Friday, November 20, 2009

Who am I when I'm not on the Pill?

Bayer Schering Pharma, once again the company behind Yasmin/Yaz, made an announcement this week that the Asia-Pacific market is opening up for sales of the birth control pill. Oral contraceptives are not popular in China, India, Vietnam and Japan. I have kept meaning to write here about Japan, as the pill was only legalised there at the end of the 1990s. Apparently women in this area of the world are suspicious of the pill and its long term side effects. In Japan 80% of women use condoms as their main method of contraception. This attitude has been put down to conservatism - mostly that women are not considered responsible for contraception, concerns that it might cause on-going infertility, and a dislike of the regime of daily pill taking. Even since its legalisation, and we can imagine much campaigning from frustrated pharmaceutical companies, women remain uninterested.

There's a book by Japanese writer Ayako Matsumoto titled Why The Pill Is Not Welcomed in which she argues the lack of interest in the birth control pill is partly due on the availability and acceptability of abortions. When the pill was released in 1960, abortion was still illegal in Western countries, but legal in Japan. Women at the time protested that the pill gave them the burden of contraception, plus the side effects of the drug, and allowed men to deny all responsibility. They saw that the pill was not treating a disorder, but changing the natural patterns of a healthy body.

Of course, in the news stories and discussions you can read about the pill and Japan on the web, there is the argument that Japanese women are restricted in their freedoms and the Japanese government wants to keep it that way. I think it would be fascinating to look further into this, and compare women's lives in Europe and the US. I have been talking here about how bound up the birth control pill is with the progress of women, their relationships to their bodies, and society's attitude towards them so it was be interesting to look more in depth at a country in which women work, choose relationships, have similar lifestyles, but do not take, or like the idea of, the pill.

I have read a little about how Japanese women are more interested in charting their own cycles, and working out when they are fertile and when they are not. As I mentioned in my last post, I had a talk with fertility awareness method expert Jane Bennett the other day. She argues that it is better business to keep women mystified about their hormone cycles as prescribing the pill creates a lot of money, and although educating women about their natural patterns would take time, once they had that knowledge no money could be made from it. Although I think capitalism always finds a way, I understand her point.

Phil Smits, head of the Women's Healthcare Global Business Unit for Bayer Schering, informed reporters this week that the women's healthcare market was valued at $16.4 billion worldwide in 2007, with oral contraceptives accounting for around 45 percent.

Aligning their company with women's liberation, and promoting the idea that Japanese women are oppressed is sure to help their cause. In his statement, made in Singapore, Smits also emphasised that use of "reliable" contraception was low, and as such suggested the methods chosen by Asian women, including condoms, are unreliable. By drawing Japan's attitude towards abortion into the matter, however significant this point likely is, has the effect of making the providers of birth control pills saviours of the unborn, moral crusaders fighting to stop the brutality of abortion. Of course, abortion shouldn't be used in place of contraception, but I doubt it actually is to such an extent as is claimed.

The statement was rounded off with the announcement that Bayer is working on drugs for women with menopause and "gynaecological disorders."I find the vagueness of that term worrying. What will women find they have wrong with them now? I came across an article last week that talked about 'restless vagina syndrome.' The 'female answer to Viagra' is all over the news today - Flibanserin is a failed anti-depressant now being marketed as a drug to increase women's sexual desire and what they like to call 'satisfaction.' It is also said to reduce the 'stress' caused by lack of desire, rather oddly - sounds like spin to me, suggesting that they are really concerned about women's desire and satisfaction, rather than exploiting their situation. Creepily it is explained in some articles as acting by 'decreasing inhibitions.'

The pill was supposed to help women enjoy sex more as they wouldn't have to worry about pregnancy. It used to be thought that fear of pregnancy prevented women from having the same level of libido as men. The pill, however, reduces libido in a large number of women, as it stamps out the important hormone testosterone, has depressive effects and stops ovulation. Women's libido peaks around ovulation for obvious reasons, and when you take the pill you don't ovulate. If the pill makes you feel low or anxious then you are less likely to be interested in sex. Despite the pill's popularity, and the resulting liklihood that many women with low libidos feel this way because of the pill, at least in part, we are supposed to get excited about the prospect of taking another pill to deal with the side effects of the first.

This development has already been greeted with the usual talk over how complicated women's sexuality is, and how it includes the complexities of their relationship, their self-image, their feelings of stress. Now, this is all true, but it's irritating how such discussion ignores the biological side, when that too exists and is important. Women are effected by testosterone levels like men, their libido is linked to their hormone levels. Pretending they aren't just allows further justification for any and all messing around with these hormones. Also, one of the most irritating assumptions to be used by both sides is that frequency of sex signifies interest and desire for sex, which is completely wrong. Just because women are having it more, does not mean they want it more. Unfortunately.

I imagine they are hoping it might get to the stage where the mere availability of this drug will force women to take it - if women can want sex more just by popping a tablet, why would they not want to? If they don't want to, what is wrong with them? And so on, and so on.

Some, well many, other interesting points came up in my conversation with Jane - she talked about the "slow creep" of the symptoms of suppressing your cycle with the pill for years. Even if you are super healthy, the pill blocks nutritional uptake, so any conditions you have or may be prone to can be provoked or worsened. She suggests that women coming off the pill should make sure they are taking good vitamin supplements and eating very healthily so your liver has the chance to clean out and clear. The healthier you are the better you will feel throughout your natural cycle.

I have been feeling far clearer this week, around two and a half months after stopping the pill. I am energetic, motivated and more, well, reasonable in my outlook and responses. I met a woman last night who related her own coming-off-the-pill story to me - she said she felt like she was 'human' again, and that the range of emotions suddenly available to her to feel and experience was shocking after years of numbness and nothingness. We talked about how if you take the pill through your teens and twenties and then stop, it's hard not to feel like you may have missed out some pretty important elements of living by being so mentally and emotionally cut off.

A study involving 900 women over a ten year period in Germany found the fertility awareness method to be a very effective form of contraception. As I have said before, it's not the same as the rhythm method - involving instead charting your temperature level and the consistency of the discharge you produce through the month. I found the study a very interesting read, particularly considering that this method is rarely openly discussed. I am intrigued, mostly at this point because I think it would be helpful to be aware of my body's changes and feel connected - I figure it will make coming off the pill less worrying. Jane is going to be sending me a home kit to try out for myself - so I'll let you know how I get along. I will be sticking with the condoms and spermicide for now, but as Jane says, it's good to find out about your body regardless and take back a sense of control and confidence.

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