Monday, December 14, 2009

Counterpoint

In the summer of this year, I was researching for a feature for Easy Living magazine on the potential side effects of the birth control pill and when searching for a news hook for the piece, I found out about the preparation of a NHS scheme which would allow oral contraceptives to be distributed from pharmacies without a prescription. At that time, all of the doctors I interviewed expressed concerns about this development, even the most conservative GPs who stubbornly dismissed my concerns about side effects.

Then last week it hit British newspapers that this scheme had recently launched in the areas of London that have the highest rates of teenage pregnancy. Bold, bright posters in the style of laundry soap adverts exclaiming that the Pill is now available without prescription are up in pharmacy windows of Lambeth and Southwark. According to the news reports the pharmacists involved were given three weeks of training in order to provide consultations for young women looking to start taking oral contraceptives or wanting to move from the Pill to long acting methods like the injection, the implant or the hormonal IUS. The implication was also there that if young women came to the pharmacy for the emergency contraceptive pill then their consultation would involve the suggestion that they start on the Pill or a long-acting method.

The British government can't seem to figure out how to handle their teenage pregnancy problem. They are looking for a quick, effective, wide-reaching fix that doesn't cost much - certainly not as much as working with individual teenage girls to discuss their attitudes towards relationships and definitely not as much as providing holistic sex education that covers both the technical and emotional aspects. The NHS as a countrywide health service can be brilliant at organizing awareness campaigns - such as their quit smoking scheme - but providing the Pill without prescription is a step in the wrong direction.

Aside from the fact that this proposal will, without a doubt, devalue the Pill as a drug, a medication, and thus make it appear harmless, and therefore keep women ignorant of its potential impact on their health and wellbeing and prevent them from seeing the signs of side effects - any 'consultations' provided by pharmacists are very unlikely to be comprehensive or cautious. We already know how most doctors deal with doling out the Pill - many simply do not tell the truth about how it works, and do not talk about the potential problems it might cause, particularly in terms of mood and emotions.

The pharmacists have probably been told to check the teenagers weight and blood pressure on their first visit - but what about scheduling follow up appointments? Will the teenage girl go back every six months and check in with the pharmacist for another consultation? How many packets of the Pill will they be given to start? It can be assumed busy pharmacies aren't going to want to have a constant round of check ups and would be more inclined to hand out Pills literally over-the-counter after an initial talk. This goes against even the loose policies presently in place for obtaining prescriptions. Women must return to their GP every three or six months to check for problems such as the increased blood pressure, migraines or breathing difficulties that might suggest a blood clot formation.

Most women get the Pill from their GP, but often family planning clinics are much more interested, at least in the UK, in the side effects a woman might suffer from on different brands. This new scheme appears to stem from the root idea that teenage girls are secretive about taking the Pill and therefore want to avoid their family GP. The spokespeople for the scheme have said teenagers go into, say, the Boots pharmacy to buy cosmetics, so they can pick up the Pill easily and inconspicuously. It seems very doubtful that teenage girls really have this problem with people knowing they are on the Pill. Would these consultations, like those available at a family planning clinic, involve discussion of condoms and the necessity that they are used for casual sex at all times? If teenage girls are using condoms properly then they wouldn't need to take the Pill, and they definitely need to use condoms to prevent getting or passing on STIs.

President Obama is putting money into a research project to investigate why men don't like using condoms and how this problem might be helped. He is backing education on the proper use of condoms, and research on the design and marketing issues that stop men using them as often as they should. This seems like an excellent move. Condoms are very effective when used correctly and diligently and even more effective if used with spermicide. Studies have shown far lower rates of unwanted pregnancy amongst young women using condoms and spermicide than those using the Pill alone. Teenage girls could also be encouraged to buy condoms with their cosmetics at Boots pharmacy. Many young women don't use condoms because they don't want to bring the subject up, and neither does the NHS it appears.

Maybe money should also be put into getting the one-size-fits-all diaphragms now designed and ready through FDA approval and out on the market as soon as possible. Then money could be put into educating women about this original, truly liberating contraceptive method. Then teenagers could buy diaphragms with their cosmetics.

The pill encourages the kind of thinking about sex and attitude towards relationships that likely causes the UK’s higher rates of teenage pregnancy. Keeping contraception invisible, unobtrusive and solely the girl’s responsibility encourages a skewed perspective on sex and relationships. This outlook separates the idea of sex from reproduction - and of course sex should not have to lead to reproduction - but it also completely ignores how a woman's body works.

I'm not a moralist, or a right wing Christian, but the action of having to stop for a moment and put a diaphragm in or stop and put a condom on could actually be helpful in more ways than just the preventing of pregnancy and the transmission of STIs. This pause makes a person consider the partnership, the other person, the situation and their feelings about that. It puts sex, however casual, into a context. Actively promoting a contraception - the Pill - that perpetuates a silence about sex, our bodies and our relationships is not the solution.

Barrier contraceptive methods involve conversation, discussion and pause. Where do teenage boys factor in this NHS scheme? Perhaps the possibility of a resulting pregnancy is one thing that stops some teenage unprotected sex from happening. But if all the girls in Lambeth are on the Pill, then perhaps there will be more unprotected sex happening, not less, and therefore more STIs spreading. These STIs might cause a few hundred teenage girls to become infertile - but perhaps that is what the British government would like. The creation of the Pill has foundations in eugenics studies.

The part of the scheme concerning moving women from the Pill to the injection and the implant is obviously part of the general British government drive to get women on to long-acting methods. These methods will further divorce thinking about sex from any reality, and promote silence and ignorance. They aren't piloting this scheme in the affluent areas of Knightsbridge or Hampstead in London. We can assume there is a link being made between poverty and teenage pregnancy rates. If we can assume this, then the scheme smacks of the crusade to stop the 'wrong' kinds of people having children.

There is research that shows how important it is to let young women's menstrual cycles mature and settle - a process which can take four or so years. The Pill will be available to teenagers that are sixteen years-old and up. These girls are developing a sense of self and sexuality and the Pill will distort that experience dramatically for some of them. Who is this scheme for?

Weight, blood pressure or genetic predispositions will probably not be discussed properly, so there will almost certainly be an increased risk of physical problems developing. The mood changing effects of the Pill will not be discussed in the pharmacy consultation room. If the young women experience low libido as a result, that will be considered a triumph! As it was handed to them at the local Boots along with their lip gloss what's the likelihood that the teenagers will consider the Pill might be the cause behind their panic attacks, their suicidal thoughts or even their severe headaches?

President Obama's decision is more progressive. Much is said about the American government's unsupportive attitude towards the birth control pill - such as the Pill not being covered by medical insurers and abstinence-only sex education. Perhaps somehow out of all that religious, moralist, conservative talk of the last Presidency around the issues of contraception, and the subsequent suspicion of the Pill, there has finally formed something useful and sensible. The British government appears wholesale fanatical about the Pill in comparison. Their attitude holds just as much ignorance, just as strong an agenda and just as little respect for women as the Religious Right has displayed at its worst.

Monday, December 7, 2009

Building up barriers

http://www.rhrealitycheck.org/blog/2009/12/02/love-glove-ten-great-reasons-use-condoms-you-might-not-have-heard-yet

Just finished reading this brilliant article on the Reproductive Health Reality Check website, Love The Glove: Ten Great Reasons To Use Condoms You Might Not Have Heard Of Yet. It begins by saying that amongst the many reasons teenagers don't use condoms one is that they start on hormonal methods and forget about STIs. The writer, Heather Corinna, goes on to refute the often used argument that condoms lessen sensation with this brilliant answer:

"Gander, meet goose. If we're going to talk about condoms changing how sex feels, we need to remember that something like the pill does too, and, unlike condoms, it changes how a woman feels all the time, both during and outside of sex. And as someone who has had a barrier over a much more sensitive part than a penis (the clitoris) and has also used hormonal medication can tell you (and that's on top of knowing the data I do as a sex educator) a latex barrier, when used properly doesn't change sensations more than most methods do for women. Other methods of contraception can cause pain and cramping, unpredictable bleeding, urinary tract infections, depression and a whole host of unpleasant side effects. Condoms are the LEAST intrusive and demanding of all methods of contraception, even though some guys talk about them -- without considering this perspective -- like they're the most. If guys could feel what life can be like on the pill, use a cervical barrier or get a Depo shot, they'd easily see condoms for the cakewalk they are."

I was reading in Barbara Ehrenreich's Remaking Love: The Feminisation of Sex the other day that although we have come to see the pill as synonymous with women's sexual liberation and the catalyst for the freedom of the 1960s, before its release women were carrying diaphragms around in their purses. The pill, she argues, only legitimised a social shift already underway.

Just as we have become so casual about the pill that many women do not consider it a drug, we have become very flip about condoms and accepting of all the myths surrounding them. As is mentioned in the above article there are ways and means of using condoms that would make them more attractive to those who insist they dislike the 'intrusion' of this method in comparison to the invisibility of the pill. If we were to have more of these conversations then we might find ourselves in more communicative relationships having much more satisfying sex as a result.

I am in the middle of reading Charlotte Roche's Wetlands - a novel from the point of view of an eighteen year old woman who is utterly fascinated by bodily functions in defiance of the sanitised image of femininity. I think the style is called gurlesque - a blend of grotesque and burlesque. I started out flinching, but it didn't take long to get used to. She details everything, her secretions, her toilet habits, her sex acts - you're better off reading it than working out from my prudish descriptions what it's like.

I also received my kit for the fertility awareness method in the post, complete with workbook and thermometer and so am reading through that at the same time. They compliment each other very well, meeting in the middle with talk of mucus textures. Reading about the fictional Helen making tampons out of toilet paper is making me a whole lot more open to charting my monthly cycle. Coming into my third month off the pill now and despite all my testosterone putting its efforts into making my skin and hair horrid, and avoiding its other duties, I am feeling relaxed and balanced. Also no more of the massive tension headaches I have had every week for the last couple of years. All these signs of nervous anxiety are slowly slipping away.

Friday, December 4, 2009

Misguided

I think I might need to revise one of the statements I have made over and over on this blog, but then I guess that is some of the fun of a blog - you get to see the evolution of ideas. I've been reading a bit more about Margaret Sanger, the lady who helped bring about the release of the birth control pill. I'd been thinking on how she fought for freedom of choice and education, and I'd previously argued that the way the pill is presented and pushed to women these days has undermined the original motivations behind its creation.

But just this week I found out that although she was involved in the feminist and socialist beginnings of the pill in the early 1900s, as she came up against opposition she changed her take on the campaign quite drastically. She advocated the pill as a tool for stopping the 'wrong' people having too many children - 'wrong' in her mind being the poor and/or the 'feebleminded' (particularly after the invention and promotion of the IQ test). Her views were very overtly racist and classist, basically suggesting the pill should be used as a method of eugenics. You might remember I talked many posts back about how the pill component was created under Nazi experimentation to sterilise the Jewish people in concentration camps.

The UK's NHS started a new public awareness campaign aimed at young women this week. It's about informing 16 to 24 year olds on what types of contraception are available to them and how to avoid getting STIs, or getting pregnant. This is great, of course, and clearly miles better than the abstinence-only rot they try and sell here in the US. However, I have been watching some of the videos online, and reading the information, and there appears to be a strong emphasis on hormonal methods, and particularly long acting methods like the injection, the implant and the hormonal IUS. Of the 15 methods mentioned - yes, at least it's not just the pill - most of them are hormone-based.

One of the adverts shown on TV works from the point of view that it is too difficult for young women to remember to take the pill every day - and that it doesn't fit in with their 'lifestyle.' The long acting methods are given as an answer to this assumed problem. In the information given there's very little said about the possible side effects of anything, and the one mention made that some women might want to avoid hormonal methods is not backed up with any explanation. Also, oddly, condoms are kind of weirdly undermined as an effective method in some places, and then supported in others. Considering the rising number of people with STIs the whole discussion is heavily weighted to methods that only prevent pregnancy.

I've talked about this trend before, which I have seen in magazine articles criticising the pill - this push towards the injection, implant and IUD which entirely ignores the actual reason the pill causes women problems - the synthetic hormones. The main benefit suggested by the NHS representatives for the long acting contraceptives is that they stop menstruation entirely. No talk of stopping ovulation, or the entire bodily process, of course. I tend to see the NHS as a benign entity, but I don't like this spinning of the facts here. The pill gives over control of women's bodies and reproduction to medical authorities, but the injection, the implant, the hormonal IUS signs us over entirely to this system. You need a doctor to administer these methods and you need a doctor to remove two of them. You don't even get to choose to stop taking them one day, like you can with the pill.

I think the promotion of these long acting methods is not unrelated to the eugenics foundations of the pill. As I have said before, the injection is more often administered to young black women than any other group of people. It is also used liberally in developing countries. I think these methods illustrate a profound lack of respect for women. It's worth saying again that the Depo injection is used for the chemical castration of sex offenders. The same injection is being given to one in five African American women. Even if I didn't know that for some women the injection, implant, IUS will impact horribly on their mood, well being and general health, I would still be very suspicious of this insistence on such contraceptives being an improvement on the pill. It's as though it's understood now that women are becoming concerned with the pill and these replacements are being ushered in that are actually more effective than the pill in divorcing women from their bodies, crudely sacrificing their health to the greater good and eroding their mental and physical wellness.

I have been in contact with another journalist lately who was curious as to why the carcinogenic quality of the pill is not widely discussed. She has been asking around, government bodies etc, and she keeps getting the same answer - that because the pill reduces the risk of ovarian and uterus cancers the fact that it increases the risk of breast, liver and cervical cancers is negligable. And the 'greater good' benefit of preventing population increase is the overriding factor for the discussion of any negative side at all. It seems it is believed that anything can be done in the name of population control.

I have been thinking about this population control argument recently. Thing is, widespread poverty really isn't down to there being too many people in a country, it's down to the distribution of the services and resources available. It's about the very very rich having control over the majority of resources, it's about poorly managed welfare systems, corrupt governments, the poor being blamed for their own poverty by pseudo-religious administrations...so so so many factors other than how many people get accidently born.

Population control is a phony argument that only serves to promote the status quo and keep people believing there's nothing else to be done about poverty, which lets the rich keep getting richer. I understand in developing countries women can be in real danger when pregnant, as can the baby that is born, because they don't have access to hospitals, clean water, or food. But is the answer to sterilise them and use their poverty to persuade women in developed countries to be injected, implanted? I dread to think what little the women in developing countries are told about the injection. Seems to me like a crude fix for a much much larger issue, an issue that it is hoped will be forgotten as a result. Also, interesting how this perspective kind of blames the state of the world entirely on women and makes it there sole responsibility to solve. Something rather Biblical about that.

I had my attention drawn to a study this week that suggests that young women's menstrual cycles should be considered a useful, important indicator of their general health. It was proposed that doctors should consider the menstrual cycle to be as vital a sign of good health as regular blood pressure levels and monitored in a similarly attentive way. Irregularities in a cycle, such as overly heavy bleeding or prolonged time between periods, can be a sign of many problems that might otherwise go unnoticed and worsen over time - illnesses such as polycystic ovaries, thyroid disfunction, cushing's disease, adrenal tumours, but also problems such as anorexia, or extreme stress. So, putting young women on the pill, or giving them the injection, the implant, or the IUS, and shutting down their cycles can mean illnesses go undiagnosed and untreated.

Apparently it can take up to six years for a menstrual cycle to mature, and settle down. Within the first three years of a young woman's cycle she can experience pain, heaviness, and irregularity as her body adjusts to the changes. This is the time in which many women are prescribed the pill, or are persuaded by their mothers or friends to take the pill - when they are finding their periods hard to deal with. The cycle will generally even out if left alone, but it more often 'dealt with' quickly with this medication. For many women their only experience of their cycle is at this early, sometimes difficult, stage. Memories of this time often keep them taking hormonal treatments long term and not questioning the logic or reasoning for this decision. We want to avoid having to experience the pain and all that again.

I can say myself, my menstrual cycle is way more manegeable now at 26 and off the pill than it was before I went on the pill at 15. I think doctors are way too eager to put teenagers on the pill, and their parents are more than happy to support this. The NHS campaign wants young women on synthetic hormones as soon as possible as it is seen as the only assured way of avoiding a lot of pregnant teenagers. Of course, the UK has a massively high rate of teenage pregnancy so they are paranoid. But instead of educating them about how contraception works and what it is that contraception is doing that stops them getting pregnant, and how getting pregnant happens and when and why, they just want to sterilise the lot long term - it's easy, and looks like some real action. Considering the little I knew before starting this blog about my body, I can only assume there's plenty of teenage girls out there entirely clueless and as such won't be using contraception effectively.

Also the message is that menstruation - which they use in the campaign as shorthand for the entire montly cycle - is a completely unnecessary process unless you want to get pregnant. It really does seem implausible that the holistic, whole body effecting, function of the cycle is unknown to so many GPs, or that they really do think it's just a matter of stopping periods. I mean, I got a B in the lower level science GCSE and I understand this after a little reading and realising. The facts are being spun for the 'greater good' here, and individual young women are seen as unimportant in comparison to what hormonal birth control means to society.

Then again though - the supposed bastions of women's liberation, the inner circle of feminists, as in the people who are supposed to be on our side, came up with this bunch of ignorant nonsense last year when the continuous contraceptive pills came out like Seasonale:

http://www.msmagazine.com/Fall2008/LikeANaturalWoman.asp

I can't believe a magazine as smart-seeming and intellectual as Ms. believes the falsity that the pill 'regulates' the cycle and that no one in their offices has ever read a book by Barbara Seaman. They ask us to criticise Big Pharma? Here, here, but Big Pharma would love this Ms. article