Thursday, July 2, 2015

New Ricki Lake & Abby Epstein Documentary on Birth Control

Ricki Lake and Abby Epstein, the duo who brought us the ever popular Business of Being Born, are back together. They are planning a new documentary called Sweetening the Pill (based on a book of the same name) which aims to open our eyes the way that BoBB did, but this time, about birth control.

BoBB questioned the "one size fits all" and over-medicalized approach to childbirth, showing women that there are more options out there for birth. Sweetening the Pill hopes to do exactly the same thing, questioning the ubiquity of hormonal contraceptives (including the pill and hormonal IUDs, rings, implants).

They are probably assuming that the same audience who cheered at their questioning of the assumption that hospital birth or cesareans are right for everyone would also cheer at their questioning of the assumption that hormonal birth control is right for everyone.

I find the concept of this film fascinating from a medical anthropology perspective. Reproductive anthropologists examine phenomena like menstruation, menopause, and birth control from a cross-cultural and biological perspective, often finding that ideas we hold true are not always universal.

If you look at a the history of medicine, you find that men's bodies were considered the ideal, while women's bodies were thought to be defective machines. Men's bodies were the basis for a normal, healthy functioning body, without the confusing aspects of menstruation, pregnancy, and menopause. Female bodies were seen as problems that needed to be solved.

Controlling our bodies' menstrual cycles allows the female body to be more like a man's, as we can control our "out-of-whack" hormones, keep from getting pregnant at any unknown time, and even cease bleeding. It created a freedom for women who were somewhat enslaved by their bodies making decisions for them, consequences that kept some from living a life they wanted or working outside of the home.

These days, the white Western body is seen as the norm, while women of color or women from other nations are to us what women used to be to men. Hormonal birth control was developed based on what would be appropriate for the European/American body, not for the Asian, African, or Latina body. Standard hormone dosages, or any hormones at all, may not be right in all bodies, similar to how not everyone's body can process lactose.

Many women find they have side effects from taking The Pill that they do not like, like feeling sick or uncomfortable, and often stop taking the pill. There has been some research on biological side effects, and we know that the pill does increase your risk of blood clots. Unfortunately, so does being pregnant! Other serious issues are rare, and it is up to women to make the right choice for themselves. Many think that choosing when to be pregnant (or never being pregnant) is the right choice for them, so taking the pill is worth the small medical risks.

There is research that has found that hormonal birth control can affect sexual desire. We know that it affects hormones, and studies have found that it might affect who we find attractive. Women might wonder "Would I be different if I wasn't on this birth control?" It is a valid question to ask.


Sweetening the Pill doesn't say that hormonal birth control isn't great, they just wonder why its the only one that is usually recommended to women when they talk to their doctors about birth control. Are there other options? What's right for me? Maybe a lot of women don't even know there are non-hormonal birth control options, other than condoms. Maybe their doctors don't even tell them the side effects.

I think that this is a valid perspective. I think that women deserve to know that there are non-hormonal options, such as the diaphragm and a non-hormonal copper IUD (Paragard).  Other examples include cervical caps, spermicide and sponges, the pull-out method (withdrawal), and natural family planning (also called fertility awareness).

The main method that the film seems to focus in on is Fertility Awareness (Natural Family Planning). They argue that though we felt empowered by The Pill, being aware of your own body's processes is even more empowering. You don't need a medication or "unnatural" hormones messing up your own natural processes, you just need to get in tune with your body.

Fertility Awareness Method: a mathematical calculation of a woman’s cycle in order to determine periods of fertility and is only effective if a woman has regular 28-day periods. Fertility Awareness requires that the woman daily monitor cervical fluid, temperature and other factors to determine fertile days. In either case, either abstinence or use of a barrier method during fertile times is required in order to prevent pregnancy. 

Fertility Awareness is a great thing to learn to do, especially if you're trying to get pregnant, but it is not a highly reliable form of birth control if you are really super trying NOT to get pregnant. If people used it perfectly, it would be as effective as people perfectly using the pill or the patch, but people don't use these things perfectly. In typical use, you take the pill at different times each day, and you might mess up or forget your tracking.

Typical use of Fertility Awareness methods (including cervical mucus methods, body temperature, methods and periodic abstinence) has a 24% "failure rate," which means it is about 76% effective. That is quite close to the effectiveness of Withdrawal (pulling out), which people often refer to as a ridiculous method to use to prevent pregnancy. The success rate for withdrawal is 78% (surprisingly effective, all things considered)! I've seen other website cite Fertility Awareness as 80% effective and pulling out as 73% effective, but I trust the data from the Guttmacher Institute, a highly respected reproductive health research organization:



So, the public health side of me thinks that it is not wise for Sweetening the Pill to get too many people moving away from their hormonal birth control, which has quite a few benefits for women, especially low income women and marginalized women and women of color. Birth control that is highly effective, like the pill (91% effective with typical use) and the hormonal IUD (99% effective), is not something we should step away from lightly. It allows women control over their lives, it helps women who truly shouldn't (medical reasons, youth, or otherwise) get pregnant, and it avoids abortions. The Natural Family Planning method really doesn't have the efficacy that these methods do.

I'm not vehemently against starting the conversation that this documentary is starting, the way some articles on the internet have been -- see the infamous Amy Tuteur's post on Time.com and Slate.com's articles to hear some outrageously unbalanced reviews. I think that this is a valuable conversation to have. I recognize that I am of a class privileged enough to be able to afford all types of birth control and have the time to track fertility, if we want to. Not everyone actually has the financial and temporal freedom to actually choose what is right for them, so we need true open and honest information on all of the options.

You can find more information on the film Sweetening the Pill at the Kickstarter site (which has been fully backed).




I think a great part of this conversation, from an academic viewpoint, is whether the Pill or Natural Family Planning is more empowering, more feminist. The film's preview implies that though the Pill was the ultimate female empowerment 55 years ago, being one with your body's processes and not relying on pharmaceuticals is more empowering. Others might think that by rejecting the pill, we are undoing the work that was done to become less enslaved by our biology.

 Best Daily's post quotes Ricki Lake/Abby Epstein:
"The progression of mainstream feminism is founded in part on women overcoming and controlling their biology", they explained. "This is because for a long time women's biology or difference has been used against us as justification for our mistreatment and oppression. Women have come to feel that they must overcome their biology in order to have equality and freedom."
To enjoy the same privileges as men, do we feel we must we be more like them, not just in our attitudes, but in our biology? Lake and Epstein think so: "The male body is held up as the "ideal" in the medical industry and the female body is seen as inherently faulty and problematic. Women have had to make sacrifices to be allowed to work alongside men in a patriarchal society. The fear is that if we stop making those sacrifices we will lose that ground."
I don't think Ricki Lake and Abby Epstein are "anti-choice" or "anti-feminist" as the Time and Slate articles call them, but I do hope that they present their information in a balanced way. I do hope they talk about the pros of hormonal birth control for so many women, and the potential cons of fertility awareness methods. I hope they talk about other methods that aren't usually talked about in the mainstream.

We will have to wait for its release to find out!






3 comments:

  1. you didnt mention the fertility awareness method. as opposed to the rhythm method which only works if you have a 28 day cycle, the fertility awareness method teaches you how to be aware of your bodies signs that you are reaching ovulation through temperature and fluid consistently. the rhythm method fails because even if you usually have a 28 day cycle that can change from month to month, and many women have cycles considerably longer or shorter (24-36 days is normal). it is a method that should be researched and mentioned.
    http://www.tcoyf.com/

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  2. I second the above poster. You are conflating the rhythm method with the Fertility awareness method. They are not the same thing and the Fertility awareness method is way more reliable and effective. You really ought to read Taking Charge of Your Fertility and properly understand the method!

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