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Over 150 million women worldwide use hormonal contraception as their preferred method of birth control. Along with preventing pregnancy, hormonal birth control can be used to manage period cramps, acne, and hormonal imbalances. The most common hormonal birth control method is combined hormonal contraceptive pills (CHC), but their popularity seems to be dipping. Since the year 2000, use of “the pill” has declined drastically, and more modern methods of contraception like the mini-pill, implants, and IUDs becoming increasingly popular. Even with all the new methods available, it seems as though none are without their drawbacks. In an era where women’s reproductive health is a political issue, it’s important to examine this shift in contraception usage, the pros and cons of the options available, and what role public policy plays, if any.
Traditional combined pills are one of the most effective methods of contraception, with a success rate of over 99%. Their recent decline in popularity can most obviously be attributed to the many unwanted side effects associated with CHC pills, including nausea, headaches, decreased libido, weight gain, and mood swings, among others. Combined pills also slightly increase a woman’s risk of having a heart attack, a stroke, and breast and cervical cancer.
An alternative to combined pills is progestogen-only pills, sometimes referred to as the mini-pill. This is just a modified version of the traditional combined pill that excludes the hormone estrogen. It’s said to have fewer side effects and helps to lessen heavy periods and cramps better than the combined pill can. However, it increases the risk of ovarian cysts and ectopic pregnancies during use.
Another long-term option is a contraceptive implant, a piece of plastic inserted into the arm that secretes progesterone to stop the ovaries from releasing an egg. It usually lasts three years, can be removed at any time, and is over 99% effective. Unfortunately, the implant comes with all the same risks and side-effects of the CHC pills, along with the risk of infection to the injection site and an increased risk of vaginal infections.
But what about IUDs? An IUD is a T-shaped plastic rod inserted into the womb that releases copper to prevent pregnancy. Even though an IUD isn’t technically a hormonal contraceptive, you can still expect some nasty symptoms and side effects just like the other methods. There’s also dispute over the pain caused by insertion with some saying that undergoing the treatment is worthy of local anaesthesia, a courtesy not always provided. Still, it’s a very effective, reversible option that can last up to ten years and is becoming increasingly popular.
Despite its flaws, hormonal contraception is a necessity for reproductive freedom, not to mention the value it can have to those with acne, hormonal imbalances and painful periods. Still, it feels as though choosing a hormonal contraception is fraught with far too many give-and-takes. Do you accept the risks and side effects for a better success rate or chance the higher risk of pregnancy to avoid them? What happens if you’re using birth control to treat hormonal acne but your combined pill makes you depressed? What if you’re sexually active but already have an increased risk of breast cancer? Considering hundreds of millions of women all around the world use hormonal contraception, you would’ve thought we could come up with one that doesn’t force them to compromise as much. Accessibility to hormonal birth control has been increasing in places across the world with government funding making it more affordable and legislation making it easier to obtain. Still, very little funding is being allocated to improve the standard of hormonal birth control available.
I recognize that I’m very privileged in to be able to complain about the “standards” of birth control when many women elsewhere in the world or of different socioeconomic backgrounds don’t have access to it at all. However, I’d argue that a large majority of the millions of women who currently access and use hormonal birth control have suffered physically, mentally, or both as a result of taking one of the most widely prescribed medications in the world. There’s no way to tell if it would be different the other way around – if men were the ones relying on birth control to prevent pregnancy. Yet, somehow, I have a suspicion that this problem would cease to exist if that were the case.
Image: Pills Birth Control, Gabriela Sanda, 2016 // CC0
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