During my senior year of college, I slumped down in the car while my boyfriend walked into the pharmacy to buy Plan B. I was horrified by the idea that I might see someone I knew, and when he suggested the morning after pill, I didn’t know whether to say “yes” or “no.” So I agreed, and every second I sank lower and lower in my seat in case someone walked by. Somewhere underneath my embarrassment, I wasn’t happy with the decisions I was making, including this one. But I didn’t feel like I could do anything about it.
I grew up in a conservative Christian home and attended a conservative Christian college. I imagined that if I told anyone about my experience—whether to receive emotional support or health care advice—I would simply be shamed. I couldn’t talk to my partner about it because I felt that he shouldn’t be burdened with my anxiety, though this was likely a cover for my true fear: that he wouldn’t understand or empathize. As the one who had suggested that I take the morning-after pill, he was already biased toward one side. ‘
After I took the pill, I had the heaviest bleeding of my life—a week before my period was due. I was cramping, confused, and, it seemed, utterly alone. Nothing happened the week I was supposed to begin my period, and I began to wonder if I was pregnant after all. I had no understanding of the intricacies of my own cycle, and even less knowledge about how Plan B worked. When my period began more than a week later, I never wanted to go through this process again.
My story is not unique. If you’re a woman in your twenties, chances are you know someone who’s taken the morning-after pill. At least one out of ten women have used Plan B or its equivalent at least once, according to a 2013 report. (Half of the respondents said they worried their birth control method failed, and half said they had unprotected sex.)
Even if you think you don’t know someone who has used emergency contraception, it’s likely someone you know has thought about using it. Research by one emergency contraception brand showed that nearly a third of women who wanted to take the morning-after pill were too embarrassed to tell even their pharmacist. (According to that research, the number of women who had taken the morning after pill was as high as 27 percent of women aged 18–35 years.) Or, maybe you know someone like me, who used Plan B and never told anyone because she wishes she hadn’t—and wishes she hadn’t felt so alone.
When women are using Plan B, often they’re choosing it because it seems like the only option. The trend among most media outlets and many health professionals is to respond to these statistics by arguing that the pill should be more accessible. But is accessibility really the problem? Why has this hormonal medication become so popular in the first place? And what if there’s a better solution for women?
What is the “morning-after” pill?
The morning-after pill contains the hormone levonorgestrel, and you’ll hear about it most often by its brand name: Plan B One-Step. The pill is meant to be taken within the first 72 hours after unprotected sex to prevent pregnancy. It prevents or delays ovulation and thickens mucus to slow sperm travel. The pill is available over the counter at most pharmacies, and there is no longer an age restriction for buying it.
The morning after pill has caused controversy over whether it triggers an abortion by creating an inhospitable womb for a fertilized egg. Some recent research indicates that all Plan B and similar products do is prevent ovulation, not implantation of a fertilized egg. Not everyone, however, is convinced.
“If we look at the basic biological act of conception, typically if the woman is already ovulating, conception takes less than an hour,” one health professional, Leah Jacobson, told me in an interview. Jacobson is the founder of the Guiding Star Project, a network of women’s health centers that serve as a “holistic healthcare alternative” to mainstream women’s medicine. “What they’re really doing,” she says of Plan B’s proponents, “is redefining conception.”
Jacobson is referring to the fact that in the United States, the start of pregnancy is no longer defined as “sperm meets egg”—when an egg is fertilized and a unique person’s DNA results. According to the American College of Obstetricians and Gynecologists (ACOG), pregnancy doesn’t officially begin until implantation, which can happen up to ten days after conception. So, by preventing implantation, Plan B may cause the destruction of a fertilized egg that hasn’t yet been implanted. This makes the “preventing pregnancy” claim more a battle about semantics than biology. “For Plan B to say that it prevents conception,” Jacobson says, “it’s either trying to be deceptive, or it’s trying to completely redefine the biological process of becoming pregnant.”
Months after taking Plan B, when I found an article online stating that Plan B could act as an abortifacient, I showed it to my boyfriend in horror. Without offering any counter argument, he was quick to dismiss my concerns. This confirmed what I had been afraid of—that I really was going to have to figure out what decisions to make in the future without my partner’s help. That was one of many red flags.
What’s wrong with Plan B, exactly?
Beyond the ethical question about how exactly it works in preventing pregnancy, Plan B poses other ethical problems. A reliance on women taking drugs to stop pregnancy reveals a cultural bias that women are expected to shoulder the greater burden in intimate relationships. As Destiny Herndon-De La Rosa, founder of the pro-life women’s group New Wave Feminists, told me,
“Men see [Plan B] as a magic eraser that can be used after the fact. . . . We put the burden of fertility on the woman’s shoulders, so it becomes her body that has to deal with the consequences of something that’s rather abrasive to her system.”
In my case, it was easy for my boyfriend to recommend Plan B—it would get him off the hook, and I would be the only one experiencing the physical and emotional consequences.
And those consequences are significant. Side effects of Plan B include nausea, vomiting, dizziness, fatigue, headache, breast tenderness, heavy bleeding during or even before your next period, and cramps. Not to mention that as a hormonal drug it can alter your menstrual cycle, hormones, and emotions. It’s far from natural, and my experience made me realize there are other, less drastic, ways to prevent pregnancy.
True feminism, as Herdon-De La Rosa argues, requires both sexes equally sharing the burdens of pregnancy.
What’s the alternative?
Part of what Jacobson hopes to teach young women through the Guiding Star Project (which you can read more about in this Verily article) is greater knowledge of their fertility cycle. The group hosts events to teach girls as young as nine about their menstrual cycles, aiming to empower them to make the best, healthiest choices for themselves. “There’s a sense of genuine bodily autonomy,” she says, “where they actually know what is happening in their bodies so they can protect and defend it.”
For a woman who knows she had intercourse during an infertile part of her cycle, for instance, it won’t even be on her radar to consider taking an abrasive cocktail of synthetic hormones such as Plan B. Herndon-De La Rosa says, “Most of the women I know who take Plan B have no clue what their cycle is.”
It’s also important to note that whether or not you have a partner, understanding the functioning of your body can help you understand your moods and hormone levels and make choices accordingly. And this isn’t just about being aware of when you’re PMS-ing. “When you’re having a natural cycle,” Jacobson says, “you can have amazing bursts of creativity and energy.”
Your cycle doesn’t have to be a mystery
Since I learned how to chart my cycle, I feel so much more self-aware of when I can get pregnant, and all the previous uncertainty—and fear that comes with uncertainty—is gone.
I learned that each woman’s cycle can range from 21 to 40 days, making fertility prediction difficult if you’re not aware of how your own body works. By learning a Fertility Awareness-Based Method (FABM) from a certified instructor, you can know with precision when you are fertile based on your body’s signs.
The average cycle is 28 days long, but most women fall under or over that range. Your cycle begins on the first day of your period and ends when your next period starts. Women typically menstruate for 4 to 8 days (whoever out there is only bleeding for four days—share your gifts with the rest of us!).
During this period (see what I did there?), follicles, each containing an egg, develop on the ovaries. When one follicle remains and the others are absorbed into the ovaries, the period is typically over, and the body begins to build back the uterine lining and to prepare to release the egg. Around day 14, the woman ovulates (releases the egg). During the next week and a half or so, the egg travels toward the uterus and the uterine lining continues to thicken. If the egg is unfertilized, it breaks apart, and the cycle begins again.
This may sound like basic health-class stuff, but it’s important to remember if you’re trying to prevent pregnancy, or if you’re simply trying to understand your body better. There are plenty of apps to help you chart your cycle, including free ones: Clue (my personal favorite), Fertility Friend, Flo, Ovia, and many more. The app Natural Cycles costs $9.99 per month (or $89.99/year), but it comes with some major perks: It’s the only FDA-approved birth control app, and all you have to do is check your temperature in the morning, input the data, and let it track your cycle. The app will let you know when you’re fertile and infertile with clear color-coded screens, and for the cost of two morning-after pills, you can have much less fear and uncertainty for the foreseeable future.
Do I have to track my cycle alone?
When she teaches young women about their fertility, Jacobson says it’s important to give them “the language to demand good, respectful behavior toward them, from everyone from their peers to potential boyfriends to healthcare workers.”
This can feel pretty odd for women who haven’t been taught to understand their bodies and share that understanding with the right people. Herndon-De La Rosa puts it this way: “We don’t invite guys into that conversation a lot. We kind of let them off the hook” from their responsibility for participating in the reproductive process. Perhaps it feels awkward or strange or unsexy to discuss one’s menstrual cycle. But there’s another reason women may not be talking about fertility with the men in their lives: “With fertility awareness, your partner is a part of that too, which is not super conducive to hook-up culture,” Herndon-De La Rosa says.
It’s fairly established that one-off sexual encounters place greater burdens on women than men—both when it comes to the physical costs in pregnancy risk and the emotional costs of sex regret. It stands to reason that giving women fuller education about their reproductive system and fertility would equip them to have greater agency in their sexual behavior and choices. If more intentional sexual choices means fewer hookups for some women, a feminist response could be: that’s a cost men will have to deal with. Women have been bearing far worse for far longer.
I never took Plan B again after college, and I wish at the time I had known what taking emergency contraception would really mean. Sure, some women who take Plan B experience nothing more than drowsiness or a headache. But the physical side effects aren’t the only issue. Both my partner at the time and I saw Plan B as a Band-Aid. Its availability didn’t make us more thoughtful in our decision-making; in fact, quite the opposite. It allowed me to remain ignorant of my fertility system, so I was less intentional in my actions and more passive.
I wish I had understood that releasing a burst of disruptive hormones into my system wasn’t the solution I needed. What I needed was space to reconsider my relationship and sexual choices, space I didn’t have when I didn’t know how to talk about my fertility or how to tell my boyfriend that emergency contraception wasn’t the “solution” he thought it was. The truth is, I never needed to take Plan B. And when I did take it, I should have chosen someone to talk about it with. Instead I experienced intense physical and emotional turmoil—with no clue that there was a better solution for my reproductive system, for my mental health, and for my emotional wellbeing.
“This should never be the first option,” Jacobson notes. “By focusing on its availability and making it easy to access, you’re making this the best we can do for women. Plan B, really, should be Plan Z.”
I’m incredibly lucky today to have a husband with whom I speak frequently about my health, my menstrual cycle, and anything else I need to confide, big or small. If more women learned to understand their own bodies, perhaps we could focus less on this patchwork solution and more on listening—not to other’s opinions, but to our bodies.