The bitter taste of hormonal contraceptives

This is the forth post in a series about the contraceptive pill and the reasons why I have decide to quit hormonal contraceptives. When trying to find honest information about the pill on the internet, Holly Grigg-Spall's blog Sweetening the Pill was one of the few places I could find that was really talking about it in a corageous and critical way. Her book, Sweetening the pill: or How We Got Hooked On Hormonal Birth Control, has recently been published. I had the pleasure of reading it and think it is a must read for women that really want to be informed and empowered to make decisions about their health and contraception. After reading the book, I asked Holly for an interview, which she gladly answered.
Versão em português

Q: Why are the stories of so many women, their negative feelings and reactions to the pill, the health problems that it generates so commonly dismissed as isolated complaints?

A: Throughout history women have been told that their health problems are "all in their heads." It used to be called hysteria, now it's called "the power of suggestion" instead. Women are treated as though they are hysterical and as though they even whip up hysteria in each other. 

Also, women are often making these complaints regarding side effects from the pill in isolation. At a doctor's office or family planning clinic office for example. Women aren't complaining about side effects as a collective. In fact, women seem to be far more likely to blame themselves, to blame their own bodies for not reacting in the right way to the drugs, or for not being compliant to the drugs, than they are likely to blame the drugs themselves or those that encouraged them to take those drugs. Therefore they often don't see their experience of side effects as a collective experience of many women, even though it certainly is that. 

We live in highly conservative times. People find it hard to question institutions like the medical industry or corporations like pharmaceutical companies. The neoliberalism of our time dictates that we see ourselves as free agents moving through the world unfettered by social pressures and individually responsible for every occurrence in our lives. Current mainstream feminism dictates that we fixate on Choice. Therefore if you make a choice and it turns out to be bad for you and negatively impact your life, that's your problem alone. 

In many other areas we accept individual's experiences as valid in the way they explain those experiences. For example, if a transwoman says she's a woman, we accept this experience as valid and honor it as valid. If someone says they are gluten-intolerant and that gluten makes them sick, we accept that as valid and reorganize to admit this experience. However, we are seeing that when women detail their experiences with hormonal birth control they are dismissed or silenced. Hormonal birth control is bound up in our ideology so tight that even honesty is seen as a threat to the status quo. 

Q: Why, as you put it in the book, it is so hard, nowadays, to criticize the pill?  

A: The pill is seen as synonymous with women's liberation and the progress of women in society through the last few decades. When we discuss "birth control" we often actually mean just "the pill." It has become a cure-all for any ailment that impacts women. We have got to a point that women's natural state is thought inherently sick (this is not to deny some women are made sick by their biology, but we are not ALL sick because we are women, which I believe is the message). 

Criticism of the pill has been co-opted by groups, like the religious Right, that are all too often anti-abortion, anti-sex before marriage, and anti-contraception as a whole. The women's movement has allowed this conversation to be dominated. This means when we criticize the pill we are seen as providing ammunition to "the other side" as it were. In the US birth control is understood as under threat by certain factions who seemingly desire to make it difficult for women to obtain knowledge of contraception and access to contraception. This has made the feminist, liberal Left even more zealous in their enthusiasm for hormonal birth control and even less open to honest discussion about safety issues - even when they are gravely serious, for example the situation with Yaz/Yasmin and blood clots. 

And we mustn't forget that hormonal birth control is a billion dollar industry within which women are patients buying drugs for many, many years of their lives. We are nothing if not a corporate-driven society these days and so this plays a huge factor in how we think about the pill. The pervasive reach of the pharmaceutical industry within the medical industry, and its influence on medical students, practicing doctors, and women themselves should not be underestimated. 

Q: In your research and during your own experience trying to quit the pill, what side effects have you discovered that are not usually mentioned in the mainstream debate and which ones do you think most affected you personally?

A: I think the impact of the pill psychologically and emotionally for women is rarely discussed with any seriousness. There is far too little solid research involving large groups of women followed over a long period of time. There is far too little attention paid to women who report these issues. It's not just depression that needs to be discussed, but also anxiety and anhedonia (the inability to enjoy activities usually enjoyed). The impact can show itself in many ways, not necessarily just a clinical state of depression, and those ways can be very damaging to a woman's quality of life. It was certainly these problems that affected me personally - anxiety, panic attacks, anhedonia, rage. Also perhaps the negative impact on women's experience of sex is not discussed enough. Not only lowered libido as a result of the pill, but lack of lubrication, lowered intensity of orgasm, pain during sex, and the heightened likelihood of infection. 

Q: In day to day discussions we can see that contraception has, somehow, been equated to the pill and other forms of hormonal birth control. What do you believe has contributed to that?

A: Capitalism. Hormonal birth control makes a few people a lot of money and if the brand "the Pill" can become synonymous with birth control as a whole they've done their jobs well. Hormonal birth control has been pushed as the ONLY choice, in fact representative of Choice itself. Also the medical industry, under the thumb of the pharmaceutical industry presents hormonal birth control as the best option for women - whether that's for contraception or cycle issues. Condoms are seen as only useful for prevention of transmission of STIs, not as contraception. All other options are viewed as ineffective, messy, obtrusive, or archaic. 

Q: We are normally caution about taking prescription drugs and wary of their side effects, but when it comes to the pill, it is never considered as a possible cause of health problems in women that are taking it or have taken it. How have we come not to think of the pill as a drug?

A: We call it "the Pill" as though it were innocuous and harmless. We don't think of it as a powerful drug or as a medical product. For all the reasons mentioned before, hormonal birth control has dominated our contraception conversation. It has become part of modern life for women. Essentially we see women's bodies, as a culture, to be inherently sick and faulty. The pill fixes the troublesome reproductive organs until they are needed for the socially useful act of providing a pregnancy. We see our cycles prior to pregnancy as a nuisance, the cause of sickness and pain, and they are used against us as indication of our inferiority to men. The pill is understood to make us BETTER. Better women. It is discussed almost as a cancer-vaccine, as the reason for women gaining equality in society, as the reason for them working alongside men in careers, as the reason they are happy even. It has been given a whole lot of credit for women's achievements through history. The pill was the first lifestyle drug and it is a gateway drug that opens women up to seeing medical intervention as not an option but a necessity at every point - menstruation, fertility, pregnancy, birth, menopause. 

Q: Since, as you stated, “our relationship to the pill is inseparable from our relationship to menstruation”, what do you believe is behind this current trend that encourages women to suppress menstruation and how is it connected to the pill?

A: Our relationship to menstruation is inextricably linked to our relationship to the pill. The pill gets rid of periods and replaces them with withdrawal bleeds. Young women are prescribed the pill to "treat" difficult menstrual cycles and "regulate" their periods. Our society perpetuates a menstrual taboo that links menstruation to shame and therefore getting rid of periods is seen as a positive. We are told there's no medical reason to have a period, which is untrue. Prior to the proliferation of hormonal birth control menstruation was seen as the fifth vital sign of good health. 

We see menstruation as inconvenient because our society makes it inconvenient. It is not possible to have your period at the beach on vacation. It is not possible to take time out if you have cramps. We must be on, and available, in all ways, at all times. Controlling menstruation is also an extension of controlling other aspects of the female body - be that weight fluctuations, or hair on legs and armpits. 

Much of the justifications for skipping periods with drugs goes back to the work of Dr Coutinho and he had ties to the development of the shot and the implant - hormonal birth control that now makes a lot of money. We seem to feel science exists separately from our ideology. This is not true, science too often sets out to prove what is necessary to prove. 

Q: Why our reactions towards male and female pill are so drastically different, and why hasn’t the male pill been as researched and promoted as the female pill?

A: It is believed that the female pill is "treating" an issue - fertility and possible unwanted pregnancy. Pregnancy is therefore the illness and the pill is the medicine or cure. With the male pill it is believed this would be a drug that is not directly treating an issue. Therefore side effects will not be tolerated, by the medical industry, or by men - the drug is not needed and so a negative impact is viewed as more important a consideration. Men do not get pregnant. It is not considered that men also have consequences from unwanted pregnancies - economic, social, health too. They may also have consequences if their partner uses hormonal birth control and suffers side effects. 

The conversation shows how we as a society feel pregnancy prevention is a woman's responsibility and that men do not have any intrinsic connection to the occurrence of a pregnancy beyond providing sperm. There's much misogyny ingrained in the medical system. It's a line of thought too often carried through in all other areas of our society - how we view men/fathers in relation to women/mothers. It's why we see men taking care of their own children as "babysitting" and women taking care of their children as doing their natural, right role. 

Q: In the book, you suggest an interesting parallel between women’s acceptance of the cesarean and of the pill. Could you talk about it briefly?

A: As I said before, the pill is a gateway drug that opens up women to being more accepting of constant medical intervention through the stages all of their lives, including pregnancy and birth. We have a one-size-fits-all approach to contraception and to pregnancy and birth because it is the method by which the most money is made or saved in ways that benefit the system. 

Treating birth as surgery is not always healthy for the woman or her baby. Treating ALL birth as surgery is certainly not in the best interests of all women. Similarly treating fertility as an illness and suppressing the cycle with powerful drugs is not in many women's best interests. Yes, sometimes drugs and sometimes surgery is needed, but it should not be seen as a standard of care for either situation. 

Q: Nowadays, there are pharmaceutical companies trying to develop another drug that will address women’s lack of sexual desire. What vision of female sexuality is implicit in this discourse that gives ideological backing for the widespread use of hormonal contraceptives?

A: I believe it is a view that suggests quantity is more important than quality. As long as women are having sex frequently, as long as men are too, then it doesn't matter whether the sex is actually enjoyable. The idea is to provide a drug that makes women "want" sex more with the understanding that more sex will equal better sex. Usually studies rest on how many times a couple is having sex not how they feel about the sex that they are having. 

Hugh Hefner hoped that the pill would make women more sexually available - because it was believed that the main reason a woman would refuse sex is because she was fearful of pregnancy - and more "sexy." Sexy is exterior, not interior. It is about women behaving in certain a way to arouse men. 

There is a pressure on both men and women to want and have sex all of the time. If you are not doing this then there is something wrong with you that needs to be fixed. Of course behind the development of this drug is money, and much is to be made if you consider how broad the definition of sexual dysfunction is currently and could become. We could all be seen as sexually dysfunctional and in need of drugs within a decade. 

Q: What does it mean for you to be a feminist? What are the battles that lie ahead, and what are your own plans for the future?

A: Feminism needs to stop being the handmaiden to capitalism. We need to stop seeing success of women in the narrow capitalistic terms of corporate status and economic gain as the be-all end-all of the feminist movement. I don't want more ridiculously high paid CEOs who are also female. I want social inequality addressed. I want the redistribution of wealth out of the hands of the undeserving few. Feminism needs to be about social change and revolution, not expanding choice for women in the free market. I'm a feminist but I'm also a humanist, I want a better way of life for men and women, for us all, because the one we have now is not sustainable and is entirely inhumane. We have got to a point where we don't believe there is an alternative, and that we just have to accept this lot. Mainstream feminism currently compounds that as it has been co-opted by those who prefer to sustain the status quo rather than challenge it.

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