Should We All Stop Taking Birth Control?

What is our obsession with the “natural” state of humanity? As if that is a thing, a truer state—a toolless, techless, laudable past we ought to revere. We’re urged to unplug; every time I use the internet I’m accosted with the warnings of a generation, endless articles shrilly decrying how this technology or that one is hastening the end of human connection or communication or authenticity. Inherent in this worldview is the idea that the tools created by humanity are somehow so “other,” so opposed to the natural world, that they manifestly alter our relationship with ourselves and with our destiny.

Holly Grigg-Spall’s new book, Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control, available in the US on September 7, investigates our complex relationship with human alteration, pharmaceutical interests, and the benefit of a “natural” state of femaleness. Hot on the trail of a volatile election year in which abortion rights and contraceptive rights were the subject of extreme debate and bias, the book takes an unusual stance on the ubiquitous use of fertility-curbing drugs and the culture that consumes (and demands) them.

In a world that bizarrely places women’s sexual nature and reproductive capacity in the center of many ideological conflicts—from Sandra Fluke to the back of a bus in India—at first glance it seems odd to argue that the pill actually facilitates oppression. But the author is proposing the idea that oral hormonal contraceptives are actually a tool of a capitalist patriarchy intent on altering and suppressing femininity, and that women’s unquestioning acceptance these powerful medications is, at best, an uneducated recalibration of the brain and body, and at worst, an acquiescence to a culture steeped in hatred of the feminine.

Grigg-Spall opens with the idea that while on birth control she felt an ineffable distancing between herself and her "femaleness": "Over the years I felt no connection between my self and my body, between my self and the world around me, between my femaleness and myself." It's difficult to parse what this may actually mean—how, exactly, do you feel no connection between your "self" and your body? But it’s likely true that hormonal contraceptives alter women and their experience of the world in significant ways, and a discussion of the facts surrounding birth control use is important.

A 2011 study on women on and off hormonal contraception found that the medication changed how they remembered things in important ways: both sets of women were shown photos and told a story about a car accident involving a young boy and his subsequent hospital visit. The women on the pill remembered more of the “emotional” aspects of the story—the boy being hurt, what happened to him at the hospital—while the women not on the pill were more likely to recall the details of the scene—what things looked like and where they were placed. And if memory contextualizes our past experiences and, obviously, acts as a touchstone for our future behavior and conception of reality, then a drug that alters this fundamental ability in even a slight way might have far-reaching consequences.

The alteration of testosterone also factors into women’s choice of sexual partners and mates. A study from last year revealed that women on hormonal birth control—which suppresses naturally occurring testosterone—were attracted to men with lower testosterone levels (usually the opposite is true). However when women go off of the pill, and their testosterone levels increase, their attraction to their partners decreased. This is a powerful, life-altering side effect to be sure. And it’s fair to wonder whether a drug that could alter our choice in long-term partners is too powerful for comfort.

Examining Victorian and pre-Victorian conceptions of femininity, Grigg-Spall explains that medical doctors of the time believed that fertility ruled the woman: “The uterus was understood to be the central controlling organ for the rest of a woman’s body. Medical practitioners believed that the uterus worked in competition with the brain. These two organs could not function harmoniously.”

But her argument, though oppositional, operates within the same logical fallacy: namely that a woman is somehow defined by her hormones, lack of hormones, or artificially achieved level of hormones; that a woman couldn’t possibly use her brain to decide to alter her hormones, taking into accounts the risks and rewards; and that the hormonal levels once believe to rule women's behavior in such a way to make her nervous, emotional, and hysterical, once suppressed, rule her in an entirely different way.

It's a philosophical question then: How much of the "self" the author refers to is dictated by hormones? And, further, is there something inherently valuable about the naturally cycling hormones present in women not on birth control? Do they "dictate" our behavior better?

In a constructive suggestion on how women unhappy on their birth control can still control their fertility, Grigg-Spall quotes from Heather Corinna’s article, “Love the Glove”:

If we’re going to talk about condoms changing how sex feels, we need to remember that something like the pill does too, and unlike condoms, it changes how a woman feels all the time, both during and outside of sex. Condoms are the least intrusive and demanding of all methods of contraception.

Though less effective (given perfect adherence and use) than birth control, the essay brings up an excellent point. We frame access to hormonal contraception as a hard won right for women—and it is—but neglect to represent the idea that it has its consequences. The idea that condoms muffle sexual sensation in a burdensome way for men, and thus hormonal solutions are “better,” is an extension of a worldview that women are solely responsible for both providing sexual pleasure and for controlling their own fertility. While some women don’t experience uncomfortable side effects when taking the pill, some do, and it’s important to consider men equally capable in taking steps to prevent pregnancy.

I’m not entirely unsympathetic to Grigg-Spall’s point of view. I won’t take birth control myself for a variety of complicated reasons, some of which do have to do with how it acts on emotion and the mind, some of which have to do with the increased cancer risk. And her point that "The choice to take the pill is fiercely protected and yet that choice is rarely autonomous and informed. It is not active choice making, but passive acceptance,” is a good one. It is important to recognize how, at least here in the US, use of hormonal contraceptives is so prevalent as to be conflated with female experience. Four out of five sexually experienced women in the US have taken hormonal birth control pills. What other class of drugs has so high a use?

Grigg-Spall advocates variations on the rhythm method—the charting of a woman's cycle using factors like internal temperature to record fertility. This is an effective, if more labor-intensive technique to decrease the likelihood of pregnancy. But in advocating for this above the comparatively easy use of pills is to forget that the world we live in isn't perfect—many of us are too busy to meticulously chart our fertility, and it's simply unreasonable to expect already overwhelmed women to start recording the consistency of their cervical mucus each day. The failing of this book is that it doesn't "meet women where they're at" (a harm reduction catch phrase that's apt here)—which is often overworked, underpaid, and keenly interested in controlling when they get pregnant.

Grigg-Spall says that we women have been sold a false bill—consumer choice disguised as freedom—by a capitalist culture, and I see the truth of this statement as it applies to capitalism generally. But to suggest that a return to the vestiges of some imagined purist femininity is most ideal is to reject the idea that controlling our bodies can be positive. The problem with the use of birth control might be that it alters a woman's experience of the world in a way that she doesn't like, that she began taking the medication without understanding its risks, because everyone was taking it. If that woman decides that she can reduce her risk of unwanted pregnancy in other ways or that she's willing to live with a higher risk of unwanted pregnancy, then she should stop taking birth control.

No appeal to the natural would be complete, however, without mentioning the moon, right? "Capitalism is built on a clock that regards time in terms of money," writes Grigg-Spall. "This understanding of time is not based on the original, essential clock of the moon phases." The author goes on to suggest that women, because their natural cycles align with the moon cycle, are biologically more connected to the "original" clock. OK, even if that were true, what would that mean? Like, actually, practically mean in my life? Why would it matter if I'm connected to the moon or the earth in this abstract, functionless, questionably real way? We need to ask ourselves whether connection to an "original" clock is meaningful in a world where we have electricity and shelter and the ability to keep track of time using a written calendar.

Sweetening the Pill will appeal to many people who believe in the power of collective menstruation, the rightness of our connection to moon phases, and the oppression of patriarchal capitalism. But it's not going to convince many women who feel they "need" birth control to switch to other methods. Regardless of whether consumer choice is freedom, it is perceived as freedom and, in the case of avoiding unwanted pregnancy, it offers women freedom in real and important ways. We should be honest about the risks, but we need to also be honest about the need.

@kellybourdet