Why It’s A Privilege To Criticize Hormonal Birth Control

It’s been a rough few weeks for hormonal birth control. In late September, The Journal of the American Medical Association published a study demonstrating a correlation between hormonal contraceptives and depression, and — as is often the case with scientific studies that tackle a thorny social issue — the press took the findings and ran with them. A few days later, The Guardian published an angry opinion piece condemning the medical establishment for allegedly conspiring to underplay and hide the negative effects of hormonal contraception; two weeks after that, Broadly upped the ante with a reveal of “the racist and sexist history of keeping birth control side effects secret.” If all this hormonal birth control backlash has you tempted to chuck your pill pack in the trash (or reach up inside yourself and rip out your Mirena), you might want to take a deep breath, count to 10, and consider the broader story of birth control. Because while there’s a lot of truth to all this birth control bad news, it’s also just one small piece of the problematic, complex story of hormonal birth control for women. To begin with, there are things that these stories get right. Yes, there is evidence that altering a person’s hormonal balance can have an effect on her mood. But the idea that this knowledge was somehow suppressed or secret until just last month is baffling — a Cosmopolitan piece from this past spring lists anxiety, mood swings, and depression as potential negative effects of hormonal contraception, pointing to a number of studies that correlate hormonal birth control with emotional distress (and, for what it’s worth, a number of studies that demonstrate the opposite).

And even with this evidence, it’s important to understand that the relationship between depression and contraception is not quite as simple as “any hormonal birth control is going to make you depressed.” The human body’s relationship to hormones is varied and complex. Different people have different reactions to different chemical formulations; what works well for one person can ruin another person’s life. If your hormonal birth control seems to be causing you emotional distress, consider trying another formulation or a non-hormonal method, like the Paragard IUD. If it’s not causing you distress, then you don’t need to panic: Nothing in these findings suggests that hormonal birth control acts as some ticking time bomb of debilitating depression. Additionally, it’s important to remember that putting too much stock in this one study in particular — or any one study, for that matter — is ill-advised. Yes, these researchers found a correlation between hormonal contraception and antidepressant use. But they were also studying a relatively homogeneous population (just Danish women), and while their two decades of data might seem impressive, it also means they were studying the effects of outdated contraceptives that are no longer on the market. Like most pharmaceuticals, hormonal contraception is constantly being updated and retooled; to treat modern contraceptives as completely equivalent to versions available 20 years ago (or, worse yet, Enovid, the pioneering pill discussed by Broadly) is misguided at best. Second, yes, Broadly is correct that the pill was developed under ethically dubious circumstances. But it’s important to couch that information in some context: While this doesn't make it okay, we should remember that historical medical breakthroughs, in general, have often come to us under ethically dubious circumstances. For much of the 20th century (and, of course, long before), ethics in medical research was something of an oxymoron. If you’re troubled by the revelation that the pill was tested on unwitting Puerto Rican women, consider that the speculum was perfected through experimental surgical procedures performed without anesthesia on slave women, or that for 40 years the Public Health Service allowed a group of Black men to suffer and die from syphilis — even after effective treatment became available — all in the name of scientific research. There’s no question that the pill’s history is upsetting; but whether it’s better or worse than other medical research conducted in the early 20th century is debatable. Yet, while it’s important to continue to study hormonal contraception, educate users (and potential users) about possible negative effects, and continually advocate for better, safer contraceptive options — it’s that process that got us from Enovid to Ortho Tri Cyclen in the first place — it’s also important to remember that there’s a tremendous amount of privilege to being able to complain about the negative effects of hormonal contraception in the first place.

If, like me, you grew up with easy access to a wide variety of contraceptive choices and legal, safe abortion, it can be difficult to truly understand the transformative effect hormonal contraceptives have had on women’s reproductive freedom — and, by extension, women’s entire lives. Prior to the invention of hormonal birth control, a woman hoping to explore her (hetero)sexuality while successfully avoiding pregnancy was entirely dependent on her male partner’s willingness to use condoms or comply with fertility tracking. Hormonal birth control literally granted women complete reproductive freedom and control over their destinies, something we should not take lightly — or for granted.

(To anyone about to argue that the same effect could have been achieved by making hormone-free IUDs available to everyone: yes, but no. Like hormonal contraception, the copper IUD isn’t right for all people. In addition to experiencing negative effects, such as heavy bleeding and incredible cramps, not everyone is a good fit for a contraceptive that requires a doctor to both insert and remove it. The ease with which the pill, patch, and ring can be casually experimented with and subsequently abandoned is important for many people, and should not be understated.) It’s a sign of how much we assume our reproductive freedom to be a given that one of the most cited lines from the Broadly piece is an offhand comment about how hormonal birth control was originally intended for men, but ended up repurposed as female birth control when it was determined women would be more accepting of uncomfortable side effects than men would. Displayed out of context on social media, this line seems like a condemnation of hormonal birth control, a sign that its sexist inventors callously chose to place the burden — and negative physical effects — of preventing pregnancy on women, and women alone. But imagine for a moment a world where medical researchers had decided that — side effects be damned! — they’d move forward with a male hormonal contraceptive (and somehow managed to overcome the many hurdles and stumbling blocks that still stump researchers today). In that world, women never would have gotten the ability to truly control their own reproductive futures, and never would have gotten access to true, unfettered sexual freedom (not to mention the positive side effects many women have come to rely on: more manageable periods, clearer skin, and higher sex drives, among others). And — in spite of all the nausea, vomiting, bloating, and mood swings that come with hormonal birth control — that world isn’t one that I personally want to live in.