27 August 2019

Sexual politics

Pill popping

Its invention was a revelation. But have women fallen out of love with the ‘wonder’ contraceptive?

By Ellie Jacobs

Since May 1960, when the contraceptive pill was approved by the Food and Drug Administration, it has been compared to everything from the jet engine to the internet: not only an invention but a moment of liberation.

The Economist described the pill in 1993 as one of the Seven Wonders of the Modern World. “When the history of the 20th century is written, it may be seen as the first [time] when men and women were truly partners. Wonderful things can come in small packets.”

A pill, half the size of a coffee sweetener, rewrote the laws of biology and the rules of behaviour. Women could have sex for the sheer pleasure of it, without worrying about pregnancy or menstruation.

Naomi Wolf, feminist author of The Beauty Myth, says it allowed women to have a private sexual life. “Before its invention, heterosexual women’s sexuality risked being made public. Pregnancy before marriage ruined the lives and reputations of women of all social classes and made them social outcasts.”

It didn’t just benefit women, says author and activist Soraya Chemaly. “It is often the case that the pill is described as transforming women’s lives, but, in fact, it transformed everyone’s lives. It opened the door to gay and lesbian rights by separating reproduction from sex.”

And, of course, it heralded the Swinging Sixties, the decade of free love that ushered in half a century of a lot more sex for everyone.

But, today, even the pill finds itself drawn into the next generation’s arguments about gender equality. This was clear at a recent – and very lively – Tortoise Thinkin, in which we asked whether a similar contraceptive should be developed for men. You can hear and see highlights from that ThinkIn below; there was no total consensus, but there was a widespread view that the pill has placed unique burdens on women – whether it’s the burden of simply having to take the tablet each day, or the heavier burden that hormonal contraception can place on women’s physical and mental health.

ThinkIn Podcast: Should men take the pill? (10:13)

From the ThinkIn…

“Women do get some really, really awful side effects from contraception, but society has just sort of accepted that that’s what we just have to put up with.”

“I’m so fascinated by the idea that our side effects are measured against being pregnant. To me it seems so strange, it’s like saying ‘do you wanna get, I don’t know, hit by a bus or hit by a train?’ Actually, I just don’t want to get hit by either.” Alice Pelton

“There were two things when I started my career that I wanted to see. One was that we could have proper rail journeys in the north, and I could get to Liverpool faster than I could get to London. And the second was that we might sort out a male contraceptive pill – and I’m going to retire with neither. And I think it’s the same problem, in that I don’t think anyone with power or the ability to make this happen is remotely interested. In terms of the pill, I put this at the feet of Big Pharma.” Professor Allan Pacey

“I would never depend on a man to take the pill…. I’m responsible for if I get pregnant – I’m the one that’s going to be carrying the baby for nine months.” Lindsay Riley

Soon after it first came on the market, the pill became the birth control of choice. In 1955, over half of American women on birth control used condoms or diaphragms. By 1965, five years after it was approved by the Food and Drugs Administration (FDA), over a quarter reported using the pill; 18 per cent reported using condoms, and only ten per cent used a diaphragm.

But not everyone has regarded the pill to be as liberating as it had first seemed in the 1960s. In her memoir The Sixties, the late Jenny Diski, writes that, with the act of sex no longer taboo, it became difficult and “uncool” to resist the men who wanted it. “My guess, no, my certainty is that large numbers of people slept with friends, acquaintances and strangers that they had no desire for…. The idea that rape was having sex with someone who didn’t want to didn’t apply very much in the late Sixties…. I was raped several times by men who arrived in my bed and wouldn’t take no for an answer.”

Susan Brownmiller, author of Against Our Will, also suggests that the pill benefitted men who got sex but abjured responsibility around the act. Once the pill became mainstream, she notes, “at some college fraternity houses the bros would put out a platter of pills for women to take”. In other words, men were using the pill as a means of coaxing – and perhaps even coercing – women into bed for recreation, happy in the assumption that they didn’t need to worry themselves about the consequences as they might have done a few years previously.

There was, of course, the rise in sexually transmitted diseases. In the 1960s, the rates of gonorrhoea soared, as people abandoned the condom – the rates rose even faster for women than for men.

A young couple attend a love-in at Slough, Buckinghamshire in 1967

By the late 1960s, women like Barbara Seaman, author of The Doctors’ Case Against the Pill, exposed the serious and largely unknown side-effects of the high-oestrogen pill, such as blood clots, heart attacks, strokes and loss of libido.

Seaman’s critique inspired the Senate hearings on the pill in 1970. As a result, hormone levels in the pill were lowered significantly and later, inside every birth control pill packet, pharmaceutical companies were required to show patients complete information about the side effects. In the US, the first brand of the combined contraceptive pill, Enovid, contained around seven times the dosage of hormones as they do today, according to the Family Planning Association.

Naomi Wolf says that women have long been conscious of some of the pill’s negative health effects. “In the 80s and 90s, we really knew that it increased risks of some serious diseases later in life and that it affected you hormonally.”

Though millions of women have been using hormonal-based contraceptives for decades, the voices questioning their psychological effects are getting louder. In a report published last year, Femedic, a women’s health platform, found that almost half of the 1,000 British women they surveyed had experienced “serious trouble” with hormonal contraceptives.

It was Alice Pelton’s realisation of the effects that the pill was having on her moods that encouraged her to create The Lowdown. Dubbed the “Trip Advisor for contraception”, anonymous users are asked to list the type of contraception they use, their age, height, weight and whether they have given birth (they can withhold this information if they wish) and the mental and physiological side effects they have encountered. “Just helping people think contraception could be a contributing factor to some of your mental or physical health is what I’m trying to achieve with The Lowdown.”

So far, the site has had over 1,200 reviews and has found that 78 per cent of women report unwanted side effects from their contraception. Pelton herself no longer uses a hormonal-based contraceptive and instead relies on condoms. Has she noticed a change in herself? “I feel a lot calmer, less emotional, a lot more in control of my emotions. I feel frustrated that it cost me all those years of feeling that way.”

Dr Susan Walker, a senior lecturer at Anglia Ruskin University specialising in contraception, has noticed a change too. “In the last few years there’s been quite a lot of chatter about the mood flattening, mood changing effects of the pill. Women are now better informed about the pill and how it works.”

But, despite the concerns, Dr Jane Dickson, Vice President of Strategy at the UK’s Faculty of Sexual and Reproductive Healthcare (FSRH), says that, on the whole, there has not been a vast drop in women requesting the pill. “Our clinics aren’t full of unhappy pill users, they are coming back because it suits them and they are happy taking it. There are also multiple non-contraceptive reasons why people take the pill. It can be helpful for women with PMT, endometriosis and acne.”

What about men? A male pill doesn’t exist but scientists have developed the first male hormonal contraceptive of its kind: the male contraceptive gel. Four hundred and fifty opposite-sex couples around the world are currently trialling a study in which they apply the gel to their back and shoulders each day, to reduce sperm production to low or nonexistent levels.

But Professor Allan Pacey, thinks that it won’t be on the market in his lifetime. “Society isn’t quite ready for it. Women aren’t quite ready for it. Men aren’t quite ready for it. Big pharma isn’t ready for it. We have to climb out of our 1950s prism for it to be accepted. But we are heading in the right direction.”

Further afield, there are those who feel that, unless biology permits otherwise, the ultimate burden will always fall on the child-bearer. In other words, women. In light of this biological fact, can we really ever guarantee reproductive equality? And, if not, would funding be better spent trying to improve the female pill?

After all, it has been a revolution; and, unlike many other revolutions, for the good. Until the pill, women all over the world had struggled to control their reproductive lives, secure abortions and acquire pessaries – primitive versions of the diaphragm – by any means necessary. In Britain, until the Abortion Act was finally passed in 1967, the number of illegal “backstreet” abortions was estimated at between 15,000 and 100,000 a year.

Some prevented pregnancy with devices such as the “Dutch cap” (an early version of today’s IUD), although wearing it could be cumbersome, the broadcaster and peer Joan Bakewell recalls: “It had to be individually fitted by a doctor and you had to carry it around with you or within you to carry on with your sex life. So if you lost it or mislaid it, you risked things. There was the feeling that getting pregnant was something you had to dread and could happen even if you didn’t want it. Then what would you do?”

The pill changed all of that, she says. “The move to something that you could just take everyday was a huge relief. A weight was lifted. You could just have sex. It was unqualified. Psychologically, that was tremendous. Everyone sort of breathed more easily because they knew it was reliable.”

Although it has been almost 60 years since the advent of the pill, the conversation that surrounds it remains divisive. Even beyond reproduction, as Naomi Wolf reminds us, there’s a debate about the pill and menstruation. “A feminist critique of the pill is that it has turned women into kind of sex fembots for the patriarchy. Especially the ‘convenience’ of not menstruating. Who is that convenient for? There was a detailed critique in the 70s and 80s of ‘the curse’ and that menstruation was bad. There was a reclamation of the body’s wisdom and utility in menstruating. That’s been completely lost. There is a new critique to be made about how the pill makes women always available and always artificially pristine from a patriarchal point of view,” she argues. (She stresses, though, that women should be free to do what they want with their bodies.)

Other women take the opposite view, arguing the control over when, whether or not they bleed is one of the ways in which the pill offers greater freedom. Especially now that it is considered safe to have very few bleeds in a year. Pelton reiterates this. “It is important to remember that all periods on contraception aren’t real. A period bleed on the pill is a breakthrough bleed, not actually a real period. So all women who use contraception are stopping their real periods. Lots of people don’t realise that.”

These arguments are important – crucial, even – for the future shape of women’s freedom. But they should not overwhelm the fundamentals. The recent anti-abortion legislation passed in several American states – Alabama, Mississippi, Kentucky, Ohio and Louisiana – serves as a chilling reminder of the ways in which hard-won reproductive rights can be reversed. “Never overstate how fundamental to women’s freedom basic reproductive control is all over the world,” says Wolf. “Women can’t have any other rights unless they have reproductive self-determination. The pill even with all its downsides is the most absolute version of that.”

Photographs by Getty Images

Further reading

When it comes to hearing the voices of women who lived through these changing times, Virginia Nicholson’s How Was It For You? Women, Sex, Love and Power in the 1960s is hard to beat. This social history about sexual revolution and female empowerment also exposes the misogyny that often came as a result of sexual liberation.

Barbara Seamen’s 1969 book The Doctors’ Case Against the Pill offers a critique of the health effects of the initial high-oestrogen pill, which were largely unknown at the time.

Sex and the Single Girl: An Unmarried Woman’s Guide to Men, by Helen Gurley Brown, is a how-to guide to navigating single life as a 1960s woman. It includes chapters on where to meet men, how to cook, do makeup and have affairs. She had originally written a section on contraceptive methods, but that was omitted from the final publication. Gurley Brown went on to become editor-in-chief of Cosmopolitan magazine for 30 years.

For a fictional yet chilling insight into a world in which women are repressed and forced to forgo their reproductive rights, read Margaret Atwood’s dystopian novel A Handmaid’s Tale.

A characterful guide to a seminal decade is The Sixties, by Jenny Diski.

John Guillebaud’s Contraception Today, Ninth Edition is a thorough work on contemporary options for contraceptive care.