girl interrupted - pills

The inadequacy of birth control technology does not need to be explained. Women’s lives are linked to pills and devices that cause weight gain, spontaneous bleeding, lowering of sexual desire, bad skin, blood clots, varicose veins, and depression. A woman might invest in an expensive or invasive technology, only to discover that it does not serve her and must be removed for something else. We use birth control because it can prevent pregnancy, endometriosis, ovarian cancer, acne. Still, one goes to the doctor to learn about one’s “options” with a sense of dismal resignation to their various imperfections.

I went on the pill at eighteen, when I first started having sex. For the next ten years I cycled through pills and more pills. Some made my skin bad. Some made me gain weight. Some were covered by health insurance and then suddenly not. Some diminished my interest in sex entirely. I suspected they exacerbated the depression I experienced in my twenties, which I treated instead with other kinds of pills. At the age of twenty-eight, after a decade on the pill, a doctor informed me that I should not have been taking pills with estrogen at all, since I occasionally have migraines with aura, which puts me at increased risk for a stroke in the event of a blood clot. I went off the pills and did not get my period again for six months.

When I next had a boyfriend and got tired of condoms, I installed a hormone-free copper intrauterine device, which eventually made my periods last twice as long. A doctor suggested menopausal hormones to deal with the bleeding and that did nothing. I took a progesterone mini-pill that made me bleed for two months straight, a relatively common side effect of the mini-pill that made sex embarrassing and clearly repelled my partners.

To be religious is often associated with a certain idea of family, but most religions have allowed for the declaration of a vocation based on one’s sexual practices. Married life was one such vocation, one way of being in the world. There were also the figures of the hermit, the monk, the ascetic, the nun. Celibacy was traditionally required to follow these roles, which were defined by either severe introspection and isolation or an equally radical commitment of one’s life to the public, to serving the community. Their roles outside family were respected by society, because of collective acknowledgment that presenting to the world as an individual allowed for orders of connection unavailable to people busy raising and providing for their offspring.

“And how realistic is it that you will consistently use condoms?” asked one doctor. I had a boyfriend by then, so for a while relied on his self-control, but I really did not want to have a baby. I got a plastic IUD with hormones in it, a technology that had been invented in the 1970s. For six months, I bled off and on until suddenly, miraculously, my body settled into something approaching stability.

We tend to think of technology as something that we invent and direct to our own ends, and machines as prosthetics that we deploy, but sometimes we conform our expectations to the technology that we inherit. This is especially true of contraception, which has seen almost no paradigm-changing innovation in the past forty years. We take as a given the limitation that the condom is the only contraceptive that protects against both pregnancy and sexually transmitted infection. We take as a given that the best ways to prevent a pregnancy are the worst ways to prevent infections. We accept the lack of options for women who cannot take hormones. We treat as exceptional the risks for people who want to get pregnant but whose partners have chronic viruses. The last advancement in contraceptive technology for men came after the invention of latex in 1920.

Private-sector investment into birth control has dramatically fallen from its peak in the 1970s. The biggest pharmaceutical and biotechnology companies have largely abandoned research in the field. It is not in a pharmaceutical company’s best interest to innovate away from a profitable and widely used once-a-day pill and toward a long-acting, cheaper alternative.

Perhaps what hinders our thinking on the subject the most is this commitment to an obsolete idea of biological destiny, initiated with the false menstrual periods of the early birth control pill, enshrined forever in 28-day plastic packages that force women to return to the pharmacy according to the waxing and waning of the lunar month. And, despite advances toward mandated coverage, this universal question remains a disproportionate financial burden, considered a personal cost borne by one half of the population rather than the other. Framing birth control as a choice, and not as a human right, had caused us to settle not only for mediocre technology and poor availability, but it had encouraged us to think of our childless lives as an arrested state.

Emily Witt - Future sex