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Part Two // Literature Review

Perceptions of Birth Control: A collection of stories and themes that emerged from interviews with undergraduates using birth control at the University of Vermont

This series of blog posts is excerpts (edited so its not so academic) of writing from my undergrad research in 2021





Prior to and during this research I read a lot about menstrual cycles, birth control, ovulation, and sex. In this lifetime I’ve had so many ideas for jobs I’d like to pursue, but the thread between them all is health, education, and human connection. Going into this research I knew I needed a foundation of literature behind me to understand what others in the field of birth control were saying (and not saying). 


Birth control was popularized by Margaret Sanger in the United States as early as October 24, 1916 when she opened the first birth control clinic in the United States in Brownsville,Brooklyn (Margaret). However, this clinic was shut down just nine days later. In the initial days of promoting birth control in the United States, Sanger focused on (white) feminist ideas of sexual liberation.


However in1921 “she focused many of her efforts on gaining support from the medical profession, social workers, and the liberal wing of the eugenics movement. She increasingly rationalized birth control as a means of reducing genetically transmitted mental or physical defects, and at times supported sterilization for the mentally incompetent” (Margaret).  Sanger, with support of doctors and social workers, opened a new clinic in 1923 and served only couples and married women. In the initial phase of birth control being promoted it was primarily the diaphragm, spermicide, and condoms that were accessible. Hormonal contraceptives were not yet in existence in the United States, but in the early 1950s Sanger played a critical role in gaining funding for research to develop the first pill (Margaret).


The pill's primary developer, Gregory Pincus, knew he would not be able to do large scale human trials domestically in the US, so found a loophole by going to Puerto Rico. “In the summer of 1955 he looked to Puerto Rico as a location for the trials” (PBS). In these initial trials the pill, which was at the time formulated with a much higher dose of progestin, was deemed 100% effective when taken properly. One research assistant, Dr. Edris Rice-Wray, informed Pincus “that 17% of the women in the study complained of nausea, dizziness, headaches, stomach pain and vomiting” (PBS). So serious and sustained were the reactions that she told Pincus that a 10-milligram dose of Enovid caused "too many side reactions to be generally acceptable" (PBS).  Pincus was extremely quick to dismiss Rice-Wray's conclusions and said that the complaints were psychosomatic (PBS). 


There were three women who died during the trials in Puerto Rico, but autopsies were never conducted to see if the Pill had caused the young women's deaths (PBS). Despite the possible side effects, the pill was first approved May 9, 1960, by the FDA (Vargas). However, “by August 1962, the FDA was informed that 26 women had reportedly suffered blood clots, including six who died (Vargas). As growing accounts and data about the side effects of the pill became clear, Pincus repetitively told news outlets that the side-effects were largely psychosomatic (Pendergrass).


Based on data gathered during the initial days of the pill being on the market, the dosage of the synthetic hormones has been adjusted and it is largely considered safe to use today. One thing to note however, is that despite complaints of side effects similar to those reported in the initial phases of research, new innovations in the pill have largely stopped since the 1970’s (Watkins). Certainly new delivery methods have been created, but the basic hormones themselves remain relatively unchanged. The most recent newly created hormone used in birth control pills is a progentin called Drospirenone which was patented in 1976 (Hill). 


One reason for this lack of new development in the field of birth control is explored in the paper How the Pill Became a Lifestyle Drug. This paper examines how, “marketing decisions, rather than scientific innovations, have guided the development and positioning of next-generation contraceptive products in recent years” (Watkins). The term “lifestyle drug” was coined in 1978 and gained popularity in the field of birth control in the early 1990s. Lifestyle drugs are drugs that are intended to be taken by healthy people, “a lifestyle drug is one used for ‘non-health’ problems or for problems that lie at the margins of health and well-being. . . . A wider definition would include drugs that are used for health problems that might be better treated by a change in lifestyle” (Watkins). The secondary things that the pill has been marketed to help include, “acne, periodic moodiness, and monthly bleeding are common conditions that constitute inconveniences, unpleasantness, and varying degrees of suffering, but they are not life threatening or wholly debilitating: (Watkins). These symptoms are a common combination often described as PMS (premenstrual syndrome). Lisa Hendrickson-Jack however has a different opinion. In her book The Fifth Vital Sign she asks, if 80-90 percent of women experience premenstrual syndrome (PMS) - can it really be called a syndrome? (Hendrickson-Jack) It is something that is seen as so commonplace, when in reality those are signs of less than optimal hormonal function. When the hormones are not functioning properly on their own and one turns to hormonal contraceptives for support in many cases “hormonal contraceptives shut down your ovaries all together. If you were to take a closer look at your ovaries, you’d find that appear inactive similar to what you’d see if you were to observe the ovaries of women in menopause” (Hendrickson-Jack 98). Hendrickson-Jack argues that shutting down ovarian function comes with a host of long term effects that are just starting to be studied. 


So while the pill as a lifestyle drug does work for some people, others experience a dramatic loss of quality of life after starting the medication. This phenomena of people experiencing hormonal contraceptives differently than one another is explored in the book This is Your Brain on Birth Control. In that book Sarah Hill explores how hormonal contraceptives impact the brain. One thing that she often reminds readers is that “No matter where you administer the hormones, they all end up in the same place. And that place is everywhere” (Hill 89). The myth that the IUD is keeping the hormones isolated to the uterus is explored in depth. Hill writes, “the hormones of birth control are picked up by all the cells in the body that have sex hormone receptors. This means that they simultaneously influence the activities of billions of cells in your body at once, echoing throughout the body from head to toe.” So “when you change your hormones - which is what hormonal contraceptives do - you change the version of yourself that your brain creates” (Hill 2). For some people they like this version of themselves more, some people like it less, and some may not notice a change. But having this foundational knowledge of the possibility of birth control to change the brain gives people a perspective backed by science that they are not crazy for thinking their birth control changed them (for better or worse). 


One thing that was missing from many of the articles I read was talk about sex — sex as pleasurable, sex as leading to pregnancy, sex as something that people want to engage in. It is fascinating to me that a pill (and other delivery methods) have been created to stop something happening as a result of sex, and yet sex is not talked about. If it were more discussed in the literature, there may be more secondary discussions about the pills' side effects like clitoral shrinkage (Hendrickson-Jack) and lower libido because because there is no natural surge of estrogen (Hill). If sex were discussed as pleasurable people might be more attuned to subtle shifts (but again, that is a hypothesis for another study).


 

Hendrickson-Jack, L., & Briden, L. (2019). The fifth vital sign: Master your cycles and optimize your fertility. Fertility Friday Publishing Inc.

Hill, S. E. (2019). This is your brain on birth control: The surprising science of women, hormones, and the law of unintended consequences. Avery, imprint of Penguin Random House, LLC.

Margaret Sanger Project. (n.d.). Biographical sketch of Margaret Sanger. The Margaret Sanger Papers Project. Retrieved December 15, 2021, from https://sanger.hosting.nyu.edu/aboutms/msbio/

PBS contributors. (2003, February). The Puerto Rico Pill Trials. PBS. Retrieved December 15, 2021, from https://www.pbs.org/wgbh/americanexperience/features/pill-puerto-rico-pill-trials/

Pendergrass , D., & Raji, M. (n.d.). The bitter pill: Harvard and the dark history of birth control:

Magazine: The Harvard Crimson. Magazine | The Harvard Crimson. Retrieved December 15, 2021, from https://www.thecrimson.com/article/2017/9/28/the-bitter-pill/

Watkins, E. S. (2012). How the pill became a lifestyle drug: The pharmaceutical industry and birth control in the United States since 1960. American Journal of Public Health, 102(8), 1462–1472. https://doi.org/10.2105/ajph.2012.300706

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