America and the Pill

The quotes above express the extremes of young women’s feelings toward the pill today. Although it is not for everyone, the pill remains the leading contraceptive of choice in the United States. Much has changed since it first came on the market. Women have more birth control options, more life choices and opportunities, and increased equality in private and public life. There is more openness and acceptance regarding sexual activity for single and married women, and less stigma surrounding unwed sex and pregnancy. The pill is a much safer product than it was in 1960, and women face fewer legal obstacles to obtaining contraception and abortion. Yet the pill is still an imperfect contraceptive, and women still encounter roadblocks on the path to full reproductive freedom.

Today nearly 12 million women in the United States take the pill. More than 45 million women of childbearing age have taken the pill at some point in their lives. Unlike their mothers who saw the pill as a miraculous godsend, many young women today take the pill for granted. As Anne S commented, “The pill seems so commonplace. It’s like asking what the impact of the telephone system is. It’s so ubiquitous, I just couldn’t picture a fully functioning society without it!”² For Alice Z it is “such a common part of my everyday routine (like brushing my teeth). . . . It’s a non-issue.”³ Elizabeth M appreciated her choices: “It’s just a question of which contraceptive options are the most fun and the least hassle.”⁴

Nevertheless, many realize that access to the pill is a luxury that was not available to women of an earlier generation and that its impact has been monumental. Martha L considers the pill “the single most empowering option that women have been given in all of history.”⁵ For Kelly R, the pill is more than an effective contraceptive: “[It] helped me to own my identity as a woman and to be in control of my life, my body, and my future.” ⁶ Jessica P feels like “one of the lucky women in the world. To be born in the United States, and to be born after the pill was available, I have never been forced to have children, or been forced to abort because I never had an opportunity to protect myself. I’ve been able to live the life I wanted to lead. And most importantly, I’ve never had to rely on the consent or willingness of my partner in order to protect myself. It’s all been in my hands. I think that’s huge, and I’m grateful for it every day.”⁷

These women all responded to an Internet query asking for opinions, experiences, and stories about the pill.⁸ They had little in common. Anne S, age twenty-one, describes herself as “married, bisexual, ex-military, living below the poverty line.” Alice Z, age thirty, married, white, and straight, a self-described atheist and a Democrat, is from a poor, working-class, fundamentalist Christian small-town family. She and her sisters are first-generation pill users and the first in their family to attend college. Mary M is a twenty-three-year-old aeronautical engineer for a company that makes jet fighters. What these women do have in common, along with more than a hundred others, is that they all had something they wanted to say about the pill, so they wrote their stories for inclusion in this book. What they tell us reflects the many ways in which the pill has been at the center of the major transformations in women’s lives over the last half century—how much has changed and how much has remained the same.

The feminist movement expanded women’s opportunities, altered relations between the sexes, and challenged social, legal, and institutional structures. The entire context in which women approach sex, relationships, contraception, and reproduction has changed dramatically. Women today have a different relationship to the pill than their mothers had. Yet at the same time, young women grapple with some of the same issues that faced their mothers, as well as some new ones. Dilemmas and difficulties remain for women seeking to control their fertility.

The first generation of pill takers felt liberated by its effectiveness and trusted it to prevent pregnancy more than other contraceptives available at the time. Today, many young women use a barrier method along with the pill, either because they don’t consider the pill to be 100 percent effective or because it does not protect against sexually transmitted diseases. Although she takes the pill, Melissa G and her boyfriend “still use condoms, but only right before climax to keep down on mess and that pesky 2 percent noneffectiveness.”⁹ Samantha J, age twenty-three, never had any trouble with the pill, “but I always use a condom as well, just in case. I guess I’m still a little nervous!”¹⁰

Many women today recognize that the pill has played a role in their sexual autonomy as well as their reproductive self-determination. “I think it’s hard enough, even for those of us raised feminist, for women to ask for what they want in sex and sexual relationships,” noted Jessica P. “Having to add negotiations about birth control on top of that power imbalance just tips the scale even more. Taking back our control of our bodies in terms of birth control really helps women to take the leap to be open and honest and ask for what we want in bed. . . . The pill has helped me feel less dependent on my male partners, and more equal with them.”

In addition to her sexual assertiveness, Jessica P also identified herself in ways that would have been rare among her mother’s peers: a thirty-eight-year-old lawyer, married, nonmonogamous, and bisexual.¹¹ In the 1960s, relatively few married women would have been lawyers, few wives would have admitted being nonmonogamous, and few pill users would have identified themselves as bisexual. Nearly all pill users at the time identified as heterosexual; lesbians would have been highly unlikely to use the pill. Today women are more likely to embrace a sexual identity that is more complex. Among the respondents to the Internet query, about 10 percent identified themselves as bisexual. For some, bisexuality raised new issues regarding the pill. Karen E explained, “The only problem with relationships . . . was that when I was dating a girl and taking the pill, she assumed that meant I was likely to cheat on her with a guy! It played into the whole stereotype of bi girls as promiscuous and always looking for a guy to screw on the side.”¹²

Along with sexual identity, expectations for sexual pleasure have also evolved since the 1960s. When the pill first arrived on the market, many women reported that it both freed them from fear of pregnancy and allowed for a spontaneity unavailable with barrier methods, making sex more enjoyable. In striking contrast, among the young women today who responded to the Internet query, several complained that the pill actually lowered their libido. Available data suggest that the pill can either increase or decrease libido—but most women are not presented with this information. Few doctors explain to their patients that the pill can lessen the sex drive in some women. Manufacturers rarely mention it in their information packets. For example, the full product information for Ortho Tri-Cyclin Lo contains a long list of possible side effects in the fine print, and another list of reported side effects that have been “neither confirmed nor refuted,” which included “changes in libido.”¹³ Internet sites including WebMD and Teens Health do not mention lowered libido as a possible side effect. ¹⁴ However, other Web sites, such as Epigee Women’s Health, note, “New research now indicates that the birth control pill may inhibit more than just pregnancy. The pill may also significantly, and perhaps permanently, dampen your sexual drive.”¹⁵

Several of the young women respondents spoke to their friends and female relatives about the effects of the pill on their libido and did their own research on the Internet. Mandy B learned that “many of the women in my life had also started to react negatively to the pill after many years. For example, we all shared a decreased sex drive. How could it be that the same pill that liberated my sexual self was also now changing my feelings about sex? I didn’t feel like me.”¹⁶ When Helen P took the pill at age eighteen, “I realized it had sucked my sex drive away. I loved the spontaneity of it, compared to condoms, and the security of it, but it got to the point where I was never interested in sex.” She bypassed her health providers, who dismissed her complaints of depression and lowered libido, and went to the Internet. “After some online research, I realized I wasn’t alone in this symptom—nobody had ever told me it was possible—and I went off the pill.”¹⁷ Valerie J was “very sad that a pill that is supposed to make sex easier and safer also makes it less desirable.” Her boyfriend “took it as a rejection, that I didn’t find him attractive, even suggested I might be a lesbian (gasp!).”¹⁸ Barbara E simply “hated the pill. It wrecked my body, gave me headaches and eradicated my libido. I suppose that’s another way to prevent pregnancy—having no desire to have sex.”¹⁹ Sally G complained, “Holy Hell. Can you even imagine if a birth control medication for men blunted their libido? There’d be outrage. No no, there wouldn’t, because no drug like that would be taken by millions of men for most of their lives.”²⁰ (Her observation, of course, is correct.)

Although today’s pill may not suppress libido more than the original oral contraceptive did, women today may well experience the effects of the pill differently. For many in the first generation of pill users, the intense fear of pregnancy diminished women’s libido to such an extent that when they went on the pill and that fear disappeared, their sexual pleasure increased considerably. Today there is no longer the terror of facing an illegal abortion, a ruined reputation, banishment to a home for unwed mothers, or a hasty marriage. With legal abortion, the “morning-after pill,” and the easing of the stigma against unwed pregnancy, women have more options and the stakes are not as high. Moreover, today’s young women are more likely to be in tune with their sexuality than those in their mothers’ generation were, many of whom experienced sex outside of marriage as secret and shameful, and only came to know their bodies over time within marriage. The sexual revolution opened up more discussion about sex, and the feminist movement encouraged women to explore and enjoy their own sexuality. With so many contraceptive options available to women today, some are unwilling to compromise their sexual pleasure for the convenience of the pill. On the other hand, not all women on the pill experience this side effect. According to one report, “As for libido, while some studies show a decreased sex drive, others show an increase.” Just as in their mothers’ day, “a lower chance of pregnancy can be quite an aphrodisiac.”²¹

Clearly, the sexual revolution and the feminist movement have had a huge impact on sexual behavior, values, expectations, and mores. Even so, the double standard, parental disapproval, shame, fear, and secrecy surrounding sex still persist. Susan G explained that as a student from a conservative Southern family, “I lived in fear of getting pregnant, mainly because it would mean my father knowing I was having premarital sex and that he would disown me.” She went on the pill when she married, and stayed on it after she divorced. Today, the twenty-six-year-old chemical engineer reflects on her contraceptive use: “I think the impact of the pill on my sex life is that it allows me to have one.”²²

Katie M’s path to the pill was even more fraught. She “never worked up the nerve to visit the gynecologist and ask them, or anyone else, about birth control. In fact, I was the perfect statistic—a product of an abstinence-only sex/health education that only led me to withhold sexual activity slightly longer than average and prevented me from using birth control because that would imply I had been planning on having sex, heaven forbid.” So she and her boyfriend began having unprotected sex. “I hated myself so much. I hated myself for not speaking up about what I knew was irresponsible sexual behavior.” When she and her partner decided to use condoms, that too was an ordeal. “Having both been virgins and both completely embarrassed about sex (that we denied we were having), we spent about six seconds furtively looking at the condom display in Wal-Mart before randomly picking a package. Even though I knew the proper way to put a condom on thanks to the Internet, I was too paralyzed by shame and guilt about having sex in the first place (an obvious sign I shouldn’t have gone that far since I wasn’t personally comfortable with it) to properly apply it. I’m pretty sure we bought the wrong size as well. Needless to say, the condom broke just as he came inside of me for the first time. I ended up with a strangely soul-numbing yet panicky pregnancy scare and that was probably the beginning of the end of my first relationship.”

Katie faced her own guilt as well as parental disapproval. “The crazy thing is that I never even considered the pill. Between my parents, my religious upbringing, and poor sexual education I was under the impression that girls that used the pill were sluts. Even if I had wondered about getting birth control, I felt I couldn’t visit a gynecologist because my mother would somehow find out I had been having sex and lose all trust in me. Or be really disappointed.” She could not even turn to her college health center, or to her friends. “There was no way I could talk to my school nurse, since I attended a Christian college. I suspected that I would probably be investigated and expelled or ‘campused’ if someone found out. I couldn’t bear the thought of my friends finding out either. I was so afraid of losing their respect and becoming ‘dirty’ in their eyes that I deliberately avoided looking suspicious.” Finally, in her junior year, she attended a free seminar on women’s health that transformed her attitudes about sex and birth control. “I researched the various types of birth control and realized how many options I had. As my sexual education expanded, I stumbled into feminism and began to realize just how many choices the pill affords me.” Taking control of her sexuality and fertility led her to feminism—rather than the other way around. “I would never stay with a man who would presume to dictate what I did with my body and sexual health. I also realized just how stupidly lucky I had been that I had never become pregnant after having unprotected sex for over a year. . . . I ended my college career older, wiser, and much better off emotionally.”²³

Katie M was one of several Internet respondents who sought help from health professionals when they felt unable to turn to family or friends. Jenny B did the same. She began taking the pill at age fifteen. In her small town in north Florida, “everyone was nominally to extremely religious and both sex and birth control were considered to be an ‘after-marriageonly’ option.” But her town also had a high teen pregnancy rate. Knowing that Jenny’s family would disapprove, a nurse at the medical office where she worked gave her the pills for free. “I had to keep them hidden from my parents.”²⁴

Like Jenny B, nearly half of the Internet respondents began taking the pill as young teenagers. The most common age was sixteen, but some were younger. The youngest was eleven when she first took the pill to control heavy bleeding. Although there is no available data for how many first-generation pill takers were unmarried when they first took the pill, or the age at which they began, young single women of the 1960s faced legal barriers, medical hostility, parental disapproval, and their own ethical qualms. Today’s teens are less likely to encounter those inhibiting factors. Some of the respondents first took the pill to alleviate severe menstrual symptoms and discovered its contraceptive benefits soon after they began taking it.

A few young women acknowledged that the pill had a negative effect on their sexual behavior. Kristy H confessed, “The pill became an easy way out for me to engage in promiscuous sexual activity, and a form of abuse. I would take it straight through for months at a time so as to miss my period and be able to have sex ‘like a man.’ Now that I’m off of it completely, I feel more in control.”²⁵ Melissa B also felt that the pill led her down a path to irresponsible sex and only later to a process of growth and responsibility. She began taking the pill at age fifteen, and remembers “the power this gave me over my sexuality and the liberty I felt to be a sexual human being.” But she also saw the pill “as a ‘free card’ to sexual activity. . . . All the same, the pill was still there as a silent partner, as my perceptions of myself as a sexual being continued to grow and be challenged into adulthood.”²⁶

These accounts make it clear that in spite of feminism and the sexual revolution, some women experience the same guilt, shame, and parental disapproval that faced their mothers’ generation. For some of them, the pill was part of a path not only to responsible contraception, but also to new ideas about sex, greater personal empowerment, and feminist identity. Other young women had no need to break away from parental attitudes because their parents were supportive and encouraging. When Carrie R was heading off to college, her father, a family physician, urged her to go on the pill. “It was his opinion that it was much simpler to start on the pill then, before I was sexually active, than to wait until after I needed contraception. . . . It was rather a weird conversation to have with my Dad, me being the really innocent sixteen-year-old homeschooled girl that I was. However, as soon as I got to university I went down to the health clinic and got a prescription.”²⁷

Many of the young women who had the support of their parents were raised by feminist mothers. Linda L was one such woman. “I have been a feminist since I was ten years old, and the magazines I would read growing up (Seventeen, YM, Sassy, etc.) always touted birth control as a positive thing. When I started dating, my mother told me to ‘use protection.’ I’m extremely grateful for our feminist foremothers who made it possible for us to have access to birth control without there being too much of a stigma.”²⁸ Erika B’s mother, an ob/gyn nurse, got her Norplant when she was fifteen, because she felt it was more reliable and long term for a teenager.²⁹ Carolyn P began taking the pill at age sixteen. “After [I told] my Mom I was interested in being sexually active with my boyfriend at the time, she insisted I get on the pill.”³⁰ Anita K reported, “When it comes to ethics or morals I have never thought twice about using birth control. My grandmother had my mother when she was barely sixteen and was forced into a miserable marriage right before my mother was born, so I have grown up with strong women telling me to make my own choices about my body. In high school, my mom was the mom who took my friends to the clinic to get birth control, since they were scared of their own mothers’ reactions to their sexuality.”³¹

Clearly, there is a wide range of attitudes toward sex and contraception in the generations since the pill became available. There is also a wide range of experiences with side effects. In spite of the vast improvements in oral contraceptives over the last half century and the wide array of hormonal contraceptives now available, many young women on the pill today suffer the same symptoms that plagued their mothers’ generation. Julie D expressed the sentiments of many when she said that the pill was “the most miserable thing I’ve ever put into my body.”³²

Some described severe psychological and emotional effects. Jane B took the once-a-month injection, and each time, “two days later I was an absolute emotional wreck. Paranoia, depression, anger, it was horrible.” Carol O said the pill turned her into “a raving lunatic.” Melissa G suffered severe nausea and vomiting, so she tried the low-dose pill but “bled constantly the entire time, and often woke up with headaches that pain killers would not relieve.”³³ Kristol R reported that the pill caused a friend of hers to be so “depressed and listless” that it took two years away from her life. For Kristol R, however, the pill was a blessing: “I haven’t told her this, but while the pill might have taken two years of her life, the pill gave me my life.”³⁴

Side effects did not trouble every woman taking the pill. In fact, some reported taking it for its noncontraceptive benefits. Several respondents took the pill because it provides control over inconvenient bodily functions, particularly menstruation. Some went on the pill to eliminate their periods altogether. Initially, manufacturers of the oral contraceptives presumed that women would object to a pill that eliminated the monthly period. But some women welcome this effect.³⁵ They skip the “placebo pills” of the fourth week in the pill packet so they can avoid having a fake period. Robyn E “found the pill to be invaluable. I actually take it all the time; I know that the manufacturers say that you should leave the seven-day gap, but I can’t see any reason to because any ‘period’ you get is just withdrawal bleeding anyway. . . . I don’t feel any sort of earthy link with my cycle; to be honest I’d be perfectly happy if it just went away. Then again, I don’t intend to have children.”³⁶

Mary M, a twenty-three-year-old engineer, raved about the pill: “More than contraception, it is a way to control my period. . . . It has so many other fantastic side effects! . . . I can have my period whenever I want. If I don’t want to have my period ever again, I don’t have to. If I want to take a beach vacation or have sex with my boyfriend, I can. I am in control of my body.”³⁷ Linda O appreciated other side effects. On the pill since age seventeen, she “really can’t say enough good things about it. It cleared up most of my acne, made my breasts bigger, and lessened my menstrual cramps. What’s not to love?”³⁸

Jane D had more professional reasons for wanted to control her cycle. As a woman in the military, she began taking the pill shortly after joining the Army and used it for nine years to regulate her period. She faced situations that would have been unthinkable for women of her mother’s generation. “Before the pill, I never knew when my period would come. I didn’t know how long it would be, or how heavy. My job in the military required me to work in remote areas. . . . We lived in tents, used port-a-johns, and got showers every three days or once a week, depending on our resources. We would do this for weeks or months. This was our job. . . . I needed to know when my periods would come and what they would be like. I didn’t want to bleed through my clothes. There were very few women in my field and I knew that I would be looked at as an example of what all women in the military would be like. I would not be viewed as an individual. The pill was invaluable.”⁴⁰ As Jane D’s experience demonstrates, new opportunities that opened up for women led to unanticipated benefits of the pill.

Pharmaceutical companies realized that some women took the pill for its beneficial side effects, rather than primarily for contraception. In 2009, Bayer Health Care Pharmaceuticals advertised the noncontraceptive benefits of Yaz, the most popular birth control pill in the United States. Because Yaz was approved only as an oral contraceptive, the FDA forced Bayer to launch a $20 million advertising campaign to counter its previous claims that Yaz would cure acne or premenstrual symptoms. The FDA ruled that the original ads were misleading and encouraged women to take the drug for purposes other than contraception. Nevertheless, some women continued to take the pill for its noncontraceptive benefits.⁴¹

Another unexpected effect of the pill was its contribution to increasing openness regarding matters of sex, reproduction, and contraception. Open communication enhanced women’s relationships with the men in their lives, their female friends, and their health care providers. In the pill’s early years, it contributed to greater communication between doctors and their female patients. As the sexual revolution and the feminist movement led to greater openness in discussions about sex, publicly as well as privately, the pill was central to those conversations. Today that trend continues.

For some young women, the pill has become a central part of their daily routine and a source of bonding with their female friends, even if their relationships with men do not last. Twenty-three-year-old Lauren C reported, “The pill and I are still together, though my high school boyfriend and I are not. . . . My best friend [and I] had been taking it for months already, and we dutifully popped our BB-size tablets at 10 every night. Sometimes it amazes me that I’ve been taking a drug every day for over five years. That’s 1,680 pills, sixty trips to the pharmacy, twenty phone calls to my doctor for refills, and—happily—no pregnancies.”⁴² Renae J echoed that theme: “While the relationship that brought the pill into my life ended nearly two years ago, my partnership with the pill is stronger than ever. Every morning, the alarm on my cell phone goes off at 10:03, and I reach for the little turquoise packet on my nightstand.”⁴³

The loyalty to the pill these women express sometimes reflects their lack of trust in men. Lucy T explained, “I am super responsible about sex. Within a month of when I started having sex I was on the pill. . . . I am always prepared. I sometimes even carry a condom in my purse. You can’t rely on guys.”⁴⁴ Regina H agreed that women often use the pill because they “can’t trust the men in their lives: to respect their sexual and reproductive choices; to take part in the process of family planning; to support women and their children emotionally, materially, and otherwise.”⁴⁵

Yet some men are willing to share the responsibility, improving relationships with their partners. Marianne B felt closer to her partner because of his participation: “I loved that he was willing to pay for half of the expense of the pills (since he was benefiting also) and knew what time I took them and would help remind me when we were on vacation and I was out of my regular routine.”⁴⁶ Lorena A found that the pill opened discussion “about honesty and health, and about the importance of communication. It also forced us to have ‘the talk’ about abortion, what we would do if I were to get pregnant. . . . It also opened the door to many a sexual history talk, which is extremely important.”⁴⁷

While some women noted improved relationships with male partners who took an interest and shared responsibility for birth control, many more described discussions with their female friends. These discussions not only served as a form of mutual education and information sharing, they also deepened female friendships. Lynn E, a thirty-four-year-old librarian married to her first boyfriend and only sex partner, explained, “I have definitely talked about contraception with friends and my sisters from time to time. . . . I guess these sorts of fairly personal conversations are good for relationships since it brings you a little closer.”⁴⁸

Cassie K works for Planned Parenthood, “so of course I discuss contraception often with my work friends and other, mostly female, friends as well. I’ve found that it’s a way of bonding and feel that it’s very positive to discuss these things in a way that is unembarrassed.”⁴⁹ Shelley H agreed: “I have discussed contraception methods with close friends in the past. . . . I guess I feel that it makes relationships closer.”⁵⁰ If the pill was a bonding experience for some women, not taking the pill could be alienating for others. Alissa S, twenty-eight years old and married for six years, complained, “I feel like a ‘freak’ because I’m the only woman I know who has never taken the pill. . . . I felt [the pill] was so unnatural, and must truly disrupt our bodies. I am afraid of all the weird side effects. . . . I do feel really left out when the conversation comes around to this topic, though. . . . My girlfriends talk about their experiences trying different brands of birth control pills . . . and I kind of just zone out. When I tell other women I’ve never taken the pill they kind of act like I’m from another planet. . . . The choice not to take the pill can be isolating in some situations. But I’m OK with that. I think my ovaries are OK with it too.”⁵¹

Sue G was another woman who was unwilling to use artificial forms of contraception. “Cutting off one of my body’s normal, natural functions just does not set well with me.”⁵² Mandy B “barely felt like a woman” while taking the pill, but after she stopped “I could feel the egg release each month and the comforting feeling of my uterine walls shedding as well. I felt like a woman again. I felt like my body was doing what it was supposed to be doing again.⁵³ Kendra H explained, “There are already so many hormones implanted in our meat and dairy products. Now, when a girl starts having sex, she starts taking the pill, or when a young teenage girl gets a cyst or has a problem getting her period normally—she is automatically prescribed the pill, which is a hormone—a strong hormone—that changes the shape and the function of your body.” After she stopped taking the pill, “I feel more confident in knowing that I’m not subjecting my body to hormonal changes that are unnatural.” Although she is glad to be off the pill, she has not yet found a satisfactory alternative. “I still hate condoms—they’re sticky, gross, smell funny and EVERY GUY has a problem with them. It’s annoying that it always falls on the girl to provide some sort of intervention when it comes to this.”⁵⁴

One approach that is increasing in popularity with young women who want a natural form of birth control is the Fertility Awareness Method (FAM). Jacqueline G is a FAM enthusiast. She initially took the pill at the age of twenty-six after an unintended pregnancy and abortion. “For the next two and a half years, my body felt numb, my sexuality dimmed, and my brain felt cloudy and dull.” Then she heard about FAM. Unlike the rhythm method, which is unreliable because it is based on averages, FAM charts the individual woman’s cycle. “I was stunned to hear about scientific birth control that was completely natural and engaged both partners in the method. . . . I told my husband about the method as soon as I got home, and he was as excited about it as I was. (He was disconcerted by my feelings of separation from my own sexuality.) We both loved how natural the method is.” Together they took an eight-hour course that “pretty much blew our minds. . . . It was a wild experience, to be able to discuss human sexuality openly with other adults, and to be able to ask the ‘stupid’ questions that most of us shared.” They learned how to chart temperatures and analyze cervical secretions to determine scientifically the exact times she was fertile. “Suddenly my fertility wasn’t something wild or uncontrollable, which is how I’d felt after the pregnancy and abortion. . . . It’s true that it requires more active participation than the pill or condoms alone, but I find it deeply satisfying to be so attuned to my body’s rhythms and fertility signals.” Now that both she and her husband know when she is fertile, “It erases the dynamic of ‘woman as all-knowing gatekeeper’ and ‘man as ignorant beggar’ when it comes to sex and pregnancy avoidance. It’s like we both learned a new language—the language of my body’s rhythms.” Now, when she sees her doctor, she feels “more empowered to advocate for my health. I now feel like I know as much if not more about my body than my doctors. My health is in my hands.”⁵⁵

Jacqueline G’s rejection of artificial forms of contraception represents the culmination of the women’s health movement and the altered relationship between women and the medical establishment that began when the pill first came on the market in the 1960s. Today’s women are more knowledgeable consumers of contraceptive products, but they do not always have the options they would like. Many expressed frustration at doctors, clinics, and nurses who pushed the pill on them when they wanted other alternatives. Unlike their mothers, who may have had difficulty getting access to the pill if they were not married, many single women complained that they are prescribed the pill regardless of their preferences for other forms of contraception. Rebecca H experienced side effects from the pill, but when she requested an IUD from a local clinic she was told it was not appropriate for women who had not had children. “So I left [the clinic] feeling demoralized, dejected, and without any options. They practically threw a new prescription for pills at me.”⁵⁶

Anita B was even more perplexed that she was offered a prescription for the pill, since she is not at risk of getting pregnant. As she explained, “I am a femme who partners with female-bodied, masculine-identified partners (butch women and transgender men), although I have had sexual relationships with biological males in the past. My current partner is female. . . . Despite the fact that I have partnered exclusively with female-bodied partners for the past four years, health care providers have repeatedly offered to prescribe the pill for me. They often ask what form of birth control I am using, and suggest the pill, AFTER I have told them that my partner is female.” She notes that women who appear masculine face the opposite problem. “My butch partners have never been offered the pill; in fact, some of them have been discouraged from seeking routine gynecological care (told that they don’t need it). . . . It is also a reminder that my feminine appearance makes my sexual orientation suspect. Health care providers want to prescribe the pill because I LOOK like someone who could—and should—have a male sexual partner. I am young, feminine, fit, and perceived to be fertile, and the medical establishment is eager to regulate my fertility. They have no interest in the fertility of my partners, who have all the same female ‘parts’ but are often mistaken for men on the street.”⁵⁷

While some complained about health professionals foisting the pill on women who do not want or need it, others expressed outrage at measures that allow health care providers and pharmacists to refuse treatments and products if they have religious or ethical objections. These “conscience clauses” came into effect in the 1970s after Roe v. Wade to allow doctors to refuse to perform abortions if they are morally opposed to it. In 2008, George W. Bush expanded the “conscience clause” provision to allow pharmacists to refuse to fill prescriptions for birth control pills or emergency contraception. Just after taking office, President Obama reversed the Bush expansion.⁵⁸

The women who responded to the Internet survey overwhelmingly and vehemently asserted their demand that the pill, and all other contraceptive options, be available, accessible, and affordable to all. Katie M fumed, “I’m completely pissed off and freaked out that there’s been a growing trend of misogyny and ‘conscience clauses’ that allow pharmacists to refuse to fill legal birth control prescriptions.”⁵⁹ Krista A insisted, “It’s not the pharmacists’, priests’, pastors’, protesters’, or anyone else’s business what I take ANY medication for.”⁶⁰

Amy K was astonished to discover that her doctor would no longer prescribe contraceptives. “To me, birth control has always been a good and safe option. I have never thought it to be immoral or unethical, and it has always been presented to me as a good thing. I never realized how strong my opinions actually were until a few years ago I received a letter from my family doctor saying that he is refusing to prescribe birth control to his patients and would use natural family planning instead. I was livid. . . . Who was he to limit the choices of his patients?”⁶¹

Others encountered more subtle roadblocks to access, particularly for the morning-after pill. This pill is a form of emergency contraception that can be taken after unprotected sex. Since the 1970s, doctors and their patients have known that an increased dose of oral contraceptives taken after intercourse can prevent an egg from being fertilized. In the late 1990s, the FDA approved two morning-after pill compounds, Plan B and Preven, for use as emergency contraception with a doctor’s prescription. Since 2004, the American Academy of Pediatrics and the Society of Adolescent Medicine have urged the FDA to allow women and girls as young as fourteen access to the morning-after pill without a prescription. But the proposal faced opposition from religious conservatives, abortion foes, and the Bush administration. Efforts to make the morning-after pill available over the counter were thwarted until 2006, when the FDA approved sale of the drug to women eighteen or older. In 2009, seventeen-year-olds gained access to over-the-counter emergency contraception.⁶²

The issue of access and availability is all the more pressing for the morning-after pill, when time is of the essence and the stakes are high. Krista A noted, “Morning-after pills are a great way to make sure a single night of passion doesn’t ruin a woman’s life.”⁶³ But emergency contraception can still be difficult to obtain, even for those who are legally eligible to buy it without a prescription. Cathy P recounted a frustrating effort to secure the morning-after pill. “They claim it’s sold ‘over the counter,’ but I still had to go stand in line at the pharmacists counter just to ask for permission to buy it. I wouldn’t have minded doing that, but I had to go to six different pharmacies . . . before finding one that had emergency contraception in stock. . . . I understood when I was told the first time, ‘Sorry, we’re out of stock.’ But five times?! Maybe there was a freakish epidemic of careless sex and coincidental condom breakage the night before . . . but I have my doubts.” When she finally found a pharmacy where she was able to obtain it, she was humiliated when “a random guy did some lame little catcall in passing. Ugh. I had the overwhelming urge to just turn around and lash out at him while waving that box of Plan B in his face like a crazed lunatic. But I just kept walking.”⁶⁴

These stories and commentaries of encounters with the pill illuminate the many ways women’s lives have changed. More than simply an effective means of birth control, the oral contraceptive has played a central role in women’s sexuality, relationships, political beliefs, and identity. Whether they love the pill or hate it, whether they faced parental opposition or support, whether single or married, whether religious or not, their testimonies reflect the profound ways in which the pill has become embedded in both public and private life.