Parts I, II, III, IV and V.
This is the final act of the five part series on hormonal contraception. In the first acts, I shared with you some of my opinions regarding the way the pill and assorted hormonal contraceptives are marketed, described some current literature on pill use, normal variation in reproductive function, and possible behavioral changes associated with reproductive hormones in contracepting and noncontraceptiving women. Today, I’ll continue to be a bit opinionated and offer up some alternatives to hormonal contraception. As always, keep in mind that I am not a medical doctor, but a biological anthropologist. This is not medical advice, and while it is research blogging this is not original research or even a review article. This is a series of blog posts written by an academic with enough expertise and enough of a strong opinion that she feels like sharing it.
So what should I use for birth control?
I would like to first mention that there are some very good reasons to use hormonal contraceptives. If you have difficulties using barrier methods and are in a monogamous sexual relationship where you are not concerned about STDs, if you are interested both in birth control and are seeking to reduce PMDD symptoms or moderate acne, or if you wish to use birth control without your partner knowing about it, hormonal contraceptives are a good choice. If you do not have any risk factors for the side effects associated with them, if you have a BMI under 25, if you were born and raised in an industrialized nation, then hormonal contraceptives are fine too if you want to use them.
However (and this is a big however), it is worth considering what parts of hormonal contraceptives have not been adequately studied (in terms of behavior, cognition, libido), and what you are comfortable supporting in terms of pharmaceutical companies. Further, water purification treatments have a lot of trouble getting hormones out of water because they are so small – this means they are getting into our rivers (I wish I had the source for this, but a colleague borrowed my textbook on this over a year ago and I haven’t gotten it back – the only article I can find on my desktop right now is Huang and Sedlack 2001 which is worth reading, but doesn’t address everything). This is not me wagging my finger – we are all complicit in any number of things every day of the week. I indulge in Cherry Coke Zero from the vending machine down the hall from my office every now and again, and I know that Coca Cola is not the best company. I own clothes from companies that use sweatshops. I am not always a shining example of righteousness. So please do not misunderstand this point as my saying that those who use hormonal contraceptives are not good people.
When none of the choices are especially appealing, and reproductive decisions are largely in the hands of women, where women are in fewer positions of power (except as the not-as-influential-as-you-may-think consumer), it is irrational to judge any individual woman for her reproductive decisions.
So, what kind of contraceptive should YOU use? I do hope you know about all of the available barrier methods: condoms, female condoms, diaphragms, sponges, and spermicides. For someone in a monogamous, long term relationship I think diaphragms are a great choice and with a little practice very easy to use. Another method worth considering is the IUD, or intrauterine device. This is one of the most popular birth control methods across the globe, but because there were some health scares with their use in the very early stages (think several decades ago) people in the US don’t use them. IUDs these days are very safe, and if you find a doctor who doesn’t want to put one in you because you haven’t had a kid yet, find another doctor (this was the advice given to me by a medical doctor, by the way). The no-IUDs-until-kids thing is a very old, conservative stance that doesn’t match the evidence for the usefulness of IUDs.
The reason I wanted to write this series of posts on hormonal contraception was not to universally advise against it. Rather, I was interested in promoting some of the research around it (and perhaps demonstrating some of the holes in what we know), in ways the average user of contraception may not think to look into. Population variation, cultural conceptions of menstruation, BMI, behavior, libido and cognition, as well as what companies profit from our use of these products, are all worth considering, alongside the convenience of taking a pill to avoid pregnancy. In time I hope we’ll be able to say more about behavioral or cognitive effects of hormonal contraception, especially given the huge numbers of women out there who use it.
Huang C, & Sedlack DL (2001). Analysis of estrogenic hormones in municipal wastewater effluent and surface water using ELISA and GC/MS/MS Environmental Toxicology and Chemistry, 20 (1), 133-139