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The opioid epidemic that has ravaged the U.S. population over the past two decades has created a healthy dose of cynicism toward pharmaceutical companies, given the role that greedy drug manufacturers and dishonest medical providers played in fueling the crisis. Now, that cynical eye is being turned on the contraception industry and the ethics of widely prescribing birth control given its potentially life-altering side-effects. Women who rely on some form of artificial contraception are increasingly sharing stories about the unexpected, sometimes devastating, side-effects. They admit to feeling duped by medical providers who warn them about migraines, nausea, and weight gain, but not about suicidal ideation, blood clots, and embolisms. Medical providers, meanwhile, are influenced by billion-dollar drug companies and political pressure to widely prescribe birth control.

Artificial contraception has been regarded as a hallmark of women’s empowerment, touted as a human right by both governments and non-governmental organizations. Planned Parenthood, a government-funded non-profit, issued a press release in 2015 entitled “Birth Control Has Expanded Opportunity for Women” and detailed its impressive benefits. It is brandished as a source of “economic empowerment,” enabling salary gains that consequently narrowed the wage gap between the sexes. It also increases “educational opportunities,” enabling women to pursue higher levels of education, including advanced professional degrees. Further, the growing phenomena of women as the primary bread-winners in households with children is also attributed to the rise in usage of birth control.

And it is true that birth control, when administered correctly, is mostly effective in avoiding pregnancy. The website of the American College of Obstetricians and Gynecologists provides a breakdown by type: IUDs and implants are most reliable, the birth control pill, injections, and patches slightly less so. But none of these methods is without potential side-effects. Some of them are relatively mild, others dangerously debilitating.

Jagged little pill

In her 2013 book Sweetening the Pill, feminist author Holly Grigg-Spall asks, “Why can’t we criticize the Pill?”

Depression, anxiety, paranoia, rage, panic attacks—just a few of the effects of the Pill on half of the over 80% of women who pop these tablets during their lifetimes. When the Pill was released, it was thought that women would not submit to taking a medication each day when they were not sick. Now the Pill is making women sick. However, there are a growing number of women looking for non-hormonal alternatives for preventing pregnancy.

Grigg-Spall’s book has been turned into a documentary with the help of Ricki Lake and Abby Epstein, which is due out this year. It’s called the Business of Birth Control, and it couldn’t be more timely.

Just last year, a Citizen’s Petition on Hormonal Contraception was made to the Food and Drug Administration (FDA) requesting “more transparency and patient warnings regarding potential side effects for different forms of hormonal contraceptives.” Citing a variety of studies, as well as extensive research and statistics, the petition outlines the adverse side-effects left unaddressed by pharmaceutical companies and medical providers alike. The list of unaddressed potential side-effects is alarming, including “increased risk of developing Multiple Sclerosis (MS), a higher risk of bone fractures, a significantly increased percentage of fat body mass (which in turn can lead to diabetes and cardiovascular problems), and increased risk or urogenital problems including urinary tract infection, Female Sexual Dysfunction,” and more. The petition highlights in particular the dangers of the hormonal injection Depo Provera and requests that it be completely removed from the market as it is “now known to increase the transmission of an often-fatal viral infection (HIV/AIDS).”

Women who commented on the petition shared personal stories of developing cancer, autoimmune diseases, and blood clots. Others shared stories of loved ones killed by a birth control drug. One mother wrote: “2 years ago, my daughter died from a blood clot in her brain caused by the birth control Yasmin. It was prescribed to her for acne and she believed it was safe. She had no risk factors, no clotting disorders.” Another woman wrote of losing her daughter to embolisms caused by the NuvaRing. One man wrote of losing his daughter to a massive pulmonary embolism (MPE) that she developed while on the Lutera pill, another of losing his daughter to thrombosis caused, once again, by the NuvaRing.

The potentially nightmarish side-effects of the birth control pill do, on rare occasions, receive attention in the mainstream media. The Guardian has published some articles by Grigg-Spall over the years. In 2018, the BBC produced a video, as part of a special series on how men and women experience the medical system differently, in which women from around the globe discussed their traumatic experiences with the hormonal birth control pill. One testimonial described suffering severe anxiety attacks which continued even after she was prescribed an anti-anxiety medication. She went to nine different neurologists who prescribed her 32 different medications over the course of two years. In her own words, “I asked every time, does the Pill have anything to do with anxiety or depression? And no one said anything about it, not any of the psychologists, therapists, or gynecologists.”

Complications from intrauterine devices (IUDs), meanwhile, have inspired a movement of their own, with platforms like IUDalert sharing women’s experiences with copper or hormonal IUDs. Reactions to the devices range from severe depression to debilitating pain to suicidal ideation, with some users describing how the insertion of the device into the uterus proved incredibly painful, resulting in heavy bleeding that lasts weeks to months. One user, Naomi, wrote a testimonial for the website in which she says she “bled every day for almost a whole two years.” Another user shared that she had “pain so severe I couldn’t go to my job or participate in normal activities.” This wasn't the only woman who mentioned the birth-control device affected her ability to work; another shared, “I noticed my sense of intelligence was diminishing, I was no longer contributing to discussions as expected at official meetings. I had low energy, too, and felt withdrawn from my job, which I used to be passionate about!” Another woman, Andrea, shared that she ended up having a hysterectomy after the IUD wrecked her mental and physical health. Compounding her suffering were the reactions of medical professionals when she described her newfound symptoms ranging from hair loss to suicidal ideation. She describes feeling “ignored by the doctors” who made her feel that she “was making it up.” 

Pill-taking teens

Amplifying the problems of dangerous side-effects and under-informed medical providers is the fact that pubescent girls are often prescribed birth control. Even if not sexually active, teen-aged girls are regularly prescribed some form of the pill to combat acne, heavy periods, or painful cramping. As a result, about 18 percent of teenage girls in the United States are taking the pill. Now, a research team at the University of Ottawa is studying the effects of oral contraceptives in pubescent and teenage girls and its possible role in the development of mood-related disorders like depression and anxiety. The fact that a 13-year-old taking birth control for breakouts is probably not psychologically equipped to deal with the potentially brain-altering effects of the drug is an ethical dilemma that neither American pharmaceutical companies nor medical providers have yet confronted.

At the same time that the United States contraceptive manufacturers fail to properly warn medical providers and consumers about birth control’s side-effects, they dominate the contraceptives market. Having generated $7 billion in revenue in 2019, they are projected to reach an astounding $9.6 billion by 2027. In other words, birth control is big business, and as such should be regarded with scrutiny. In fact, just last year, Bloomberg Business reported that a far less dangerous sort of birth control does exist, in the form of a gel applied an hour before intercourse that does not interact with the female hormonal balance. But, it will likely never be marketed to consumers, the article reports, because its “low price . . . could limit drugmakers interest.” The drug, called Amphora, has yet to be approved by the FDA despite publishing its first clinical trials in 1999.

If pharmaceutical companies have big financial motives to push the Pill, it seems that at least some medical providers do too. A 2018 CNN analysis of federal data showed that Bayer Pharmaceuticals “paid 11,850 doctors $2.5 million related to Essure,” a device similar to an IUD that is meant for female sterilization. A patient safety expert at John Hopkins Medicine commented on the transaction, saying, “That looks like a bribe. That looks like gaming the system. That looks like the pharma company is paying off doctors.” (Essure was soon discontinued after the FDA raised concerns about the device’s association with “serious risks including persistent pain, perforation of the uterus and fallopian tubes, and migration of the coils into the pelvis or abdomen.”) An expert in pharmaceutical regulations affirms the pervasiveness of these controversial transactions, stating that drug manufacturer payments to medical providers is a practice “consistent across numerous drug specialties and drug types, across multiple different fields of medicine. . . . No specialty is immune from this phenomenon.”

There is a growing discrepancy, it seems, between the watered-down information offered by organizations like Planned Parenthood that vaguely acknowledge that birth control can have side effects but then quickly assures us that “many people use the pill with no problems at all” and the personal testimonies of those whose lives have been irreparably damaged by the drug. The growing number of women coming forward to share the debilitating side-effects of artificial contraception express a common refrain: not only are they traumatized by the life-changing effects of the drug, they feel that medical providers—whether the prescribing doctors or the psychological and neurological professionals to whom they turn for help—are ill-equipped to help them. For these patients, women’s health becomes a secondary concern when those controlling the drug market are overly influenced by financial interests. Still, women are making their voices heard, challenging disappointing standards with petitions, platforms, and documentaries—all calling for a more ethical approach to family planning.