In Defense of the Pill and in Favor of Improving It

Sarah Seltzer

The 50th anniversary of the birth control pill has brought a lot of complaining about its lack of perfection. Still, for many women, it remains utterly liberating and effectively keeps its satisfied users from the whole "biology is destiny" thing.

A lot of women have been complaining about the pill recently as the little birth control drug celebrates its 50th anniversary. It has unpleasant side effects; it puts the financial and personal burden of contraception squarely on women’s shoulders; it kills libido. There’s a whole crowd out there who think the new types of pills which change your menstrual cycle or get rid of it all together are unnatural because they suppress our goddess-given rhythms.

This brand causes migraines. This one creates crazy mood swings. One can switch to the patch or the nuva-ring, but then there are more side-effects. For young woman, birth-control bitching and switching feels like a mandatory rite-of-passage, a hormonal equivalent to dissing skinny jeans and then buying them, or discussing how the Sex and the City movie sucked, but you’re going to see the second one anyway.

The fact remains that all the critiques leveled this week are valid: the pill is far from perfect, both medically and socially, and we really do need a male birth control pill. We also have to put pressure on the medical establishment to keep innovating for those women whose options still feel limited. As Geraldine Sealey wrote in her Salon article “Why I Hate the Pilll:

The truth is that the development of innovative birth control methods has virtually come to a standstill. According to a 2008 report by Harper and several colleagues, public and private funds for contraceptive research have dried up in recent years. Most pharmaceutical companies have withdrawn from investing in contraceptive R&D, perhaps due to fears of costly personal injury litigation.

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For Sealey and many of her friends, there ought to be better and more options for contraception. She cites a Guttmacher study which shows almost half of all women unhappy with their current methods, and points out that this discontent can lead to unintended pregnancies.

Still, I feel like our little buddy in its colorful plastic, day-by-day case is in need of a defense. Because for many women, the pill remains utterly and completely liberating. Just as it did when it first came out, the pill effectively keeps its satisfied users from the whole “biology is destiny” thing. For the women who refill those prescriptions month after month, a few weird side effects will be endured so that we can enjoy what the pill gives us: freedom.

First of all, there’s freedom from even worse side effects–the ones that mother nature bestowed on us. Sealey describes feeling like a freak because hormonal contraception doesn’t work for her. But there are a group of women who feel like freaks without the pill, who need the pill for a variety of physical reasons. I like to joke about this group, in which I’m included, saying that we’re solid proof that there’s no intelligent design. We’re also the modern-day equivalent of those women in Victorian novels who were probably labelled hypochondriacs or hysterics because they were constantly laid up with a “sick-headache” or often left the room “feeling faint.” Yep, that’s us women with totally irregular or debilitating periods, the ones who watch those commercials for tampons and hip birth control brands and nod vigorously at every symptom mentioned and then some that aren’t. There are women out there with allergies to painkillers or to latex, women with back pain and headaches and cramps that are so bad we wouldn’t be able to work or play sports or socialize for many days out of the month if we didn’t have the pill. But we have it, and we can function a lot better with it–we don’t have to take to our beds or shun mixed company. This is a decided feminist victory. I know that saying “I take the pill for reasons other than birth control” can feel like a cop-out, but its capacity to allow many of us to live normal lives shouldn’t be underestimated.

And it’s true, even more importantly, that the pill is effective and excellent birth control when used correctly. We hear horror stories of women who skip pills and end up pregnant. But the pill is capable of being really great insurance. Just ask the neurotic women out there, the ones who really, really don’t want to deal with a pregnancy scare. For them, the pill is a great boon, and almost totally foolproof when combined with another method, or even on its own, After a decent period of taking the regularly and training oneself not to forget to take it, a lot of worry evaporates. There’s no need to fret about a mishap the way there is with barrier methods of birth control, and no need to even think about birth control when one is about to have sex. With a brand that doesn’t affect sex drive, it’s pretty wonderful and revolutionary to be freed from that particular paranoia.

Of course, there is one major thing society could do to really ensure that the pill remains revolutionary: provide better health insurance. One of the key factors in being able to take advantage of the pill is access to a caring, patient Ob-Gyn who will help a woman find a method and brand that works best for her–sometimes trying three, four or five types of hormonal birth control. A good doctor will also help women get the best discount on her prescription and field questions about how many skipped pills mandates back-up and other emergency situations. A good doctor can’t be found without a good insurance plan. Furthermore, one of the main reasons women skip pills or aren’t able to back up their birth control is because they can’t afford to.

A recent Ibis reproductive health study in Massachusetts, even after health care reform, found a correlation between young adults’ insurance coverage and personal choices about contraception use:

Insurance coverage of contraception was a significant factor in shaping women’s decisions about contraceptive use and method selection; our results reveal that there are a number of systems gaps that impact the ability of young adults to access affordable and continuous contraceptive and other SRH services. Young adults who find themselves uninsured for transitional periods; young adults who are enrolled in health plans with religious restrictions on counseling, referrals, or service delivery; young adults who travel and seek routine care outside of their defined insurance coverage area; and young adults who are enrolled in non-prescription YAPs are among those populations that may find themselves “underinsured” with respect to contraceptive services. Young adults also felt that providers offered only limited information about the full range of contraceptive methods.

In order for the pill, which is liberating for some women, to be revolutionary for all, this kind of information and access needs to dramatically increase–and that requires political and social will.

Geraldine Sealey’s piece and this piece together prove that women’s bodies and needs are widely divergent–hence everyone feeling like “a freak”– and the options as they currently stand don’t cover us all. The current vogue of anti-pill backlash shows that women are ready for another leap of innovation and activism the way we were before the original contraceptive pill appeared. We need to keep the revolution going until all women can be satisfied with their birth control.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Health Systems

The Crackdown on L.A.’s Fake Clinics Is Working

Nicole Knight

"Why did we take those steps? Because every day is a day where some number of women could potentially be misinformed about [their] reproductive options," Feuer said. "And therefore every day is a day that a woman's health could be jeopardized."

Three Los Angeles area fake clinics, which were warned last month they were breaking a new state reproductive transparency law, are now in compliance, the city attorney announced Thursday.

Los Angeles City Attorney Mike Feuer said in a press briefing that two of the fake clinics, also known as crisis pregnancy centers, began complying with the law after his office issued notices of violation last month. But it wasn’t until this week, when Feuer’s office threatened court action against the third facility, that it agreed to display the reproductive health information that the law requires.

“Why did we take those steps? Because every day is a day where some number of women could potentially be misinformed about [their] reproductive options,” Feuer said. “And therefore every day is a day that a woman’s health could be jeopardized.”

The facilities, two unlicensed and one licensed fake clinic, are Harbor Pregnancy Help CenterLos Angeles Pregnancy Services, and Pregnancy Counseling Center.

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Feuer said the lawsuit could have carried fines of up to $2,500 each day the facility continued to break the law.

The Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care. Unlicensed centers must disclose that they are not medical facilities.

Feuer’s office in May launched a campaign to crack down on violators of the law. His action marked a sharp contrast to some jurisdictions, which are reportedly taking a wait-and-see approach as fake clinics’ challenges to the law wind through the courts.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before the U.S. Court of Appeals for the Ninth Circuit.

Some 25 fake clinics operate in Los Angeles County, according to a representative of NARAL Pro-Choice California, though firm numbers are hard to come by. Feuer initially issued notices to six Los Angeles area fake clinics in May. Following an investigation, his office warned three clinics last month that they’re breaking the law.

Those three clinics are now complying, Feuer told reporters Thursday. Feuer said his office is still determining whether another fake clinic, Avenues Pregnancy Clinic, is complying with the law.

Fake clinic owners and staffers have slammed the FACT Act, saying they’d rather shut down than refer clients to services they find “morally and ethically objectionable.”

“If you’re a pro-life organization, you’re offering free healthcare to women so the women have a choice other than abortion,” said Matt Bowman, senior counsel with Alliance Defending Freedom, which represents several Los Angeles fake clinics fighting the law in court.

Asked why the clinics have agreed to comply, Bowman reiterated an earlier statement, saying the FACT Act violates his clients’ free speech rights. Forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs,” Bowman said.

Reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, Googling “abortion clinic” might turn up results for a fake clinic that discourages abortion care.

“Put yourself in the position of a young woman who is going to one of these centers … and she comes into this center and she is less than fully informed … of what her choices are,” Feuer said Thursday. “In that state of mind, is she going to make the kind of choice that you’d want your loved one to make?

Rewire last month visited Lost Angeles area fake clinics that are abiding by the FACT Act. Claris Health in West Los Angeles includes the reproductive notice with patient intake forms, while Open Arms Pregnancy Center in the San Fernando Valley has posted the notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

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