The previous chapters made it very clear that the pill was a game changing invention in the twentieth century. But there is one more important question that still remains unanswered: what was the impact exactly on the individual lives of women? The birth control pill has a tonne of advantages. Still, it is also important to pay attention to possible disadvantages and even dangers in some cases. Who informed women of the use of the pill, the advantages and risks? Today, a lot of young women are still demanding more attention for the side effects, especially on social media, since even today not all users of the pill are aware of the possible risks. Nevertheless, the pill gives women the necessary power to decide if and when they want to become a mother. But what if you forget to take the pill? Luckily, there is still an emergency contraceptive pill.

In this last chapter we zoom in on the side effects of the pill, the importance of sensitization and the emergency pill.

How dangerous is the pill?

Advantages, temporary side effects and risks

The contraceptive pill changed the lives of women on an individual level, since the pill can reduce heavy bleeding, painful cramps or irregular periods. The combination pill makes it, in some cases, even possible to skip a period. Even though these advantages occur more often than the side effects, it is also very important and necessary to pay attention to this side of the story.

When discussing the risks of taking the pill, it is important to keep in mind that each body is unique and reacts differently. We can distinguish three types of side effects: we already mentioned some advantages, but there are also risks and temporary inconveniences. It is true that the pill can be dangerous in some cases. However, this is very much related to a person’s medical history and which kind of birth control pill they are taking. For example, for smokers it is recommended to use the progestin-only pill, since pills with estrogen can indeed lead to some serious sickness. Women who already suffered from breast cancer, blood clots, heart attacks, … are also advised against using the combination pill. These high-risk side effects happen but are not common. However, that does not mean that it is not important to stay informed. More information can be found here.

People who start taking the pill can experience some temporary inconveniences, such as headaches, nausea or changes in their periods. The pill is a hormonal form of birth control and the body needs some time to adapt to these new circumstances. If these side effects, occur and, to what extent, is also dependent on the brand of pill used. In most cases, these inconveniences disappear after two or three months. These temporary complaints are not exclusively linked to the pill, also IUD users can experience, for example cramping, back aches and irregular periods. Normally, this disappears again after three to six months, which is a seemingly longer period. Again, these are only some examples. More information on the side effects of the pill can be found here and on IUD's here.

(Source: "Birth Control Pill", Planned Parenthood; "IUD", Planned Parenthood.)

Personal stories: ‘It sucked’: Eight women open up about being on the pill - BBC Future

What are your chances of getting pregnant tonight? (1970-1987), made by Health Education Council, published by Health Education Authority

Is the pill the best form of contraception?

Even though the birth control pill was a game changer, it is not ranked as the best form of birth control. However, when it comes to risks of becoming pregnant, it is considered to be safer than withdrawal, a diaphragm, fertility tracking or even a condom. When using these forms of birth control there is a 12-24% risk of getting pregnant. Nonetheless, it is necessary to use a condom in combination with any other form of birth control, since it is the only one that prevents STD's. IUD's, implants and sterilization are considered to be better than the pill with only a 1% risk of getting pregnant compared to the 6-9% for women on the pill. These forms of birth control also work for a longer period of time. You only need to renew them once every few years, except for sterilization which is permanent. The birth control pill needs to be taken every day. When you stop taking the pill, or you forget one day, there is an increased chance of immediate pregnancy. This can be an advantage if you want to get pregnant, but is a big disadvantage if that is not the case. Then, the emergency contraceptive pill is a useful solution.

(Source: "Birth Control Pill", Planned Parenthood; "IUD", Planned Parenthood.)

How well does birth control work

Family planning

Sensitization

If taking the birth control pill can be dangerous, why is it considered a game changer? The growing human population of the earth has been a serious concern for a very long time. Spreading information and advice about birth control was forbidden by law in some countries. However, in the nineteenth century steps were already being taken to inform the public about birth control methods. They brought attention to the social and economic effects of sexual blindness. These attempts to sensitize were mostly unsuccessful. Only in the second half of the next century, education about fertility practices on the family level would be effective, when clinics for family planning and health care were founded. The previously mentioned Margaret Sanger played an important role in this process within the US, and similarly Marie Stopes in the UK, since they founded the first birth control clinics. Next to these pioneers, other birth control advocates like Aletta Jacobs in the Netherlands and Dhanvanthis Rama Rau in India played an important role in resisting the public protests that initially occurred out of religious and moral opposition. Another important player in this sensitization process is Planned Parenthood, also called Family Planning, and their involved associations. One of their main tasks is measuring and regulating the number and spacing of children within a family.

(Source: "Planned Parenthood", Britannica Academic.)

Care enough... to get the facts on family planning (1965-1980), made by National Urban League

Wise Parenthood by Marie Stopes (1922, London)

Would you be more careful if it was you that got pregnant?

One of the ways to spread information among a great number of people is through advertisement. They may convey messages that provoke and instigate people to question their assumptions and challenge the societal norms of the time. In the 1970s contraception was a taboo subject to be openly debated, not to mention being exposed in public spaces.

The depicted poster “Would you be more careful if it was you that got pregnant” was created to spread awareness on contraception, safe sex and family planning issues. It was part of a campaign issued by Family Planning UK and was displayed in the waiting rooms of doctor’s offices. This pre-digital age poster had an astounding and even offensive effect when it first appeared. These shock tactics were effective in drawing men's attention to the issue of unwanted pregnancy - the impregnated image subverting the model's biological masculinity is thought-provoking per se, in addition to the model’s facial expression deeply mirroring the agony that the state of an unsought pregnancy may bear. The expression of the male model was a very successful bet. The model was discovered in the production department of the advertisement agency and attracted attention as his face looked simply confused about the whole thing. As he didn’t understand what was happening, he came up with just the right expression. He requested for his name to be kept secret as his mother was a devout Roman Catholic. However, the popularity of the poster makes us suspect things went down differently. It is a famous example of the power of advertising, and the image has become part of popular British iconography. It is still referred to and reproduced, while different versions of it have seen the public eye in many countries and a pub in London is named "The Pregnant Man" after the original pub that the poster’s production agency Saatchi & Saatchi opened to honor the campaign. It found its way into Time magazine and soon it was the topic of numerous editorials, earning it a Yellow Pencil at the 1970 D&AD Awards.

(Source: "Would you be more careful if it was you that got pregnant?", Victoria & Albert Museum; A. Fendly, Saatchi & Saatchi: the inside story, 1995.)

Would you be more careful if it was you that got pregnant, made by Cramer Saatchi Advertising Agency, Alan Brooking, Bill Asherton and Jeremy Sinclair, issued by Family Planning Association, UK (1969)

And today?

Today, the discussion moved from informing about the need for birth control to the need for informing about the dangers of the pill as mentioned above. The recent discussions about the possible side effects of the Astrazeneca Covid-vaccine have rekindled the debate, since the risk of thrombosis is higher for users of the birth control pill, as explained above. It raises questions why the vaccine becomes contested because of these side effects, but the contraceptive pill does not.

What if my contraception lets me down?

The morning after pill

People have been looking for ways to prevent or disrupt the progression of a pregnancy ever since they realized it was the result of a sexual activity. A solution was provided by the invention of emergency contraception. This could be used after unprotected intercourse or when there is a possibility of pregnancy due to a deficiency in the used contraceptive measures. Some forms can be taken up to 120 hours after the intercourse happened or sometimes after the time of expected ovulation, other forms only 72 hours. However, the earlier it is taken, the more effective it is.

The first example of emergency contraception based on hormones was created in the early 1960s, shortly after the invention of the combined birth control pill in the late 1950s. Just like the estrogen birth control pill, the morning after pill based on that hormone can cause deep vein thrombosis. That’s why in the late 1980s they rekindled research into progestin only methods. However, there are still some side effects from using the morning after pill, like nausea, vomiting and changes in the cycle. There is no proof of effects on existing pregnancies.

(Source: Norman Goldstruck, Dirk Wildemeersch, "Emergency contraception: history, methods, mechanisms, misconceptions and a philosophical evaluation", Gynecology & Obstetrics 4, no. 5 (2014): 2161-0932.)

Progesterone only morning after pill

If last night you contraceptive let you down, you're not alone (1970-1987), made by Health Education Council, published by Health Education Authority

Debate on emergency contraception

There are still some points of discussion concerning emergency contraception. First of all, there are some questions about efficiency. Not all women are sure about the regularity of their cycle. That means that the efficacies of early hormonal methods are often overestimated. Next to that, there are also some doubts about the effectiveness after ovulation, which can be used as an argument in a bigger debate: the impediment of science by religious and moral behavior. Some people see emergency contraception as abortifacient, others consider it a benefit for their health and well-being. The doubts about effectiveness after ovulation, for which there is reasonable evidence, can be used in both cases: some see it as an argument that the morning after pill is not abortifacient. Others, who have no religious bias, consider it a deficiency, which limits the method.

Finally, this discussion about religious and moral behavior is also linked to the availability of the morning after pill. Some brands are allowed to be purchased without prescription in many countries. However, that does not mean that they are necessarily available. This also depends on the physician and the pharmacist: they can refuse to prescribe or stock the morning after pills out of religious or moral reasons. There is still some debate necessary on this: should pharmacists be allowed to counsel women on this? Shouldn’t they only be allowed to inform them of potential side effects or problems?

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