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OTC Birth Control Won’t Help Women If They Don’t Get Better Information


There’s a scene in a classic 1980s brat pack movie called “Sixteen Candles” where two teens are careening along in a car. Haviland Morris plays Caroline. She leans over to Anthony Michael Hall (the aptly named Geek) and feeds him a birth control pill, laughing drunkenly as he spits it out.

“Do you have any idea what that could do to a guy my age?” he asks. She replies, “I know what it can do to a girl my age. It makes it okay to be really, super careless.” This is what the pill looked like to my young mind. It gave youthful folly a consequences-free pass. The reality was much different, and more personally altering than I ever could have expected.

A recent tweet from Alexandria Ocasio-Cortez read “Psst! Birth control should be over-the-counter, pass it on.” The idea is that hormonal birth control pills are such a basic aspect of women’s health care that they should be readily available, perhaps even less regulated than Sudafed. Worries over pseudoephedrine are that consumers will get all “Breaking Bad” and start manufacturing methamphetamine.

But making hormonal birth control pills over the counter is all about controlling women’s reproduction without giving them adequate information about potentially damaging effects. While arguments can be made that a lack of expertise may make consumers pay more attention to potential side effects, those potential negative reactions that many women may experience are rarely disclosed.

Going on the pill didn’t seem like a big deal when I was 16. In fact, I barely thought about it at all. Visiting a gynecologist was anxiety producing. I had no idea what to expect, and I was freaked out about being touched. The whole thing made me lightheaded.

After my first exam, my gynecologist said I had polycystic ovarian syndrome. She said that I needed to go on the pill to regulate my cycle, which up to that point had been erratic. I was not sexually active at the time, but shortly thereafter I did feel that there was now no reason not to be. I had no idea what the risks were, or what the effect would be, other than to make it “okay to be really, super careless.”

The Unseen Side Effects of Birth Control

There has been a begrudging willingness lately for women to open up and start talking about the side effects of hormonal birth control. But that willingness comes with concerns that a negative perspective will begin to accompany the ovulation-suppressing hormone cocktail.

Progressive women fear the public conversation over women’s reproductive health options will lead to a repression of reproductive options, and use the spate of anti-abortion legislation in several states to justify this. The realization that Catholic interests fund apps that encourage natural family planning, helping women track their ovulation cycles, have raised additional fears about limiting women’s ability to shut down their reproduction.

Mainstreaming the conversation about women’s health is a good thing, but many of the common procedures and practices that affect women’s health, primarily those that alter or manage women’s reproductive health, are medically serious enough to require physician oversight. Hormonal birth control, from pills to patches to IUDs, have been part of the birth control arsenal of most women I’ve ever known. It’s taken by upwards of 10 million American women per year. But the fact that practically everyone’s on it at some point or another doesn’t diminish its potential risks, or the need for medical professionals to disclose them.

I went off the pill in my early 30s because I was not prepared to say no to motherhood. I told my doctor this, and that I had been diagnosed with polycystic ovarian syndrome in my youth. She looked concerned and said that with that condition, pregnancy could be very difficult. I’d been prepared for that. But I wasn’t prepared for my doctor to find absolutely no trace of it. She said I never had it.

I was confused. At the time I started the pill, insurance would only cover the prescription if it was medically necessary. Was a polycystic lie concocted so my insurance would cover it? If it wasn’t medically necessary like I had believed, would I have stayed on it for more than 15 years? I don’t know. I didn’t have the necessary information to make that choice. And I didn’t know what it had been doing to me until I went off it.

Women Need More Communication from Their Doctors

When there are medical solutions for women’s reproduction, the question needs to be asked as to what problem they are fixing. In each social and legislative conversation about women’s reproductive health, women are treated like a problem to be solved. Their bodies, reproductive systems, and level of responsibility for those things, are up for constant debate.

The increase in women’s reproductive options is directly responsible for women having been able to achieve in fields that were previously only open to men. Family responsibilities waylaid women or derailed their careers, but as women marry and start families later, there are inevitably women who wait too long and find the door closed. Women are in the unenviable position of making choices that will determine their family’s future before they’re even ready to start one.

If the answer is hormonal birth control, the problem being solved is that women do not have enough control over when, how, and with whom they get pregnant. The pill allows women to have more sexual freedom without risk of pregnancy and increases their sexual availability to men. Women are able to maintain uninterrupted, longer-term economic engagement.

While there has been a push back against the idea that birth control is entirely a women’s responsibility,  women have to maintain practical responsibility for their own bodies. That’s just how it works. Women’s bodies have the gift of reproduction, and that gift has innate responsibility.

What Happened When I Dropped the Pill

When I went off the pill, I felt amazing. Everything was different, as though I could see color for the first time. Air was sweeter. Happiness and clarity were easier to find. Anxiety, while still present, was less pronounced. It was like a rollercoaster, a log flume, a giant rush, as though I were standing at the top of a cliff and realized I could fly.

Aspects of my personality emerged that I hadn’t known I was missing. I had always thought I was introverted and anti-social, but suddenly I liked people. It was a complete shift in how I viewed life. How could I have known? I went on the pill when I was a child and didn’t stop taking it until I was well into adulthood, nearing middle age. I was approaching the climax of my reproductive life but, in practical terms, I had skipped a developmental stage entirely.

Women need to know what is possible, not just what is convenient. The medical risks associated with hormonal birth control methods, and how hormones function in their bodies, must be disclosed. Without knowing what the existing landscape is, how will they be able to tell when it has been altered?

Women’s satisfaction must also be considered. Studies on women’s happiness abound, letting women know what kind of life gives the most joy. Most recently, the permanently single life course has been growing in popularity. But these studies define happiness as a feeling for which there must be a recipe. Living a life with the most joy comes with difficulty and heartbreak because all life comes with that. Redefining motherhood out of the happiness equation is a mistake. Kids don’t ruin women’s lives, but they can reprioritize and fulfill them.

We Still Don’t Know So Much About These Pills

The solution of hormonal birth control was so well embraced by culture, and by women who wanted the freedom that it offered, that many of the medical risks and psychological side effects were downplayed by doctors and a society that wanted young women to avoid pregnancy, for their own good. This left women often unaware that issues of depression, anxiety, and decreased libido were a result of hormonal adjustments and not some defect to their actual selves.

Women are often at war with their bodies: struggling to not bleed all over the place, wanting to hide their burgeoning breasts, struggling to not get pregnant, struggling to get pregnant, struggling with pregnancy, and struggling with menopause, to name a few. Each and every iteration of a woman’s reproductive life is subject to public debate. With so many perspectives on how women should live, attain happiness, and manage their reproductive lives, women need all the information available to make their own choices.

Women are subjected to diatribes and directives on how to achieve the greatest happiness, how to take use sex and reproduction as a bargaining chip for abortion rights and climate change respectively, how to be liberated from their reproductive responsibilities or childcare commitments. What is missed in all this is that women are not a problem to be solved.

Yet the conversation about women’s health, from psychology to sex to reproduction, treats women as though they and their bodies are an issue; a problem needing a fix. Women need to know the risks associated with all forms of birth control, the benefits of them, as well as the potential risks to not giving the family aspect of family planning some consideration.