America and the Pill: A History of Promise, Peril, and Liberation (19 page)

The loyalty to the pill these women express sometimes re- flects their lack of trust in men. Lucy T explained, “I am super responsible about sex. Within a month of when I started hav- ing sex I was on the pill. . . . I am always prepared. I sometimes even carry a condom in my purse. You can’t rely on guys.”
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Regina H agreed that women often use the pill because they “can’t trust the men in their lives: to respect their sexual and reproductive choices; to take part in the process of family plan- ning; to support women and their children emotionally, mate- rially, and otherwise.”
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Yet some men are willing to share the responsibility, im- proving relationships with their partners. Marianne B felt

closer to her partner because of his participation: “I loved that he was willing to pay for half of the expense of the pills (since he was benefiting also) and knew what time I took them and would help remind me when we were on vacation and I was out of my regular routine.”
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Lorena A found that the pill opened discussion “about honesty and health, and about the impor- tance of communication. It also forced us to have ‘the talk’ about abortion, what we would do if I were to get pregnant. . . . It also opened the door to many a sexual history talk, which is extremely important.”
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While some women noted improved relationships with male partners who took an interest and shared responsibility for birth control, many more described discussions with their female friends. These discussions not only served as a form of mutual education and information sharing, they also deepened female friendships. Lynn E, a thirty-four-year-old librarian married to her first boyfriend and only sex partner, explained, “I have definitely talked about contraception with friends and my sisters from time to time. . . . I guess these sorts of fairly personal conversations are good for relationships since it brings you a little closer.”
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Cassie K works for Planned Parenthood, “so of course I dis- cuss contraception often with my work friends and other, mostly female, friends as well. I’ve found that it’s a way of bonding and feel that it’s very positive to discuss these things in a way that is unembarrassed.”
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Shelley H agreed: “I have discussed contraception methods with close friends in the past. . . . I guess I feel that it makes relationships closer.”
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If the pill was a bonding experience for some women, not taking

the pill could be alienating for others. Alissa S, twenty-eight years old and married for six years, complained, “I feel like a ‘freak’ because I’m the only woman I know who has never taken the pill. . . . I felt [the pill] was so unnatural, and must truly disrupt our bodies. I am afraid of all the weird side ef- fects. . . . I do feel really left out when the conversation comes around to this topic, though. . . . My girlfriends talk about their experiences trying different brands of birth control pills . . . and I kind of just zone out. When I tell other women I’ve never taken the pill they kind of act like I’m from another planet. . . . The choice not to take the pill can be isolating in some situations. But I’m OK with that. I think my ovaries are OK with it too.”
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Sue G was another woman who was unwilling to use artifi- cial forms of contraception. “Cutting off one of my body’s nor- mal, natural functions just does not set well with me.”
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Mandy B “barely felt like a woman” while taking the pill, but after she stopped “I could feel the egg release each month and the com- forting feeling of my uterine walls shedding as well. I felt like a woman again. I felt like my body was doing what it was sup- posed to be doing again.
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Kendra H explained, “There are al- ready so many hormones implanted in our meat and dairy products. Now, when a girl starts having sex, she starts taking the pill, or when a young teenage girl gets a cyst or has a prob- lem getting her period normally—she is automatically pre- scribed the pill, which is a hormone—a strong hormone—that changes the shape and the function of your body.” After she stopped taking the pill, “I feel more confident in knowing that I’m not subjecting my body to hormonal changes that are un-

natural.” Although she is glad to be off the pill, she has not yet found a satisfactory alternative. “I still hate condoms—they’re sticky, gross, smell funny and EVERY GUY has a problem with them. It’s annoying that it always falls on the girl to pro- vide some sort of intervention when it comes to this.”
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One approach that is increasing in popularity with young women who want a natural form of birth control is the Fertil- ity Awareness Method (FAM). Jacqueline G is a FAM enthu- siast. She initially took the pill at the age of twenty-six after an unintended pregnancy and abortion. “For the next two and a half years, my body felt numb, my sexuality dimmed, and my brain felt cloudy and dull.” Then she heard about FAM. Un- like the rhythm method, which is unreliable because it is based on averages, FAM charts the individual woman’s cycle. “I was stunned to hear about scientific birth control that was com- pletely natural and engaged both partners in the method. I

told my husband about the method as soon as I got home, and he was as excited about it as I was. (He was disconcerted by my feelings of separation from my own sexuality.) We both loved how natural the method is.” Together they took an eight-hour course that “pretty much blew our minds. . . . It was a wild ex- perience, to be able to discuss human sexuality openly with other adults, and to be able to ask the ‘stupid’ questions that most of us shared.” They learned how to chart temperatures and analyze cervical secretions to determine scientifically the exact times she was fertile. “Suddenly my fertility wasn’t some- thing wild or uncontrollable, which is how I’d felt after the pregnancy and abortion. . . . It’s true that it requires more ac- tive participation than the pill or condoms alone, but I find it

deeply satisfying to be so attuned to my body’s rhythms and fertility signals.” Now that both she and her husband know when she is fertile, “It erases the dynamic of ‘woman as all- knowing gatekeeper’ and ‘man as ignorant beggar’ when it comes to sex and pregnancy avoidance. It’s like we both learned a new language—the language of my body’s rhythms.” Now, when she sees her doctor, she feels “more empowered to advo- cate for my health. I now feel like I know as much if not more about my body than my doctors. My health is in my hands.”
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Jacqueline G’s rejection of artificial forms of contraception represents the culmination of the women’s health movement and the altered relationship between women and the medical establishment that began when the pill first came on the mar- ket in the 1960s. Today’s women are more knowledgeable con- sumers of contraceptive products, but they do not always have the options they would like. Many expressed frustration at doctors, clinics, and nurses who pushed the pill on them when they wanted other alternatives. Unlike their mothers, who may have had difficulty getting access to the pill if they were not married, many single women complained that they are pre- scribed the pill regardless of their preferences for other forms of contraception. Rebecca H experienced side effects from the pill, but when she requested an IUD from a local clinic she was told it was not appropriate for women who had not had chil- dren. “So I left [the clinic] feeling demoralized, dejected, and without any options. They practically threw a new prescription for pills at me.”
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Anita B was even more perplexed that she was offered a prescription for the pill, since she is not at risk of getting preg-

nant. As she explained, “I am a femme who partners with fe- male-bodied, masculine-identified partners (butch women and transgender men), although I have had sexual relationships with biological males in the past. My current partner is fe- male. . . . Despite the fact that I have partnered exclusively with female-bodied partners for the past four years, health care providers have repeatedly offered to prescribe the pill for me. They often ask what form of birth control I am using, and sug- gest the pill, AFTER I have told them that my partner is fe- male.” She notes that women who appear masculine face the opposite problem. “My butch partners have never been offered the pill; in fact, some of them have been discouraged from seeking routine gynecological care (told that they don’t need it). . . . It is also a reminder that my feminine appearance makes my sexual orientation suspect. Health care providers want to prescribe the pill because I LOOK like someone who could— and should—have a male sexual partner. I am young, feminine, fit, and perceived to be fertile, and the medical establishment is eager to regulate my fertility. They have no interest in the fer- tility of my partners, who have all the same female ‘parts’ but are often mistaken for men on the street.”
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While some complained about health professionals foisting the pill on women who do not want or need it, others ex- pressed outrage at measures that allow health care providers and pharmacists to refuse treatments and products if they have religious or ethical objections. These “conscience clauses” came into effect in the 1970s after
Roe v. Wade
to allow doctors to refuse to perform abortions if they are morally opposed to it. In 2008, George W. Bush expanded the “conscience clause”

provision to allow pharmacists to refuse to fill prescriptions for birth control pills or emergency contraception. Just after taking office, President Obama reversed the Bush expansion.
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The women who responded to the Internet survey over- whelmingly and vehemently asserted their demand that the pill, and all other contraceptive options, be available, accessible, and affordable to all. Katie M fumed, “I’m completely pissed off and freaked out that there’s been a growing trend of mi- sogyny and ‘conscience clauses’ that allow pharmacists to re- fuse to fill legal birth control prescriptions.”
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Krista A insisted, “It’s not the pharmacists’, priests’, pastors’, protesters’, or any- one else’s business what I take ANY medication for.”
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Amy K was astonished to discover that her doctor would no longer prescribe contraceptives. “To me, birth control has always been a good and safe option. I have never thought it to be immoral or unethical, and it has always been presented to me as a good thing. I never realized how strong my opin- ions actually were until a few years ago I received a letter from my family doctor saying that he is refusing to prescribe birth control to his patients and would use natural family planning instead. I was livid. . . . Who was he to limit the choices of his patients?”
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Others encountered more subtle roadblocks to access, par- ticularly for the morning-after pill. This pill is a form of emer- gency contraception that can be taken after unprotected sex. Since the 1970s, doctors and their patients have known that an increased dose of oral contraceptives taken after intercourse can prevent an egg from being fertilized. In the late 1990s, the FDA approved two morning-after pill compounds, Plan B and

Preven, for use as emergency contraception with a doctor’s prescription. Since 2004, the American Academy of Pediatrics and the Society of Adolescent Medicine have urged the FDA to allow women and girls as young as fourteen access to the morning-after pill without a prescription. But the proposal faced opposition from religious conservatives, abortion foes, and the Bush administration. Efforts to make the morning- after pill available over the counter were thwarted until 2006, when the FDA approved sale of the drug to women eighteen or older. In 2009, seventeen-year-olds gained access to over- the-counter emergency contraception.
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The issue of access and availability is all the more pressing for the morning-after pill, when time is of the essence and the stakes are high. Krista A noted, “Morning-after pills are a great way to make sure a single night of passion doesn’t ruin a woman’s life.”
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But emergency contraception can still be dif- ficult to obtain, even for those who are legally eligible to buy it without a prescription. Cathy P recounted a frustrating ef- fort to secure the morning-after pill. “They claim it’s sold ‘over the counter,’ but I still had to go stand in line at the pharmacists counter just to ask for permission to buy it. I wouldn’t have minded doing that, but I had to go to six dif- ferent pharmacies . . . before finding one that had emergency contraception in stock. . . . I understood when I was told the first time, ‘Sorry, we’re out of stock.’ But five times?! Maybe there was a freakish epidemic of careless sex and coincidental condom breakage the night before . . . but I have my doubts.” When she finally found a pharmacy where she was able to ob- tain it, she was humiliated when “a random guy did some lame

little catcall in passing. Ugh. I had the overwhelming urge to just turn around and lash out at him while waving that box of Plan B in his face like a crazed lunatic. But I just kept walking.”
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These stories and commentaries of encounters with the pill illuminate the many ways women’s lives have changed. More than simply an effective means of birth control, the oral con- traceptive has played a central role in women’s sexuality, rela- tionships, political beliefs, and identity. Whether they love the pill or hate it, whether they faced parental opposition or sup- port, whether single or married, whether religious or not, their testimonies reflect the profound ways in which the pill has be- come embedded in both public and private life.

Conclusion

When the history of the 20th century is written, it may be seen as the first when men and women were truly partners. Wonderful things can come in small packets.

The Economist,
naming the birth control pill one of the Seven Wonders of the Modern World, 1993.
1

A

fter fifty years on the market, has the pill fulfilled the utopian dreams it inspired in 1960? The answer is yes and

no. The pill did not solve what many at the time saw as the most pressing problem facing the world: the population explo- sion. Nor did it put an end to war or poverty. It did not eradi- cate unhappy marriages, unwanted pregnancies, abortions, or unwed motherhood. It was not the magic pill that would pre- vent pregnancy with no side effects or health risks. It did not unleash a sexual revolution or alter the sexual habits of the un- married. The pill was not the pharmacological engine for any