Closeup/Medicine

A blessing and a curse

Must she who lives by The Pill also fear dying by it?

Joann Webb April 17 1978
Closeup/Medicine

A blessing and a curse

Must she who lives by The Pill also fear dying by it?

Joann Webb April 17 1978

A blessing and a curse

Closeup/Medicine

Must she who lives by The Pill also fear dying by it?

Joann Webb

As far back as Helen Peterson can remember. the pill has been the answer. She recalls, as a “tearful and naïve 17year-old," going with her mother to the doctor—complaining of painful, irregular periods. “I was so embarrassed I could hardly speak," says the executive secretary, now 29.“But I remember what he said as he patted me on the shoulder in his fatherly way: ‘Now don’t you worry, I’ve got just the thing to fixyou up. We’ll putyöu on the pill.’ ’’And it was done. No examination, no pap test, no explanation, just a pat and a prescription. And from that day to this, without interruption, the pill has been as much a part of her life as her packand-a-half cigarette habit.

Like many women, Peterson “felt sick” when she read recent newspaper reports about a long-term British study linking age, pill use and smoking to deaths from heart attacks. It was shocking news, the latest in a rush of pill scare stories that are driving pill users, their partners and physicians to a state of utter confusion. Gradually, a society in which 30% of fertile women take the pill, and many more have or will, is catching on to the fact that pill users are still guinea pigs. They are testing the most powerful drug ever consumed by so many for so long, and there is no agreement among professionals about the hazards involved. “What’s a woman supposed to do?” asks Peterson, expressing the perplexity of a generation of women who took the pill young, got hooked on the freedom it provided, and only then considered the consequences.

The British study by Dr. Valerie Beral concluded that smokers who take the pill run increased risks of dying from cardiovascular disease, principally heart attack— and that the risks rise dramatically the more women smoke, the older they are, and the longer they take the pill. Those conclusions, though fiercely disputed by some of the most prominent researchers in the field, have pushed Canada’s Health Protection Branch and the U.S. Food and Drug Administration to issue major warnings. Effective July 1, Canadian women will read this ominous addition to the scanty patient information sheet that comes with their pills: “Cigarette smoking and age are related to heart attacks. Adding the pill to either of these conditions further increases the risk of heart attack. Women over age 30 should consider the cessation of smoking if they take the pill. Women over 40 should not be on the pill.”

In the United States, the FDA has issued a warning that “pill users who also smoke ... are 10 times more likely to die of a heart attack or circulatory disease than women who do not use the pill and do not smoke.” All pill packages sold since April 1 come with an overwhelming brochure isting every piece of information about the pill, pro or con, known or suspected.

It runs to several thousand words, many of them difficult and contradictory, most of them disquieting.

Such confusion can only fuel the pill horror stories that have become a popular topic of conversation in recent years. Indeed the pill has been blamed for every physical and psychological ill imaginable. Yet nobody knows how much blame it deserves: solid facts (as opposed to suspicions) are appallingly few. Since women have been popping them for 17 years now, it is easy to forget that not even doctors understand how oral contraceptives really work. It is only known that by some biological trick a combination of two hormones, estrogen and progesterone, acts to suppress fertility. Simulating pregnancy, the body releases no eggs, thus preventing conception. Incredibly, though the pill is swallowed every day by an estimated 900,000 Canadian women and 60 million women the world over, no major long-term pill studies were initiated until the end of the Sixties. Only recently has speculation about long-term effects been tied to solid medical research.

Among the most common side effects attributed to the pill are sore breasts and legs, water retention, nausea, depression, anxiety and headaches. But even pill users who are symptom-free run increased risks of, among other evils, blood clots, strokes, heart disease, high blood pressure, hardening of the arteries, abnormal fetuses (if the pill is taken when pregnant), urinary tract infections, some eye and skin disorders and delayed return to normal ovulation. Precisely how or to what extent the pill causes or aggravates these conditions is simply not known. However, while it is well known in the medical community that some antibiotics and barbiturates interfere with the pill’s effectiveness, few of the pill’s users seem to know. Nor do many realize that the pill is so potent it can distort the results of routine lab tests.

When side effects are severe or health risks unavoidable (when, for example, there is a family history of blood clotting), most women follow their doctors’ advice

and switch to another method of birth control. But for the majority of healthy, symptom-free women, the pill dilemma is a recurring one. As part of Peterson’s annual checkup ritual she says to her doctor: “Are you sure it’s okay for me to be on the pill?” As part of his annual ritual he soothes her. “My wife’s been on it for 15 years,” he says. “Would I let my wife take it if I didn’t think it was safe?” Peterson knows full well that many doctors won’t advise their wives to take the pill, that in fact there are as many opinions about the pill as there are physicians. Gynecologists and health clinics report that every new pill story is followed closely by a ripple of panic as women call in with questions, trying to make sense of the statistics and contradictory conclusions. But they say few women seem to switch methods on the basis of scare headlines alone. Overall, pill sales have remained constant for the past four years.

Dr. John Harkin, chief of obstetrics and gynecology at Toronto General Hospital, has no doubt some women will panic over the warnings that come with their dial packs in July. “There are women with a terrible need for contraception,” he says. “And now every time they take the pill they’ll think they’re taking cyanide or £ something.” He estimates that childbirth g causes 15 times more deaths, and that for I most women the pill’s side effects are zero. £ “It’s like other things. Five or 10% of the people cause most of the noise.” Harkin is furious over the Ottawa action, concerned that women will be unnecessarily scared off the pill, putting further stress on overloaded abortion facilities. “There are moans and groans about us knocking people off [with the pill],” he says. “We don’t think we are. But we’ll be knocking off fetuses for those ladies who stop taking the pill after the warning.”

Dr. Robert Kinch, head of the committee that drafted the warning, says women should make an effort to keep the dangers in perspective. He believes that even common headache tablets are more lethal than the pill. Besides, most pill users are aged 18 to 30, so are too young to be affected by the latest statistics. In turn, he is outraged at the American action. “A woman reading this stuff,” he declares, brandishing a copy of the lengthy U.S. warning, “will never take the pill again.” That is hardly likely, for Kinch is overlooking the sweet freedom the pill appears to provide. In the Fifties and through most of the freedom-conscious Sixties, the pill was hailed as the liberator of women and men from the terrible fear of unwanted pregnancy. Idealists waxed eloquent about \ the joys of biological independence, the dawning of sexual equality. Others talked I hopefully of a new age in which women i would be easier to get into bed and more ? fun once they got there. Whether any of

that speculation has come to pass or is ever likely to come to pass remains to be proven. But there can be no doubt the pill caused a revolution, if only in expectations. University of Wisconsin professor Larry Bumpass, one of the few people who have explored the “psycho-sociological” effects of the pill, believes its revolutionary impact cannot be overestimated. “It raised, for the first time, expectations that control of fertility should be complete,” says Bumpass. When that freedom reached out, as it had to, and touched other perceptions, “there was no turning back.” Despite its problems, the pill continues to be regarded with profound gratitude, especially by those who remember when unplanned babies or monthly pregnancy scares were the norm. Just one popular luxury the pill now affords is the option to delay children until careers are established, homes bought, personal goals indulged. In conversation after conversation, pill-generation women say they are glad they were born in this age. It’s a recurring theme: “The pill has freed me ... it has given me choices.” For the first time ever, sex is being enjoyed by large numbers of young women without the probability of “paying later” with motherhood, unwanted marriage or abortion.

At some point, however, a woman starts to conjure with the unknowns—and then her sense of freedom quickly diminishes. She comprehends the enormity of what she is doing: pumping powerful chemicals through her body, perverting a natural function—ovulation—with no guarantee that she won’t still have to “pay later” with a terrible disease, an early death. She wonders whether she will ever be able to conceive. “I worry that when I try to have a child they’ll tell me I can’t because I took the pill for so long,” says Peterson. “Wouldn’t that be a terrible irony?” Looking ahead, she even becomes fearful of damaging the fertility of her children and grandchildren. Nobody can assure her she won’t. “The older you get the more scared you get,” comments Nadine Mitchell, a 22year-old psychology major at Brock University in St. Catharines, Ontario. Most of her friends are five-year pill veterans. “Every girl I know in residence is on the pill and they all say they’re worried about screwing up their bodies.”

Longtime pill users, or women committed to ongoing relationships, are more willing to experiment with other methods of birth control, but most agree that after the pill the old standbys seem inadequate. “They’ve given me two pregnancy scares in six months,” says one single career woman who wants to postpone having children until she is established professionally. “I’m going back on the pill, risks be damned. Nothing is worth that worry.” Having experienced the freedom of risk-free sex, anything less than 100% efficient birth control is no longer good enough. And that explains, says Bumpass, the recent boom in popularity of the “permanent” birth control methods—vasectomies for men, tubal ligations for women. Though sterilization was unusual (and frowned upon) just a decade ago, more than half the Canadian couples who want no more children have chosen sterilization of one partner, usually the woman. As well, more women now refuse to accept that an accident should be paid for with a baby. One out of every four pregnant women opted for a legal abortion last year—a 15% jump that “will go up another 15% with the new warnings,” Harkin predicts. Even the recent swing back to the condom has been attributed to worried pill-generation women who want their men to start sharing the burden again. “The pill was fine when I was 18 and the slogan was live better chemically,” says Diane Rotteau, a 27-year-old editorial assistant who has been married five years. “But our lovemaking is more mature now and it’s no problem for my husband to use a condom.”

Nevertheless, to women who’ve never used anything but the tidy little pill, all other methods still seem crude. “Dia-

phragms and IUDS are something we associate with stretched-out vaginas,” laughs Nadine Mitchell. “And foam, well, it’s considered awkward—it’s a nuisance and messy.” Which focuses on what Bumpass calls the second revolutionary aspect of the pill; the expectations it raised that birth control should not interfere with sexuality. Of the most widely used methods—the pill, intrauterine devices (IUDS), diaphragms, spermicides, condoms, coitus interruptus and rhythm— the pill and IUD are most efficient, perhaps because they’re the two methods that require no thought whatever during intercourse. There is no need to stop, nothing to remember, fiddle with, worry about—no potential for human error. “Those housekeeping chores turn me right off,” says one 28-year-old Toronto secretary, closely echoed by her husband. While such squeamishness may on the surface seem petty or downright lazy, it is no minor consideration among men and women who have grown accustomed to perfection. “It amazes me how men don’t even ask if you’re safe any more,” says Jennifer Stin-

son, 30, a social worker.” They just assume you’re on the pill and if you’re not that you should be.”

The IUD, unfortunately, is far from a perfect solution to the pill’s problems, for it has many of its own. To begin with, it is only recommended for women who have had children (though others use it). When inserted in the uterus by a doctor to act as a long-term barrier between sperm and egg, it usually causes pain. As well, horror stories of its side effects—real or supposed— easily compete with those of the pill. Women know it can perforate the uterus and cause injury and infection; shift and permit pregnancy; produce severe cramps, spotting and heavier flow; be rejected by the body. “God only knows what it does in there,” says Dr. Peter Cole, director of Toronto’s family planning services.

Though it came back into vogue about the same time as the pill became available, it has never been as popular, maybe because it so graphically involves harboring a

foreign object in the body, which a lot of women find distasteful.

So far, proposed alternatives to current methods aren’t wildly exciting. Pill variations, such as a nasal spray which functions essentially the same way but lessens potential damage to the body, are in the experimental stages. Even when they become available, however, they will have to be used through entire reproductive cycles before long-term effects will be determined. As for the much-discussed male contraceptive pill, it is indeed undergoing tests worldwide, but the Canadians involved say the work that remains to be done is hampered by a chronic shortage of funds, as is all birth control research. Even the most hopeful among them say it won’t be on the market for at least five years. And then, it remains to be seen whether men will risk taking it and women will risk trusting them. More promising is research into developing mechanical methods that present no danger to anybody but work better than the ones we have. They seem even further down the line. “We’re stuck with what we’ve got for another 10 years,” concludes Toronto’s Peter Cole.

To women worried about now, that’s no answer at all, and with a touch of the childbearer’s age-old resentment they complain about the injustice of it all. “We want to shake somebody,” says Mitchell, who’s just beginning to wonder what she’s doing to her body. “I know it’s a cliché, but if they

can put a man on the moon, why can V they do something better about birth control?” In particular, women’s anger is directed against pill manufacturers, who have been slow to commit money to pill research and even slower to publicize unpleasant results; against doctors, some of whom still prescribe the pill like cough syrup and many of whom rarely take time for explanations; against men in general, who reap the pill’s benefits without the risks, no matter how much they may worry and wish it were otherwise.

What’s a woman to do? She must, it seems, keep right on making the best of a bad lot. Says Kinch, cautiously: “One of our anxieties about the new warning is that not all physicians will have the time to read and fully alert their patients.” It evidently is up to the individual to go beyond scavenging bits of information from the media and ill-informed friends. She must demand that her doctor, no matter how harried, help her relate the latest pros and cons in the pill controversy to her unique priorities. Only then should she gamble. “We balance risks all our lives,” concludes Bumpass. “Crossing the street. Flying in planes. The pill is part of that aspect of life.” As for Helen Peterson, she has arrived at the same conclusion that was thrust upon her 12 years ago. “Yes, I still worry,” she says, speaking for a whole generation. “But for me the pill is still the best answer there is.” \?