HEALTH

The birth-con­trol pill is no longer be­ing hailed as the con­tra­cep­tive holy grail. But what is?

Elle (Canada) - - Contents - By Joana Lourenço

Why are women abandoning the pill?

half a cen­tury ago, the ar­rival of the birth­con­trol pill marked a defin­ing mo­ment in the women’s-lib move­ment. “The pill” was po­si­tioned as a mir­a­cle drug that of­fered the bod­ily au­ton­omy we so desperately craved. Women were free to lead dream ca­reers— and make their way into se­ri­ously se­nior po­si­tions—with­out wor­ry­ing about a baby in­ter­rup­tion. It worked to­ward lev­el­ling the play­ing field with men in the work­place. And there’s no denying the pill’s ef­fec­tive­ness (99 per­cent when used cor­rectly) and con­ve­nience, with­out which many women wouldn’t be able to lead—and en­joy—their cur­rent life­styles. Hav­ing con­trol over the re­pro­duc­tive cy­cle is what women have al­ways loved about the pill. But now, some women are turn­ing to dif­fer­ent ways of pre­vent­ing preg­nancy to re­gain con­trol over their bod­ies. Whether they’re shun­ning hor­mones, look­ing for free­dom from daily pill-pop­ping or seek­ing longer-act­ing re­versible forms of birth con­trol, a small but sig­nif­i­cant num­ber of women are look­ing for change once again.

The pill is popular, but pre­scrip­tions for oral con­tra­cep­tives have slightly dropped in Canada over the past five years, ac­cord­ing to fig­ures from phar­ma­ceu­ti­cal-in­dus­try an­a­lyst IMS Health. Dr. Dustin Costescu, an as­sis­tant pro­fes­sor and fam­ily-plan­ning spe­cial­ist in ob­stet­rics and gynecology at McMaster Univer­sity in Hamil­ton, Ont., has seen this shift in his own prac­tice. “Those on the pill still make up the majority of re­versible-birth-con­trol users,” he says, h

“but that num­ber is start­ing to de­crease as peo­ple take up other meth­ods, in par­tic­u­lar the in­trauter­ine de­vice.”

In some cases, women are turn­ing to nat­u­ral, sus­tain­able choices for not only their own bod­ies but also the planet. “Women are ques­tion­ing the im­pact of th­ese hor­mones on the earth, par­tic­u­larly the way in which es­tro­gens in our wa­ter sys­tem af­fect marine habi­tat and wildlife,” says Costescu. “But as a fem­i­nist, I cau­tion that our pro­tec­tion of the en­vi­ron­ment shouldn’t come at the ex­pense of pro­vid­ing good birth-con­trol op­tions for women.” He notes that ef­fec­tive­ness is still the most im­por­tant rea­son why a woman chooses her birth con­trol. “There are great op­tions on the mar­ket now that are very ef­fec­tive and hor­mone-free.”

This dis­trust of hor­mones is a big fac­tor for women who are look­ing for al­ter­na­tive birth-con­trol meth­ods, but there are other rea­sons for ditch­ing the pill. One has to do with re­claim­ing a sense of au­ton­omy from the med­i­cal es­tab­lish­ment. Crit­ics of the pill ar­gue that physi­cians in North Amer­ica de­fault to a one-size-fits-all ap­proach to women’s health care. “The tra­di­tional prac­tice among clin­i­cians is that you start a pa­tient on the pill and then if she is un­happy, you move on to some­thing else,” says Costescu.

It’s easy to for­get what a pow­er­ful drug the pill re­ally is, be­cause it’s so eas­ily and fre­quently pre­scribed. “It’s ba­si­cally seen as tak­ing an As­pirin,” says Holly Grigg-Spall, the Los-An­ge­les­based au­thor of Sweet­en­ing the Pill or How We Got Hooked on Hor­monal Birth Con­trol. She calls it the “sa­cred cow” of the med­i­cal in­dus­try, a medicine beyond re­proach. So while the pill has dom­i­nated the scene for the past 50 years, word has spread about a va­ri­ety of highly ef­fec­tive forms of birth con­trol. Here’s what else is out there. THE IN­TRAUTER­INE DE­VICE The IUD, a small T-shaped de­vice in­serted in the uterus to pre­vent preg­nancy, is mak­ing a come­back in Canada. A 2009 study led by Dr. Sheila Dunn, the re­search and pro­gram di­rec­tor for the Bay Cen­tre for Birth Con­trol in Toronto, de­ter­mined that IUD-in­ser­tion rates in On­tario have been in­creas­ing since 2001, par­tic­u­larly among women aged 25 to 39. “Cer­tainly, there’s more knowl­edge of th­ese de­vices than there used to be, and we’re putting in more of them than be­fore,” says Dunn. Hor­monal IUDs, like Mirena, pump out a low dose of pro­gestin; cop­per IUDs, on the other hand, work be­cause the cop­per cre­ates a toxic en­vi­ron­ment for the sperm. Nei­ther type re­leases es­tro­gen, the hor­mone that’s mostly im­pli­cated with health risks such as blood clots, heart at­tacks and strokes. That makes them a good al­ter­na­tive for women wor­ried about the health risks as­so­ci­ated with the pill.

Note: The cop­per IUD can also be used as an emer­gency con­tra­cep­tive. It works up to seven days after un­pro­tected sex, and, un­like the morn­ing-after pill, such as Plan B, it’s ef­fec­tive re­gard­less of a woman’s weight. (Plan B may be un­re­li­able for women who weigh more than 176 pounds.) h

JUSTISSE The side ef­fects of the pill have been ques­tioned since the drug was in­tro­duced to the Cana­dian mar­ket in 1961. Th­ese in­clude an in­creased risk of some can­cers and var­i­ous mood dis­or­ders and a lack­lus­tre libido. (It’s well known that the drug al­ters lev­els of testos­terone hor­mones that can, in turn, al­ter your sex drive.) Sim­ply put: Some women just don’t want to take hor­mones day after day.

Amy Sedg­wick, a holis­tic re­pro­duc­tive health prac­ti­tioner, is one of those women. She ditched the pill 10 years ago due to un­wanted side ef­fects and now re­lies on Justisse, a fer­til­ity-aware­ness method that re­quires women to track their basal body tem­per­a­ture and cer­vi­cal mu­cus. (Sex dur­ing fer­tile days re­quires backup birth con­trol, such as con­doms.) Since co-found­ing the Red Tent Sis­ters—an on­line re­source of­fer­ing ed­u­ca­tion about nat­u­ral birth con­trol and sex­u­al­ity—Sedg­wick has seen a grow­ing de­mand for in­for­ma­tion on non­hor­monal meth­ods. “We opened in 2007, and at that time the work I was do­ing was pretty ob­scure,” she says. “But now this whole topic is in more women’s con­scious­ness.” Sedg­wick be­lieves that the pill pre­vents body lit­er­acy. “I knew noth­ing about how my body worked un­til I came off the pill and started learn­ing about fer­til­ity. And I have a health-sciences de­gree.” Grigg-Spall agrees: “When you learn how your men­strual cy­cle works and what it means to ovu­late, you’re re­ally com­ing from a place of em­pow­er­ment and in­formed choice. If, after learn­ing all that in­for­ma­tion, you then de­cide to take the pill, that’s great.” WITH­DRAWAL Many women who want to go the nat­u­ral route use the fer­til­ity-aware­ness method, but it takes a huge amount of self-con­trol on your part­ner’s part—and trust on yours—for this form of birth con­trol to work. In 2009, 11.6 per­cent of women re­ported re­ly­ing on the with­drawal method to avoid preg­nancy, ac­cord­ing to a Cana­dian Na­tional Con­tra­cep­tion survey. But it can back­fire: About 19 per­cent of cou­ples who “pull out and pray” may find them­selves dec­o­rat­ing a nurs­ery. n

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