Tuesday, August 11, 2009

Thinking outside the (birth control pill) box

by Amelia Thomson-DeVeaux

A few days before I left for Vietnam earlier this summer, I went to my doctor to get a prescription for malaria medication (which I turned out not to need), and ended up getting into a long conversation about birth control. I had recently gone off a low-estrogen form of the birth control pill, because since starting it I had acquired strange new mood swings, gained a few pounds, and - I'll be honest here - I was terrible at remembering to take it. My doctor asked me about the NuvaRing, and the IUD. He gave me a lot of booklets. I flipped through them, trying to remember a workshop I had attended in high school, where a Planned Parenthood employee quickly explained most forms of birth control, so that we could answer questions if they came up during a phone banking (they didn't). I had a couple of friends on the NuvaRing, but still didn't know much about it. The IUD was completely foreign, and frankly a little scary.

"So you just insert this piece of plastic into my uterus," I asked my doctor. "And it stays there for five years. And I don't get pregnant." It seemed too simple to be true. Didn't it get infected up there, or fall out, or something?

"Well, it doesn't protect against STIs," said my doctor. "But neither did your pill."

Condoms have achieved a secure position in American pop culture, even though we may not all have been treated to the condom-on-banana practice session that some health classes employ (the Virginia public schools did not think it was necessary for us to know how to use a condom, as long as we could recognize one in the wild). So has the birth control pill. Not so with most other forms of contraception, which is very unfortunate, considering that some insurance companies don't cover the pill, which can run up to $60 a month. My own track record with the pill also suggests that even though the optimal success rate may be 99%, most of us are not capable of remembering to take a pill at exactly the same time every day, or even remembering to take it at all. This, as you might imagine, reduces the effectiveness of the pill quite drastically.

The IUD, on the other hand, sits quietly in your uterus for five to ten years, costs around $300 at insertion (you can't beat $5 a month for birth control, and that's if your health insurance doesn't cover the IUD - and most do), and, even better, can be hormone-free. Female condoms are made from plastic, which is great news for people with latex allergies, and they even increase female pleasure. The NuvaRing and the birth control patch work almost exactly the same way as the pill, so it provides the same benefits such as acne reduction and lighter periods, but the NuvaRing simply needs to be inserted once a month, while the patch is placed once a week, so there's no pill to remember to take every day.

These alternative forms of birth control are, thankfully, getting a little press. Chloe Angyal has a piece up on Splice about the female condom, and there was an article in Slate last week by Kate Klonick about why more young women should think about the IUD. But the IUD in particular is dogged by its somewhat checkered past. It was a popular form of birth control in the 1970s, until a particular IUD called the Dalkon Shield was linked to pelvic inflammatory disease, which in severe forms can cause infertility or death. The Dalkon Shield has been off the market for decades, but its legacy is such that when I told my mother I was thinking about an IUD, she gave me a concerned look, and said, "Oh, sweetie, those are so dangerous." The result? Women over 40 are terrified of the IUD, and women under 40 have never heard of it.

But today, the IUD is back and remarketed - and as far as we know, it's totally safe. But it's mostly marketed to married women. Why? Because it doesn't protect against STIs, and doctors seem reluctant to give long-term forms of birth control to young women. This, however, is bullshit. I'm 20 years old right now - the chances that I'm going to want to have a child in the next 5 years are zilch. And yes, I have also heard of condoms - you have to use them when you're on the pill, too.

One would think that in this chilly economic climate, we would want as many cheap forms of contraception on the market as possible - as Lisa Belkin of the NYT told us last week, babies are expensive, as are STIs. But instead, the world of birth control is pretty much dominated by the condom and the pill - and that really needs to change. So if the pill isn't, for whatever reason, working for you, never fear. You do have options, and let's just hope that more sex educators and doctors join the struggle to put those options into women's hands.

Please note: we are not doctors, nor are we qualified to dispense medical advice. If you are considering any of the birth control methods mentioned above, please consult with a physician to discuss if they are right for you.


At August 17, 2009 at 10:11 PM , Anonymous Dan said...

I don't suppose your doctor even mentioned fertility awareness methods. They cost almost nothing-- just paper or software for charting. Some methods don't even require a thermometer. They work extremely well once both partners make the effort to learn about her body.

At August 19, 2009 at 9:45 AM , Blogger Amelia said...

To be fair, Dan, FAMs actually are pretty challenging for college students - they require a partner who is equally committed to learning about them, and then abstinence or a barrier method on unsafe days. I think they're mostly better if you're in a long-term committed relationship and actually thinking about pregnancy, because they're easily reversed to attempt pregnancy.

It's also very challenging for women who have irregular periods, and that's something that you really can't control. But yes, when correctly used it's quite effective (if getting pregnant isn't a disaster for you) - if anyone else is interested, here's Planned Parenthood's rundown: http://www.plannedparenthood.org/health-topics/birth-control/fertility-awareness-4217.htm

At September 25, 2009 at 10:21 AM , Blogger gina said...

Since the IUD doesn't affect hormonal levels do you know if that means that its ineffective in preventing migraines? I'm on the pill for both reasons - and I was interested in a more long term control method, but I can't take the migraines that I get without the pill.


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