The birth of a new century came and went, but one more millenianial celebration remains – the 40th anniversary of the birth control pill.
The pill, which is the colloquial name for oral contraception, is the most popular form of reversible birth control for American women under the age of 35. When taken correctly and consistently, the pill is reported to be 99 percent effective in preventing pregnancy. Certain variations on the drug have even been effective in preventing conception, after sex. But as early as its 1960 debut, the pill began a swirling controversy about the morality of its use that continues today.
John Rock, one of the inventors of the pill and a devout Catholic, spent his life trying to reconcile his faith with his science.
The Roman Catholic Church is a longtime protestor of all medical forms of birth control, calling contraception unnatural and claiming it opposes God’s will.
Today Church leaders continue to encourage unmarried couples to remain abstinent, and married ones to practice a non-medical form of birth control known as the rhythm method. The rhythm method requires that a couple only have sex during safe periods when a woman is not ovulating and thus unlikely to conceive. Most doctors agree that the approach, also termed family planning by periodic abstinence, is not as effective as the pill.
When the pill was launched, Rock said his creation was as natural as the rhythm method, according to a March 13 story in The New Yorker examining Rock’s scientific contribution.
According to Rock, the pill simply adjusted the level of a naturally produced hormone in a woman’s body to keep her eggs unfertilized. The hormone progesterone, a key component in the pill, prevents another egg from releasing and threatening the already fertilized egg. The pill also regularized women’s menstrual cycles by conforming them to a standard 28 days. Rock offered this as further proof of his drug’s naturality.
But the concept of birth control was immersed in controversy long before Rock and his colleagues ever developed the pill.
Margaret Sanger, a nurse and birth control advocate in the early 20th century, attacked the U.S. Comstock Law, which outlawed the importation or distribution of any device, medicine or information designed to prevent conception or induce abortion. The law also prohibited people, including doctors and nurses, from mentioning or printing the names of sexually transmitted diseases.
The case against Sanger for publishing information about birth control was dropped in 1916. Around the same time, she again gained notoriety with the government by establishing the first birth control clinic in Brooklyn, N.Y. As a result, Sanger was charged with maintaining a public nuisance.
Sanger spent some time in jail for promoting birth control, and she devoted her life to fighting for the reproductive rights of women.
The problem of birth control has arisen directly from the effort of the feminine spirit to free itself from bondage, Sanger wrote in the pamphlet Birth Control – A Parent’s Problem or Woman’s? Woman herself has wrought that bondage through her reproductive powers and while enslaving herself has enslaved the world. The physical suffering to be relieved is chiefly woman’s. Hers, too, is the love life that dies first under the blight of too prolific breeding. Within her is wrapped up the future of the race – it is hers to make or mar. All of these considerations point unmistakably to one fact – it is woman’s duty as well as her privilege to lay hold of the means of freedom.
How the pill works
In Sanger’s day, douches, condoms, sponges and vaginal suppositories were popular forms of birth control. Nowadays, more than 80 million women worldwide take oral contraception, according to an Oct. 8, 1999, Family Health International article. Yet myths and misperceptions about the pill continue to prevail, even after almost half a century.
One myth, which was particularly prevalent in the early days of the pill, is that women who take birth control pills are loose or easy. But in fact, many women on the pill are married or in monogamous relationships and use the contraceptive to plan when and if they will have children, according to a 1996 report published by the Planned Parenthood Federation of America.
Women also take birth control pills for reasons besides preventing pregnancy. Many consumers of the pill take the medication to regulate their periods or minimize the risk of obtaining certain diseases.
According to Planned Parenthood, taking the pill offers some protection against pelvic inflammatory disease, which commonly leads to infertility, ovarian cysts and ovarian cancer. Women minimize their risk of experiencing rheumatoid arthritis, iron deficiency anemia and, with some brands, acne.
Birth control pills are broken into two categories – combination pills and minipills. Combination pills contain estrogen and progestin, a synthetic form of progesterone, while minipills are only progestin.
Minipills also are taken daily, but they work by reducing and thickening cervical mucus to prevent sperm from reaching the egg, according to the April 1997 Federal Drug Administration Consumer. These pills also prevent the uterine lining from thickening but are slightly less effective than combination pills, according to the Consumer.
On the other hand, combination pills work by suppressing ovulation, the monthly release of an egg from the ovaries. These pills are either constant or phasic, meaning the amount of progestin and estrogen mimics the natural cycle more closely.
Most combination pills are purchased in 21-day or 28-day packages. With 28-day packs, women take placebos during the week of their period and in 21-day packs, they stop taking the pill for the last seven days of the menstrual cycle.
Side effects of the pillDoctors warn that the pill is only effective when used properly. According to Family Health International, the four most common pill-taking errors are starting a pack late without using a back-up contraceptive method, taking pills out of order, interrupting daily use for any reason and failing to use additional back-up contraception when two or more pills are missed.
Women should take the pill correctly and, preferably, at the same time every day to secure the highest protection against pregnancy. If a woman misses two or more pills in a row, she should use a back-up contraceptive method until she has been taking active, hormonal pills again for at least seven days, according to Family Health International.
The pill also has side effects, especially when women first start taking the hormones. Side effects include nausea, headaches, breast tenderness, weight gain, irregular bleeding and depression. In the April 2000 issue of Marie Claire magazine, writer Kelly James-Enger offered advice about how to reduce side effects.
She wrote that women who experience nausea, breast tenderness, weight gain, irregular bleeding and depression can try low-dose pills. If problems are severe, they might consider taking minipills, which usually produce fewer side effects. Women also can prevent nausea by taking the pill along with dinner or a snack, Enger added.
Unlike the early versions of the pill, today’s pills have lower hormone doses. Susan Haney, outreach coordinator for GW Student Health Services, said these lower doses result in fewer side effects. But some women are better candidates for the pill than others.
Who should take the pill
Haney said non-smokers under the age of 35 are the prime candidates for taking birth control pills. The most serious complications that the pill produces in some people are cardiovascular difficulties. Specifically, some pill users are at risk for high blood pressure and blood clots in the veins.
Smokers have a high risk of developing these cardiovascular complications because nicotine constricts the veins and thickens the blood, making clots more likely. Those over the age of 35 are also at risk because the cardiovascular system begins to slow down.
Haney said monogamous women are b
etter candidates for the pill because oral contraception prevents pregnancy but fails to protect against sexually transmitted diseases. Women on the pill might want to use back-up contraception like a condom to prevent sexually transmitted diseases, in addition to pregnancy.
(The pill) is a good choice because of its effectiveness rate, Haney said. I think it’s a good method.
Emergency contraception increases
Taking higher doses of birth control pills is also used as emergency contraception when women are trying to prevent a pregnancy after having sex. When the pill was first introduced, the Federal Drug Administration refrained from approving higher doses for the purpose of preventing a pregnancy after sexual activity.
But the morning-after pill is essentially the equivalent of numerous higher-dosed birth control pills in one drug. In recent years, FDA approval of the morning-after pill made emergency contraception more available to women.
GW has offered emergency contraception for several years now, and campus health care officials have seen an increase in the number of women who want to take emergency contraception, Haney said.
She said this increase is indicative of students taking more responsibility for their behavior and is a positive sign.
We hope it’s a reflection of students getting educated about emergency contraception, Haney said.
Student Health is incapable of starting women on the pill because the organization could not handle the volume of women who require yearly gynecological exams. But students can get exams at reduced rates and prescriptions for birth control pills from GW Hospital’s OBGYN department by calling Student Health.
We’re hoping to be supportive, Haney said.