America and the Pill: A History of Promise, Peril, and Liberation (17 page)

Although lawyers for the manufacturer, Wyeth-Ayerst, successfully defended Norplant, negative publicity continued, and in 1999 the manufacturer agreed to a settlement. After

spending $40 million defending Norplant, the company dis- continued production in 2002. Norplant’s use in the United States declined, although it remained popular in other coun- tries. Newer products have reduced the number of implanted tubes, making insertion and removal easier.
44

In the United States, many of the controversies surrounding contraceptives have resulted in lawsuits where experts and au- thorities have battled against each other on behalf of either consumers or manufacturers. Some of these legal actions were important and well deserved, especially the litigation against the Dalkon Shield. But some researchers believe that the nu- merous lawsuits have inhibited the development of new con- traceptive products in the United States, mainly because of the huge costs of liability insurance.
45
By the 1980s, in the United States, there were more liability suits for oral contraceptives than for any other category of drug—so many that liability in- surance was temporarily unavailable. Legal challenges to con- traceptive products continued into the twenty-first century.
46

In addition to the liability problem, regulations that required lengthy testing discouraged investment in contraceptive innova- tions. The cost of research and development for new contracep- tives also soared. Gradually, as U.S. pharmaceutical companies withdrew from contraceptive development, researchers came to rely on government funding. Research continued in Europe, where there were fewer lawsuits.
47
Nevertheless, in Europe as well as in the United States, measures put into place to protect consumers had the unintended result of limiting the number and variety of contraceptive products available to men as well as women.
48

American women have become discerning consumers of birth control products, largely as a result of the efforts of fem- inists and women’s health care advocates to improve the safety and accessibility of the pill and other contraceptives. Today, women in their childbearing years encounter many new con- traceptive products, a very different sexual culture, and trans- formed medical and pharmaceutical institutions. They have vastly greater control over their reproductive lives than their mothers had. Yet as they tell their stories, we find that while much has changed, much has also remained the same.

7

The Pill Today

I love the pill!

The pill sucks!

T

he quotes above express the extremes of young women’s feelings toward the pill today. Although it is not for everyone, the pill remains the leading contraceptive of choice in the United States. Much has changed since it first came on the market. Women have more birth control options, more life choices and opportunities, and increased equality in pri- vate and public life. There is more openness and acceptance regarding sexual activity for single and married women, and less stigma surrounding unwed sex and pregnancy. The pill is a much safer product than it was in 1960, and women face fewer legal obstacles to obtaining contraception and abor- tion. Yet the pill is still an imperfect contraceptive, and

women still encounter roadblocks on the path to full repro- ductive freedom.

Today nearly 12 million women in the United States take the pill. More than 45 million women of childbearing age have taken the pill at some point in their lives. Unlike their mothers who saw the pill as a miraculous godsend, many young women today take the pill for granted. As Anne S commented, “The pill seems so commonplace. It’s like asking what the impact of the telephone system is. It’s so ubiquitous, I just couldn’t pic- ture a fully functioning society without it!”
2
For Alice Z it is “such a common part of my everyday routine (like brushing my teeth). . . . It’s a non-issue.”
3
Elizabeth M appreciated her choices: “It’s just a question of which contraceptive options are the most fun and the least hassle.”
4

Nevertheless, many realize that access to the pill is a luxury that was not available to women of an earlier generation and that its impact has been monumental. Martha L considers the pill “the single most empowering option that women have been given in all of history.”
5
For Kelly R, the pill is more than an ef- fective contraceptive: “[It] helped me to own my identity as a woman and to be in control of my life, my body, and my fu- ture.”
6
Jessica P feels like “one of the lucky women in the world. To be born in the United States, and to be born after the pill was available, I have never been forced to have children, or been forced to abort because I never had an opportunity to protect myself. I’ve been able to live the life I wanted to lead. And most importantly, I’ve never had to rely on the consent or willingness of my partner in order to protect myself. It’s all been in my hands. I think that’s huge, and I’m grateful for it every day.”
7

These women all responded to an Internet query asking for opinions, experiences, and stories about the pill.
8
They had lit- tle in common. Anne S, age twenty-one, describes herself as “married, bisexual, ex-military, living below the poverty line.” Alice Z, age thirty, married, white, and straight, a self-described atheist and a Democrat, is from a poor, working-class, funda- mentalist Christian small-town family. She and her sisters are first-generation pill users and the first in their family to attend college. Mary M is a twenty-three-year-old aeronautical engi- neer for a company that makes jet fighters. What these women do have in common, along with more than a hundred others, is that they all had something they wanted to say about the pill, so they wrote their stories for inclusion in this book. What they tell us reflects the many ways in which the pill has been at the center of the major transformations in women’s lives over the last half century—how much has changed and how much has remained the same.

The feminist movement expanded women’s opportunities, altered relations between the sexes, and challenged social, legal, and institutional structures. The entire context in which women approach sex, relationships, contraception, and repro- duction has changed dramatically. Women today have a dif- ferent relationship to the pill than their mothers had. Yet at the same time, young women grapple with some of the same issues that faced their mothers, as well as some new ones. Dilemmas and difficulties remain for women seeking to con- trol their fertility.

The first generation of pill takers felt liberated by its ef- fectiveness and trusted it to prevent pregnancy more than

other contraceptives available at the time. Today, many young women use a barrier method along with the pill, either be- cause they don’t consider the pill to be 100 percent effective or because it does not protect against sexually transmitted dis- eases. Although she takes the pill, Melissa G and her boyfriend “still use condoms, but only right before climax to keep down on mess and that pesky 2 percent noneffectiveness.”
9
Saman- tha J, age twenty-three, never had any trouble with the pill, “but I always use a condom as well, just in case. I guess I’m still a little nervous!”
10

Many women today recognize that the pill has played a role in their sexual autonomy as well as their reproductive self- determination. “I think it’s hard enough, even for those of us raised feminist, for women to ask for what they want in sex and sexual relationships,” noted Jessica P. “Having to add ne- gotiations about birth control on top of that power imbalance just tips the scale even more. Taking back our control of our bodies in terms of birth control really helps women to take the leap to be open and honest and ask for what we want in bed. . . . The pill has helped me feel less dependent on my male partners, and more equal with them.”

In addition to her sexual assertiveness, Jessica P also iden- tified herself in ways that would have been rare among her mother’s peers: a thirty-eight-year-old lawyer, married, non- monogamous, and bisexual.
11
In the 1960s, relatively few married women would have been lawyers, few wives would have admitted being nonmonogamous, and few pill users would have identified themselves as bisexual. Nearly all pill users at the time identified as heterosexual; lesbians would

have been highly unlikely to use the pill. Today women are more likely to embrace a sexual identity that is more complex. Among the respondents to the Internet query, about 10 per- cent identified themselves as bisexual. For some, bisexuality raised new issues regarding the pill. Karen E explained, “The only problem with relationships . . . was that when I was dat- ing a girl and taking the pill, she assumed that meant I was likely to cheat on her with a guy! It played into the whole stereotype of bi girls as promiscuous and always looking for a guy to screw on the side.”
12

Along with sexual identity, expectations for sexual pleasure have also evolved since the 1960s. When the pill first arrived on the market, many women reported that it both freed them from fear of pregnancy and allowed for a spontaneity unavail- able with barrier methods, making sex more enjoyable. In striking contrast, among the young women today who re- sponded to the Internet query, several complained that the pill actually lowered their libido. Available data suggest that the pill can either increase or decrease libido—but most women are not presented with this information. Few doctors explain to their patients that the pill can lessen the sex drive in some women. Manufacturers rarely mention it in their information packets. For example, the full product information for Ortho Tri-Cyclin Lo contains a long list of possible side effects in the fine print, and another list of reported side effects that have been “neither confirmed nor refuted,” which included “changes in libido.”
13
Internet sites including WebMD and Teens Health do not mention lowered libido as a possible side ef- fect.
14
However, other Web sites, such as Epigee Women’s

Health, note, “New research now indicates that the birth con- trol pill may inhibit more than just pregnancy. The pill may also significantly, and perhaps permanently, dampen your sex- ual drive.”
15

Several of the young women respondents spoke to their friends and female relatives about the effects of the pill on their libido and did their own research on the Internet. Mandy B learned that “many of the women in my life had also started to react negatively to the pill after many years. For example, we all shared a decreased sex drive. How could it be that the same pill that liberated my sexual self was also now changing my feel- ings about sex? I didn’t feel like me.”
16
When Helen P took the pill at age eighteen, “I realized it had sucked my sex drive away. I loved the spontaneity of it, compared to condoms, and the se- curity of it, but it got to the point where I was never interested in sex.” She bypassed her health providers, who dismissed her complaints of depression and lowered libido, and went to the Internet. “After some online research, I realized I wasn’t alone in this symptom—nobody had ever told me it was possible— and I went off the pill.”
17
Valerie J was “very sad that a pill that is supposed to make sex easier and safer also makes it less de- sirable.” Her boyfriend “took it as a rejection, that I didn’t find him attractive, even suggested I might be a lesbian (gasp!).”
18
Barbara E simply “hated the pill. It wrecked my body, gave me headaches and eradicated my libido. I suppose that’s another way to prevent pregnancy—having no desire to have sex.”
19
Sally G complained, “Holy Hell. Can you even imagine if a birth control medication for men blunted their libido? There’d be outrage. No no, there wouldn’t, because no drug like that

would be taken by millions of men for most of their lives.”
20
(Her observation, of course, is correct.)

Although today’s pill may not suppress libido more than the original oral contraceptive did, women today may well experi- ence the effects of the pill differently. For many in the first gen- eration of pill users, the intense fear of pregnancy diminished women’s libido to such an extent that when they went on the pill and that fear disappeared, their sexual pleasure increased considerably. Today there is no longer the terror of facing an il- legal abortion, a ruined reputation, banishment to a home for unwed mothers, or a hasty marriage. With legal abortion, the “morning-after pill,” and the easing of the stigma against unwed pregnancy, women have more options and the stakes are not as high. Moreover, today’s young women are more likely to be in tune with their sexuality than those in their mothers’ gen- eration were, many of whom experienced sex outside of mar- riage as secret and shameful, and only came to know their bodies over time within marriage. The sexual revolution opened up more discussion about sex, and the feminist movement en- couraged women to explore and enjoy their own sexuality. With so many contraceptive options available to women today, some are unwilling to compromise their sexual pleasure for the con- venience of the pill. On the other hand, not all women on the pill experience this side effect. According to one report, “As for libido, while some studies show a decreased sex drive, others show an increase.” Just as in their mothers’ day, “a lower chance of pregnancy can be quite an aphrodisiac.”
21

Clearly, the sexual revolution and the feminist movement have had a huge impact on sexual behavior, values, expectations,

and mores. Even so, the double standard, parental disapproval, shame, fear, and secrecy surrounding sex still persist. Susan G explained that as a student from a conservative Southern fam- ily, “I lived in fear of getting pregnant, mainly because it would mean my father knowing I was having premarital sex and that he would disown me.” She went on the pill when she married, and stayed on it after she divorced. Today, the twenty-six-year- old chemical engineer reflects on her contraceptive use: “I think the impact of the pill on my sex life is that it allows me to have one.”
22