels of estrogen in birth control pills suppress FSH and LH "fooling" the pituitary gland into thinking a woman is pregnant. Ovulation will then not occur which prevents pregnancy.		The progesterone in birth control pills creates a thick cervical mucus making it difficult for sperm to reach the uterus. It also impedes an egg from attaching itself to the uterine lining (endometrium) because of changes in the cellular structure of the lining.
[From The University of Florida, Jacksonville]

Hearing Directly From Women [back to top]

• Early Experiences and the Initial Decision
• Side Effects
• To take it or not to take it? Reconciling side effects
• Costs and health insurance
• After the Pill
• Can Men Lend a Hand?

With the desire to hear from experienced voices speaking from this side of the Pill, we asked our closest friends to share their stories —their reasons for going on the Pill in the first place, whether they encountered side effects, and what, ultimately, made them choose to stay on or go off. Many of the experiences they described mirrored our own, while other stories offered entirely new and different viewpoints. What binds each story to the next is an overarching sense of ambivalence about the Pill. Though some women experienced more disruptive side effects or had more negative experiences with the Pill than others, every woman admits to having mixed feelings about going on or staying on it. Several women used the term “love-hate relationship” to describe their feelings about the Pill, and all of the women disclosed that they have concerns about what the Pill has done or is doing to their bodies. For some, this concern persuaded them to go off the Pill… although many continue to be disappointed by the lack of viable alternatives and wonder if they should go back on. Of the women who currently take the Pill, almost all have at least considered going off – despite their continued need for contraception – and many remain on with misgivings.

For all of the women who responded, the decision to start taking the Pill, how they experienced the Pill, and their decisions to stay on or go off were highly influenced and complicated by other factors like healthcare, health coverage, financial concerns, and of course their relationship with their partners. These factors are inextricably linked, with each one influencing and complicating the next. For example, a woman may become interested in going on the Pill because she’s heard of some of its more positive side effects or health benefits. Then, her decision may be negatively impacted by her parents’ reaction, or lack of support and communication. She may decide to go on anyway, without receiving much input from her doctor or her boyfriend. She then might experience the negative side effects of the Pill, which may also affect her sexual relationship. And finally she wonders whether she made the right decision after all. Add to that complications brought on by a sudden change in her insurance coverage. What begins as a very personal decision for women becomes convoluted and complicated (oftentimes unnecessarily) by parents, boyfriends, insurance policies, laws, and doctors. In the end, it becomes impossible to separate the birth control Pill from these other factors.

Another common theme in women’s testimony was frustration at the lack of available information about the Pill and the (often unmet) need to learn from the experiences of other women. This zine is offered in reaction and response to that lack, by presenting stories in women’s own voices and letting the themes speak for themselves.

Early experiences and the initial decision [Back to top of Section]

The decision to go on oral contraception can be influenced by many factors, and they’re not all tied to sex. Regardless of the initial rationale, many women make this decision at a very early age. Because of this fact, many of the women’s stories of early experiences with the Pill involve some influence of their parents (positive and/or negative). As some women have told us, sometimes even when parents want to be open with their children about sexuality, the communication still does not happen. Shame about sex and lack of communication translates into less information and less transparency about birth control. It has a ripple effect that touches not only the sexually active woman, but her parents, partners, and doctors. When young women don’t have hands to hold, or feel like they don’t, they can potentially endanger themselves.

In addition to reactions from parents and feelings associated with developing sexuality, women’s early experiences were marked by a lack of comprehensive information about the Pill. For some women, this lack of knowledge was combated by having another woman (usually a female relative) to learn from about the experience of being on the Pill. Some regret not having the experience of someone older to lead the way, like a sibling or really close adult, someone to bounce ideas of about sex and birth control.

“I was 17, had only been having sex with my high school boyfriend for about a month, when my mom started talking to me about going on the Pill. This was great because she was open and I could ask her some questions and I ended up going to my family doctor for my first annual exam.[My physician] talked me through, taking it slowly, and finally wrote me a prescription for the Pill. All in all, a really good experience. My mom wanted me to have control over my body and to her, that meant going on the Pill. She was part of the “Pill generation,” when that contraceptive option created freedom and control for women—of course she would want the same for her daughter. But I'm not so sure the Pill does mean those things.”

“I started on the Pill my first year in college ... I had been with my (first) boyfriend for almost a year-and-a-half. I can't even remember what got me to get on the Pill (I guess that's an indicator of how monumental it was for me) ... I do know it was a combination of having insurance and living away from home. I certainly could have talked to my mom about it, it's just a matter of not really wanting to.”

“I know that my initial decision to go on the Pill was complicated by the shame I felt talking to adults about sex and the relative isolation I felt at that moment in my life in relation to sex. This made me less able to make a fully informed decision about the Pill. At that age, I could have used more personal accounts and honest communication from other women, but didn’t really know how to ask for it. So my decision was somewhat haphazard and based on the fact that my boyfriend and I were monogamous and wanted to be able to have unprotected sex.”

“I was so terrified of talking about sex or anything close to it with my parents, which is funny because my mom tried to be so open about it but I think she always just ended up freaking me out more. Like when she told me in 8th grade that since I was having my period I would probably have a pelvic exam the next time I went to the doctor. I lived in fear of doctor's visits for so long after that … I remember a boy asking me on a date when I was 13 or 14 and I said no because my parents would have to drive me and I couldn't imagine having (or think of how) to tell them I was going on a date. I knew my mom would do that ohhhh squeal thing and I was just too embarrassed. I think I felt weird, like I was the only one. Whereas if I'd had a sibling I might have felt like it wasn't just me and it all would have felt a little more normal.”

“I have never been on the Pill, and there are a few good reasons why. Many girls (and I mean girls) make the decision to go on the Pill, without much knowledge or serious conversation with people who know about it. For me, I was lucky enough to have an older sister who talked to my mother and me about the Pill. Maybe it was different for my family. We are pretty open about sexuality. My dad actually asked me when I was 15 if I masturbated, and when I told him no, and blushed, he suggested I do it. This was very embarrassing at the time, but also sent a message that it was okay to discover my sexuality. My mom wasn't quite as open. But I know that I asked, or confided in her, she would have been cool.”

“I went on the Pill at the age of 17 … way before any of my other girlfriends were having sex. The idea of birth control seemed way beyond their scope. But apparently it was time for me. I knew it was the right choice. Really, I knew that it was a protection for my parents—a way for them to avoid the embarrassment/disappointment/shock of their only child, “little princess,” getting pregnant.”

“I know my boyfriend liked the idea of not using condoms and I'm sure I did too. At the same time, though, the feeling of sex without a condom didn't make much of a difference for me [at the time and with that partner], so that wasn't a big forcing issue for me, but it was there.”

Side effects [Back to top of Section]

A fair amount of women first become interested in the Pill because of its purported health benefits, several of which are presented by Ortho Pharmaceuticals on its website:

“While the Pill is an extremely effective method of contraception, it provides many other health benefits. Many women are unaware of the non-contraceptive health benefits of the birth control Pill. The Pill may reduce menstrual cramps, make your cycles more regular, lighten blood flow, and may provide some protection against developing ovarian cysts, pelvic inflammatory disease and two forms of cancer: cancer of the ovaries and cancer of the lining of the uterus.”

Some women who aren’t sexually active decide to go on the Pill, or are advised to go on the Pill by their physicians, because it will help regulate their periods and reduce severe menstrual pain. The Pill may also be helpful to women who don’t have periods at all or who have irregular periods. This can be a result of strain on the body due to rigorous training/exercise (ballet or gymnastics are the usual culprits) or by more serious health concerns, such as anemia and eating disorders.

“[Prior to going on the Pill] I experienced, off-and-on, really bad bouts of cramps, that I had heard (through magazine advertisements) the Pill would help with. Anyways, I started then, just got the Pill from the gynecologist at the University medical center, no big deal. They did sit down and talk about side effects, although do we ever really listen? And, of course, the Pill came with a bunch of ‘info brochures,’ that just end up in the trash when you get home.”

“My sister did not initially go on the Pill because she was sexually active—although she may have been—she went on the Pill because she was an anorexic athlete, and she had stopped having her periods … I think that I was quite young, I don't think that I had stated bleeding yet, and so I wasn't very aware of what the Pill meant. I just knew that my sister was sick and this was supposed to help her be healthier. I remember the months after my sister got help. It is hard to say what was going on, she was obviously dealing with a lot. She was maybe 15 or 16. What I remember was that she would have these violent mood swings, she would cry a lot, over nothing. Obviously she already had a lot of body issues, the Pill just seemed to make them worse.”

In 1996, Ortho Tri-Cyclen was approved by the FDA as a treatment for acne, and what should remain an attractive side effect is fast becoming the main reason many young women go on and stay on the Pill. The fact is, beauty sells. This ad is currently was taken from the official ORTHO TRI-CYCLEN website:

“ORTHO TRI-CYCLEN is from the #1 maker of prescription birth control and clinically proven to help your skin look better. ORTHO TRI-CYCLEN is the first birth control Pill that has been clinically proven to help reduce moderate acne and maintain clearer skin in women 15 or older, with no known medical reasons not to take oral contraceptives, who menstruate, want contraception and are not responsive to topical anti-acne medications. Studies show that nearly 9 out of 10 women who took ORTHO TRI-CYCLEN saw improvements in their skin. What makes ORTHO TRI-CYCLEN good for your skin? It lowers the levels of serum free-testosterone, the hormone that contributes to acne breakouts. Therefore, it may help your skin look its best without compromising its effectiveness in preventing pregnancy.”

With a lack of information about long-term effects and decreasing quality of health care, it seems dangerous for drug companies or doctors to link reproductive choices with cosmetic choices. Instead of buying Clearasil, will teenage girls who aren’t sexually active start popping oral contraceptives?

Despite the initial promise of health benefits and positive side effects, many women must learn to cope with a set of unpleasant side effects, that were sometimes not recognized as linked to the Pill until after many years of use.

“In retrospect, I do believe that the Pill was affecting my mood, or heightening my depression. At the time, however, I wasn’t fully “aware” of my own susceptibility to depression. This is why I may not have realized to what extent the Pill exacerbated it.”

From a PBS report on the Pill, we learned that when the Pill was initially released on the US market, some of the side effects experienced by women were not necessarily linked to the Pill: “Unaware that their problems were due to the Pill, most women with serious non-reproductive health problems went to see medical specialists. Someone with blurred vision would be referred to an opthalmologist. A woman experiencing depression would see a psychiatrist. Those suffering from strokes were treated by neurologists. These patients in turn seldom told their prescribing doctors about their treatments for conditions not directly related to their reproductive health. And in the early years, the specialists caring for these women were not aware of the Pill's dangers either. In some cases, doctors may not have even asked patients if they were on the Pill when they took case histories. It didn't seem relevant. With so little information-sharing between patients, gynecologists and specialists, doctors were slow to see the link between Pill use and serious side effects.”

“My senior year of college I started taking ORTHO TRI-CYCLEN so that I could have easy, fun, condom-free-yet-pregnancy-safe sex with my boyfriend. Some benefits, like clearer skin, made my decision to go on the Pill easier… not that I had many concerns. Most of my friends were on the Pill and loved their short, painless periods. Unfortunately for me, my body was NOT happy about the introduction of synthetic hormones into her system. If there was a negative side effect, I experienced it. I gained upwards of five pounds, bled most of the month (taking the “easy” and “fun” out of my sex) and felt depressed ALL THE TIME. Really, the Pill was very effective in preventing pregnancy… because I had much less sex, what with my lack of desire to be touched, much less fucked.”

“I made the decision to start taking the Pill because I was sexually active and for no other reason. I knew vaguely of some of the possible side effects. If I can recall correctly and honestly, the side effect that scared me the most was the risk of weight gain. But frankly I didn’t do a whole lot of research on my own about the Pill. Sure, I read the fine print on the box of pills after I got them, but by that time my decision was made. I had gone to the public library and found one wimpy book about “body changes” in teenagers. But I don’t think I was really looking for that kind of information—the information you get in health class or the information that even a good doctor would provide me.”

“Basically every time [my sister] would go on the Pill, she would turn into an emotional nightmare. She would have a lot of mood swings, and didn’t really feel in control of herself, how she would react to things. All of life’s little problems would just loom over her and she would feel helpless, and was always filled with self-doubt. She says that the Pill makes her crazy. And its true that she is a completely different person when she’s on it.”

“I saw a new doctor, who was shocked that I had been put on a tri-cyclic drug, given my family’s history of depression. She switched me to ORTHO CYCLEN. My side effects did not abate. I stayed on the Pill for nine months, hoping my period would regulate, the bleeding would stop, and my mood would improve … I quit that shit when I quit my boyfriend.”

“I can definitely say that birth control really affected my mood. I became depressed on birth control extremely fast, and have basically avoided it as much as I could ever since. One solution apparently is to take an antidepressant concurrently with taking the birth control—I have never wanted to try that because of my aversion to being on drugs in general; but I know many people who do that and are happy with it. But all of this information should be available to more women and in more clear form.”

“I have such a love hate relationship with [birth control pills] ... It messed with my moods—I was an emotional wreck the first two months—and in that annoying I'm crying and have no idea why way and I gained weight and my breasts got bigger and none of my clothes fit ... blech ... my body was so out of whack and I ended up getting lots of yeast infections and urinary tract infections and really didn't feel like having sex because my body was being so weird … At the same time I loved them because I always knew when my period was going to be so I could have the necessary supplies but also so I knew when to be worried if it hadn't come.”

“Just this last week I decided to go back on my antidepressant, something I've been considering for weeks now. I'm still amazed by the effects of hormones and neurotransmitters, and all those other chemicals we have the power to manipulate now. Sometimes my experience with these medications makes me feel powerless and confused about my moods and makes me question myself more often. Sure we all hate those references to PMS, but when you've had a little purple [antidepressant] Pill lift you from a suicidal state to one of normalcy, you have to wonder if your funk is based in reality or in the level of chemical x in your bloodstream –So I have no doubt that the Pill could affect more than our fertility. And as I've only started taking it a few months ago, I hope that it doesn't prove to be a problem with my history of depression. Because other options are limited.”

“Whatever doctor said that birth control has nothing to do with moods is missing the point, frankly, because birth control pills are essentially neatly packaged hormones and hormones, quite clearly, effect mood; so it is rather inconceivable to imagine that birth control pills wouldn’t, in some way, effect a person’s mood. It also seems that, like corticosteroids, the people who notice the effects most are people with preexisting mood sensitivities, i.e. if you have an underlying history of depression or low grade mania, you are, for whatever reason, more susceptible to many medications (particularly birth control) affecting your mood. Such people are highly sensitive to minor hormonal changes in their body. Accordingly, people who have PMS are also more likely to have their mood affected by birth control. If you know this about yourself, warn your physician ahead of time. Most physicians under-appreciate the effect a corticosteroid can have on a patient’s mood and don’t warn patients enough. In general, I think, physicians underestimate the power of drugs and medications on mood—for the same reason a lot of physicians underestimate the need for mental health care.”

Indeed, not every woman we spoke with experienced the same kind of severe mood swings or depression.

“Honestly, I was on the Pill for about four years and I didn't have any side effects that I noticed at all. Who knows what hormones are really doing to you ... but there wasn't anything that I found out of place from before or after. Of course, I had depressions, moodiness, mood swings ... but that's never changed for me ... that's who I am. Eventually, however, as I actually started thinking about what was in those little white pills that subtlety turned blue around menstruation time, I realized that I didn't like the idea of putting hormones into my body. I also realized the small length of time these pills have actually been tested to see their long-term side affects before they're put on the market and grabbed up by women looking for freedom from pregnancy and condoms. This was what eventually made me go off of the Pill, coupled with moving way from my long-term boyfriend.”

To take it or not to take it? Reconciling side effects [Back to top of Section]

While many women expressed reservations about the effects of the drugs, many women seemed to interpret the Pill as a “necessary” evil at one point or another in her life. The benefits often appeared to outweigh her reservations. As one woman put it simply, “The Pill made me crazy and the cervical cap and diaphragm made me pregnant.” More than one described her experience with the Pill as a love-hate relationship.

“I have mixed feelings about the Pill. On the one hand it did cause a revolution that allowed women greater freedom and flexibility, but on a deeper level women only had lack of freedom because of the tight constraints of Patriarchy. Chemically the Pill could be so much better. It is not very similar to human hormones. And there is the whole deal about the fact that we have so many Xenoestrogens floating around in the environment that we are overloaded with estrogen. We don't really need more estrogen.”

“Last June my mom was diagnosed with breast cancer. And it's no lie that there have been links to the Pill and breast cancer. So now what? Chatting with doctors doesn't always help: everyone has her own opinion and they keep telling me: the decision is mine. So, I made my decision. And I think about it every morning when I swallow my small white/blue/green Pill. It prevents me from an unwanted pregnancy. I don't get bad cramps. I know exactly when my period is going to come. And breast cancer may already be in my genes regardless of any extra estrogen I may take. As a feminist, it's good to know that the decision was mine. No one, even me, can say if it was the right or wrong decision-but it was mine. And isn't that what the sisterhood is fighting for?”

“I feel tied to the Pill now, it's this love-hate relationship. I like what it enables me to do—have spontaneous sex where no part of me is thinking, I might get pregnant from this, but I don't like “it.” Taking it every night isn't so much of a hassle as it makes me feel like I'm taking medicine, like I'm not well, like I'm purposely putting something into my body that doesn't always make me feel good.”

“Even though I haven’t had too many problems with the Pill, I’m feeling ambivalent about it. I think it helped me through some difficult times with my menstrual cycle. And I worry about what my cycle will be like if and when I go off the Pill. Doctors have been telling me that all these so-called “abnormal” changes my reproductive organs are going through are actually “normal” and easily explained by my birth control Pill use – and this is confusing to hear. If I’m putting this thing into my body and fucking with its chemistry, maybe it’s NOT a good thing that my body’s cells and systems are responding. The lack of long-term research conclusions makes me uncomfortable.”

“I hate the idea of regulating hormones in my body with drugs, I hate that I have to take them at 6:30 in the morning because it is the only time I can consistently remember to take them and so I have to wake up to take a stupid Pill at 6:30 on the weekends—the only days I don't actually have to wake up that early.”

A woman’s ambivalence with the Pill is complicated when a partner is unable to either fully empathize with her experience or places pressure on her—either to go on the Pill or to perform sexually as though the Pill is not effecting her hormonal levels. Even when a couple is determined to share the burden of birth control, the fact is that women shoulder the burden because they have to visit the doctor and they have to put the hormones in their bodies.

More than one woman expressed anger in retrospect at the lack of communication or inability to share contraceptive responsibility with their first partners. And while it seems that many women felt these doubts and reservations at the time, few were able to identify and articulate those feelings well enough in the moment to change the situation entirely.

“I first went on [the Pill] because I had a boyfriend who was unemployed and so it fell to me to buy condoms. Since my co-pay for birth control was only $15.00/mo I chose it as the cheaper option.” When she found that they lowered her libido and made her feel strange in her body, “my dumb boy was pissed at me because he was convinced that I was just denying him sex because I was mad at him or unhappy in the relationship … which of course wasn't the case. Then that pissed me off more since I was paying for the damn pills so I could afford to have sex with my boyfriend but then the pills made my body so weird that I didn't feel like it and on top of it my boyfriend was getting unreasonably pissed at me for it. Though this probably should have clued me in that I should dump his ass, at the time it was just frustrating. I don't think I really realized the full extent of what the Pill was doing to my body until I went off them a year later and suddenly dropped a bunch of weight and stopped having so many yeast/UTI problems.”

“I do consider whether or not the Pill may have also affected my libido during the years that I was on it, because I often felt less sexually interested than my partner. Though the fact is, because I was fairly young, I had little if any experience of my libido without the effects of the Pill, so it is difficult in retrospect to draw any real conclusions.”

“I also dislike the Pill because of the way it changed my boyfriend’s attitude about sex. Suddenly birth control became MY responsibility and mine alone ... but I guess that has more to do with him and his bad attitude than the Pill itself … thank God I quit them both!”

“I was not sexually active during high school, actually I was twenty before I started having sex. At that time, I already knew how the Pill affected my sister. I just didn’t want to take that risk. When I was in college I had also talked to other young women about their decisions to go off the Pill. Many of them said that it made a huge positive benefit in their lives. A few told me that they had similar reaction to my sister, and really that was enough for me to swear off taking them ever. I figure that I don’t really need the hormones tricking my body, it seems really unnatural. I am not a very sexually active person, so it seems sort of extraneous to my life. I have only been with two people, and those relationship were not long, committed relationships. Both of the men I have been with have asked me why not? I have told them, and that both of them were not that excited about my decision. Lets face it, I think every one thinks that condoms are a drag, I know I do, but at the same time, I m not really willing to sell my well being and sanity for that little bit of pleasure. They still put some pressure on me to do it. Nothing huge, they just kept asking why not, even after I told them, like they didn’t accept my reasons as valid.”

Costs and health insurance [Back to top of Section]

The financial burden of birth control can complicate feelings of resentment towards partners—at any age—but is especially difficult for teenagers who don’t have a lot of money and most likely haven’t fully developed their communication skills with their sexual partners, either to talk about sex itself or to talk about financial expectations in terms of birth control.

“One thing that I do remember very distinctively is the underlying resentment I had towards my boyfriend at the time for putting hormones into MY body and risking MY health. Don't get me wrong, I chose to be on it and certainly he would have supported me if I wanted to stop, but I still harbored an underlying resentment ... that I acted upon in a very passive aggressive way ... At one point in my last year of college, my dad changed insurance to one in which I had to pay first for the prescriptions, then count on reimbursement. So, I talked with my boyfriend and asked him to share the cost of the semester’s pills (I think it ended up to be $120 or so each). He did willingly, of course, with the expectation, as I had, of getting the money back. It took a long time for all of the paperwork to go through. Probably around five months later, I received reimbursement for the pills—but I never gave the money back. Something inside me decided I was totally justified in keeping it in repayment for putting pills into my body for so long. To this day, I haven't told my (now) ex-boyfriend, who remains one of my closest friends. I have definite doubts about my decision and do feel bad for lying to him, but part of me still feels that justification and slight satisfaction ... besides, what's $120 bucks compared to my health?”

One of the largest problems to tackle may be the way the health care system in the United States is designed in general, making the cost of birth control a factor in a woman’s decision to use oral contraceptives.

From an article by Ceci Connolly, “More Women Opting Against Birth Control, Study Finds,” we found that “Since 2001, the number of uninsured Americans has risen by 4 million … Buried in the government's latest in-depth analysis of contraceptive use was the finding that the number of women who had sex in the previous three months but did not use birth control rose from 5.2 percent in 1995 to 7.4 percent in 2002 … Jeffrey Jensen, director of the Women's Health Research Unit at Oregon Health and Science University, said he regularly encounters patients who have trouble affording birth control, even if their private insurance covers it.”

Even condoms are not as affordable as they “should” be considering how serious it is if a woman unprepared to raise a child gets pregnant—especially when she is stigmatized and/or unable to have an abortion.

“I was listening to the director of Blue Shield of California (one of the larger California health insurance companies) talk about birth control and the outrage that should be out there with the amount of money that is poured into pharmaceuticals like Viagra, and not poured into things like birth control research and development. Nevertheless, influence in America is where the money is, particularly in a country in which autonomy is valued so unbelievably highly, and thus the ones with the most money have the most influence on what pharmaceuticals get produced. And, as ever in America, old white men continue to hold (though this is changing, as we know) the majority of the dollars, and thus that gets translated into Viagra trumping birth control.”

While there are differing reports on how much money is spent on “women’s health” (and for which types of women’s health issues), the fact is that many women are forced to shift health coverage, and health insurance companies often decide to simply stop covering a particular drug. This was the case, for example, with Kaiser in California—they suddenly stopped covering ORTHO TRI-CYCLEN and many women were forced to switch to a “generic” version of the drug—Zovia—that actually affected their bodies quite differently from ORTHO.

“When I went on Zovia I didn't get my period and I thought I was pregnant. This culminated in me sitting in the bathroom with a pregnancy test, crying on the phone with my sister while we talked about what I would do if it came up positive—you know, the positive sign they show women being happy about in commercials, but that I can only connect with panic. Now, with ORTHO CYCLEN, the side effects aren't so apparent, but when I'm in some foul mood I can't help wondering if it's me or the hormones. Yuck!!”

Not everyone we spoke with were unhappy with their health care policy or physicians, but a few women did describe how difficult it was to get answers to all their questions because doctors simply did not have the time to spend during a visit. It was easier to whip out a prescription for a new birth control Pill with different hormonal levels, using a woman’s body as “trial and error,” than to talk through all of a woman’s concerns. This may be a symptom of the entire health care system rather than the fault of individual doctors, but either way, women get the short end of the stick.

“Increasingly now, doctors don’t have much control over what they can offer patients. What they can offer patients is based upon each patient’s particular health insurance, unless the patient wants to pay for it out-of-pocket. If a health insurance company says, “we’ll cover X and Y drug, but not Z drug,” then your doctor is not going to offer you Z drug. And if a health insurance company says, “we’ll pay you for eight minutes of time, per patient,” what you’re left with is an extremely rushed office visit. Really, this sucks all around, as most (good) doctors don’t want to be in this situation any more than patients do; mainly because most doctors are control-freaks and would rather not have their actions dictated by some health insurance policy maker. It’s also why an increasing number of doctors are leaving the whole health care system as we know it and becoming “cash only” practices (i.e. they don’t deal at all with health insurance companies and all of their patients pay out-of-pocket. Those patients definitely get the kind of care we should be expecting, with hour long appointments to discuss every birth control or medication option under the sun, but obviously, only about 2% of America can afford this kind of physician. Thus, most people’s experiences with the health care system in regards to birth control is more a reflection of health care policy and insurance.”

After the Pill [Back to top of Section]

Some women have enough of a negative connection with the Pill that once was enough—they will never take it again. A few women will never start. However, many women we spoke with, despite their ambivalent relationship with the Pill, continue to stay on the Pill or will go on again when they are with a long-term partner. Some women have reconciled their feelings of ambivalence with the conclusion that it’s difficult to tell which, of all the toxins and foreign substances we put into our bodies, have which effects on us.

“I went back on the Pill (a different one this time) eight months ago when my fiancée moved up to New York. Partially for cost reasons (especially since I can't tolerate latex anymore and non-latex condoms are too expensive), partially for convenience reasons—condoms are really a pain in the ass to spontaneous sex, and also because the sex is better. My body is a little weird but I can't really attribute that to the Pill anymore since I recently realized I have an allergy to onions and garlic that throws my body into a tizzy. So maybe it’s the Pill but maybe it’s the garlic since it is absolutely impossible, no matter how hard you try, to never eat onions or garlic unless you give up eating out and cook everything from scratch at home.” SW

“I'm off the Pill and have been for a few years now. I haven't noticed big changes (I was on ORTHO TRI-CYCLEN) ... other than my skin did freak out after I went off of it. I don't know if the Pill was keeping it clear or if the sudden change in hormone release timing and levels coupled with stresses of break-up and moving just made it bad ... but it was. And I proceeded to go on Accutane ... talk about fucking with your body. That stuff is definite poison, but the vain side of me decided it was really important. Who knows if I could have avoided poisoning myself with that shit if I hadn't messed with my hormones in the first place ... never will know. Now, I'm happy to be “Pill free,” although, I would probably go back on the Pill if I had a long-term boyfriend. With one recent partner, I felt a real difference between using and not using condoms. We had predominately unsafe sex (believe me, I've lectured myself a million times). After our first night of being together, the condom came off and I took the “morning after Pill.” This is total poison that puts you and your body through hell for about a week.”

“Needless to say, I fear going on the Pill again… although the introduction of lower hormone level pills (whatever they’re called) lessens the anxiety slightly … the argument goes on… but the bottom line for me was that the Pill wreaked havoc on my body, and I can’t stand behind it. Even if my skin looked great.”

Can Men Lend a Hand? [Back to top of Section]

So what about asking men to put the “poisons” in their system as opposed to women? Isn’t there rumor of a male birth control Pill in the works? As Alex Mar writes in “Jagged Little Pill,” yes, there is, and what took them so long?

According to the article, “Earlier this year, Dutch pharmaceutical giant Organon, along with Germany's Schering, announced that they expect their hormone-based contraceptive for men to hit the European market in as few as five years. Once that happens, it may only be another year or so before a U.S. debut. So, it will soon be possible for a man to avoid impregnating his partner by drastically lowering his sperm count. Unlike a vasectomy, the effect is temporary, completely reversible. And of course, the very notion is incredible: For over 30 years a "male Pill" has been in various stages of development, but this is the first time serious drug money has backed it up.”

This is compelling, to be sure, but, as one friend admits,

“I wouldn't put [the responsibility] into my boyfriend’s hands. Other options for me—yes. A male Pill—nope.”

Even if men use and are responsible for birth control, unfortunately, there’s no way around the fact that since women are the ones at risk of pregnancy, it’s their bodies that are always on the line, no matter what kind of birth control a couple is using.

“I hate what a drama this all is for me, it makes sex so complicated—even when I'm with someone I plan on being with forever. Then it occurs to me that sex is complicated—it’s designed to create a human life and if you don't want that life you are working to contrary purposes which always makes things complicated. I guess I really hate that I have this whole dialog going on inside my head, and I think most women do, but that men don't. That sex doesn't have this same labyrinth of difficulties for them and that really frustrates me. Especially in those moments where I feel like today, or yesterday, or the day before, or two days before that SHOULD have been the day where my period started, but it didn't, but I don't feel like scaring the boy with that information, but then I'm holding it in and freaking out, and getting stressed at work and so on. Then my period comes and I'm so excited and the boy says, “that’s good” and I get even more upset thinking about how this isn't something boys have to deal with.”

“The biggest problem lies in the force behind the need for change, not being enfranchised enough to advocate the need for that change.” She says further, “I do want to point out that there ARE those amazing doctors out there—who spend their lives advocating for women’s health, like issues of birth control, abortion, domestic violence, etc ... There really are some wonderful physicians out there who are fighting in the trenches to make a difference everyday. Especially in places like Planned Parenthood. One of my advisors is the director of the SFGH abortion clinic and fights everyday for women’s health rights. There are many female (and male) physicians out there like her … I would definitely argue that doctors could do a better job of advocating for their patients, connecting with and explaining all of this to their patients, but, well, a lot of those kinds of doctors, frankly, don’t end up in the places that you and I go to for our health care. I’m beginning to realize that many of the best doctors don’t end up in places like private practice or small health plans or whatnot. They decide they can’t stand to work in a place like that, and so they end up in a whole host of other places that you or me or most people I know don’t ever go, such as primary care homeless health clinics, big health policy positions in government, research and big academic institutions where they get to spend their time with patients the way they wish to (for the most part). The people who really care are usually the same people who really want to make a huge difference … so those people end up in places like the above, because they feel like private practice is too small and their care is too dictated by health insurance companies … They end up in big influential policy positions, or deans of medical schools or heads of research programs because they can’t stand not being able to at least try to make some big difference in one of the most unbelievably complicated and fucked up health systems in the world. Because some health care experiences these days suck, and who wants to give care like that if they can help it?”

“I’ve been using condoms, more or less happily, ever since I went off the Pill. And of course, their importance should not be undermined. For anyone not in a monogamous relationship, condoms are the only method effective against STDs.”

“I do believe that women who are intelligent and conscious of their bodies can create effective birth control for themselves without the use of synthetic hormones. And besides we should ALWAYS be using condoms no matter what else we are using! Yes, even in long-term relationships—husband do cheat. Often.”

The “problem,” with birth control, it seems, is difficult to find answers to. Women and men who are both sexually active and don’t want to have children will always face the risk of pregnancy.

One woman suggests: “1) A National health care plan 2) more money spent on birth control research and production 3) “emergency” contraception becoming non-emergency and available over-the-counter 4) abortion becoming a procedure done by most, if not all, general internists and family medicine doctors 5) more women getting into policy influential positions and 6) more women controlling the majority of money in America.”

We know that the only thing we can really do to better inform ourselves is to keep talking about the Pill and other birth control methods, how it effects our bodies, the ways in which our partners can be supportive, and how our health care system can further assist us with our important decision. We hope that by talking with women even in our small circle we have contributed to furthering the dialogue.

Please keep talking! Send us your comments and experiences. katiefi@yahoo.com or jrockadelic@yahoo.com

Resources [back to top]

Web Links:

• Scarleteen: Sex Education for the Real World
• Back Up Your Birth Control: Where to get EC
• Women's Health Collaborative
• Girl Nation

Books:

• What Your Doctor May Not Tell You About(TM) Menopause: The Breakthrough Book on Natural Hormone Balance, by John R. Lee and Virginia Hopkins
  
• Wise Woman Herbal for the Childbearing Year, by Susun S. Weed and Janice Novet
  
• Our Stolen Future: How We Are Threatening Our Fertility, Intelligence and Survival-- A Scientific Detective Story, by Theo Colborn, Dianne Dumanoski, and John Peter Meyers