The Business of Birth Control

Documentary, screened with The Trouble Club at The Vagina Museum, London
19 October, 2022

Members of the Trouble Club (like me!) were invited to a screening of a new documentary, The Business of Birth Control, from Abby Epstein and Ricki Lake. The filmmakers describe it as an examination of “the complex relationship between hormonal birth control and women’s health and liberation.”

Naturally this concept appealed to me. Part of my doctoral research included the development of birth control (and the U.S. government’s permission to use it). Of course, before and throughout the pill’s development, it was illegal. It was not until 1962 that the Supreme Court decided it was legal for married women to use birth control at all. This was because it was deemed “natural” for women to have children and any barrier to it was inexplicable. Margaret Sanger was an early crusader for a birth control pill, driven in part by desperate letters that were sent to her from women who were sick and dying from too many pregnancies, botched at-home abortion attempts, and caring for too many (often ailing) children. Sanger’s reputation has diminished in recent years due to her alignment with the eugenics movement at the time, which she deemed necessary to get support for the pill’s development.

The documentary offered some of this background, particularly as the birth control pill allowed women for the first time to independently control their fertility. In other words, they did not need the cooperation of their husband. It’s important to remember that in the mid-twentieth century, it was generally expected that women submit to their husbands. Saying they weren’t in the mood or that they were ovulating was not an option (and sometimes isn’t today for various reasons). The film quickly moved on to complications with hormonal birth control and the blithe way in which doctors began (and continue to) prescribe it. Hormonal birth control is used to regulate periods, help with heavy and uncomfortable periods, clear acne, and, of course, to control fertility.

The film includes interviews with several family members of women who died as a result of taking hormonal birth control, in particular Yaz and the Nuva Ring. These deaths were tragic and avoidable, and are a heavy reminder that no medication is 100% safe for everyone. However, the film was very focused on these tragic stories and on a  “new generation seeking holistic and ecological alternatives to the pill.” This includes daily temperature-taking and other tools to learn fertile days.

The filmmakers maintain that they are not anti-hormonal birth control, but instead set out to share information with women that they think has been withheld. I agree that there is too little transparency in the pharma market. Indeed, the film (like the series Dopesick) revealed a lack of FDA oversight in drug development and marketing. Particularly in the U.S., drug commercials flood the airwaves, perhaps giving patients a sense of being informed, but in fact we are only being marketed to.

Still, despite the Epstein and Lake’s remarks, captured in this Rolling Stone article as well, the film is clearly out to show the complications with hormonal birth control and very little of its positive results. The facts remain that fertility awareness methods are nuanced and complicated, and many women will not have the time to do it properly. Others in abusive relationships who do not have the luxury of saying “no” can’t rely on natural methods. What’s more, accidental pregnancy now carries the risk of forced motherhood, as many states restrict access to abortion.

The more sinister risk of a film like this is the hijacking of the message by the right. While I agree that women absolutely need all the information available to make choices about birth control, painting hormonal birth control as dangerous introduces serious problems. For decades, the anti-choice movement has pretended that women’s welfare and safety were at the heart of abortion restrictions (such as hospital admitting privileges, waiting periods, required ultrasounds, and parental or partner consent). My fear is that this film will be used an “proof” that birth control — already in the sights of many anti-choice republicans — is dangerous as well.

The truth is that hormonal birth control has been around for 70-odd years and relatively few people have died from it. Perhaps the answer to the problems with it should be a demand for more research and better options. I’m not a medical or pharma expert, but it seems to me that there hasn’t been much “new” in the birth control arena, apart from different formulations and methods of taking it. The real problem is that women need this product and will take the risks that come with it quietly. Instead, pharma companies should be investigating new, more effective, safer options. There is a market for it, and we don’t need to sit quietly, taking what we were given decades ago.