Tuesday, April 6, 2010

Questioning the power of the pill: Do we need more innovation in birth control?

Feministe has an interesting piece about an interview Laura Eldridge gave about her new book on birth control.  Eldridge is a critic of hormonal birth control, and argues that its side-effects have been downplayed and women led to believe they only have one reliable choice for family planning.  While I certainly agree that the pill may not work for everyone (and as someone who is generally suspicious of pharmaceuticals, taking such a powerful medication for so long makes me nervous), I also agree with Feministe that for many women, it's hard to overstate the immense power of the pill.  Birth control access, more than anything else, really changed the way we as women were able to live our lives, so I will go to the mat defending it, even if I acknowledge we need to have an open conversation about the pros and cons of different methods.

We also have to be critical consumers, and recognize the role pharmaceutical companies and marketing play in our (and our doctors'!) awareness of different methods.  In the comments on the Feministe post, the author and commenters go back and forth on whether it is still standard for doctors to deny the IUD to women who have not had a child.  One commenter notes that her doctor offered her Mirena as a potential method.  Mirena is an IUD, in that it is inserted into the uterus, but it is also a hormonal method.  Traditional IUDs are non-hormonal, and work by making the uterus inhospitable to both sperm and fertilized eggs.  Mirena is essentially a slow-releasing hormonal implant, but one situated within your uterus.  As a result, I'm not surprised young women are being offered Mirena while the copper IUD is apparently held in reserve: Mirena is a brand-name prescription product being sold under patent.  Pharmaceutical marketers have gotten the word (and, likely, the kickbacks) out to doctors, and they're in turn getting the word out to you.  The copper IUD had been around since the beginning of the 20th century, any patents on it have long since expired.  In other words, you're not getting offered the copper IUD because no one gets paid to recommend it to you.

As Eldridge shrewdly points out, although it seems like there's a new type of birth control coming out every month, there's actually a dearth of innovation in the contraception market.  Most of the options we have today are the same our mothers had in the seventies.  And so, with that dearth of options, comes the sad reality that hormonal contraception is currently the best way we have to prevent pregnancy (with the exception only of the copper IUD and sterilization).  We've seen plenty of inventive ways for those hormones to be delivered (a pill, a shot, a ring, an IUD), and new hormones with supposedly new benefits (and new side effects), but the basic stuff is the same.  Each of the next-most reliable methods come with their own problems: condoms and withdrawal require partner participation (which can be difficult to obtain for many women), and the diaphragm just isn't that effective, even with perfect use (6 out of 100 women using it for a year will become pregnant).  For each of those three methods, inconsistent or imperfect use shoots you into scary 16-18% pregnancy land.  And many women just don't want to take those kind of chances.

Nonetheless, the table below (which I think everyone should show to their partners--it's shocking to me sometimes how little men understand about birth control) does highlight that there are options outside of the pill, which many of us find our doctors hesitant to discuss.  Withdrawal, in particular, has been maligned by the medical community.  Now, I would not recommend this method to a teenage girl, or for use with a one-night stand.  The key ingredient in making it work is trust and commitment.  When I worked as an adviser to college freshmen, I told them that if they wouldn't trust their boyfriend to pull their parachute cord, they shouldn't trust him to pull out.  But for people who have that trust, withdrawal is a viable contraception option, and certainly as viable as periodic abstinence methods, which take a whole lotta commitment themselves (to do it right, you have to take body temperatures and examine mucus and stuff).  I worry that one reason the medical community doesn't consider this a "method" is the paternalistic attitude towards women's health.  Our doctors think we need a regime, a schedule, rules, when all we're looking for is a little honest advice.

I'm glad Eldridge is opening up the contraception conversation.  We can applaud the pill for all it has given us (and fight like hell for our right to access it and other methods), while still asking: isn't there something better yet?

Note: Contraceptive failures are measured as the percent of women experiencing a pregnancy within a year of use.  A 4% failure rate means that out of 100 women using the method for one year, four will become pregnant.


  1. ok--so i know this comment is totally useless, BUT i want to note that i want to leave a long, detailed commentary of all the issues and thoughts i have about various methods (and have been thinking about it all evening) and how glad i am that you posted this to get a dialogue going. BUT i really have to finish this dern problem set and go to bed for class tomorrow morning. maybe i can leave it tomorrow. sadness.

  2. You mentioned how men often don't understand how birth control works. I think that many (most?) women also don't have a very good idea. My mother would blame this on the lack of even basic anatomy taught in public schools, and that one (myself included) could graduate from college without learning any human physiology.

    Is it still believed that antibiotics interfere with birth control? I was recently prescribe antibiotics, and the doctor made no mention of this side effect. And if so, does that mean that antibiotics make you ovulate? I think this is pretty complicated stuff, hormonal birth control.

  3. According to medicinenet, antibiotics can accelerate the breakdown of estrogen by the liver, and inhibit its re-circuation by the digestive system. This, in effect, prevents you from getting the full dose of hormones, so the effectiveness goes down (I'm not sure whether this applies to progestin-only pills, but I wouldn't want to risk it!). The same is true for anyone experiencing vomiting or diarrhea, you might not be getting the correct level of hormones, and therefore might not be protected.

    I agree, Mongoose, many people don't have full information about how our reproductive systems work, and in turn how contraception works. For example, with emergency contraception, many people didn't know that the most high-risk sex is before you ovulate (because sperm can live in the female body and wait for an egg, but an egg isn't viable for long after it's released), and therefore pregnancy can be prevented after sex by taking a high dose of hormones that prevents ovulation. To be really informed consumers we need to seek out this information and educate ourselves.


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