Originally Published in Farrago Edition Five (2022)

Content Warning: discussions of eugenics, racism, misogyny, and ableism

Nothing sparks controversy, discomfort, and anxiety quite like women's reproductive health. From the early days of the oral contraceptive pill in the 1960s, to abortion rights in 2022, Western civilisation seems endlessly fixated on how women should be regulating their bodies. In recent years, much of this discourse has centred upon hormonal birth control in particular--the readiness with which it is prescribed, its adverse side effects, and how it actually functions in the body. But rather than coming from a place of patriarchal control (as many debates over women's health do), these conversations seem instead to be coming from a place of women's collective distrust for ruling medical practices.

At the beginning of 2021, I realised that the Almighty Pill was not a good fit for me and decided to explore my other options. Little did I know, books, podcasts, and studies into hormonal contraception had really hit the mainstream, most of which challenged the status quo around female physiology and patriarchal standards of medicine. To a certain extent, I found this abundance of information to be empowering. But to another, more troubling extent, I grew increasingly disturbed by the mere prospect of meddling with my hormones. Before I knew it, I was stuck in an anxious space between wanting to take hormonal contraceptives and, simultaneously, feeling deeply afraid--even guilty--about doing so.

Of course, none of these modern resources is intended to provoke fear. Rather, they serve to counter the dark and troubled history surrounding hormonal birth control, including issues of eugenics, medical negligence malpractice, and misinformed consent. They thrive on the correct assumption that knowledge is power; especially for women, who have for so long been deprived of knowledge of and power over our bodies. But the more research I did, the more my thinking fell prey to one discomforting binary: either the pill is an evil patriarchal concoction that's completely rewiring who I am as a person; or the pill is a uniquely radical measure toward my bodily autonomy as a woman.

What if it could be a little bit of both?

Let's take a closer look at the good, the bad, and the potentially not-so-ugly parts of hormonal contraception. Only then can we truly reach some sort of middle ground in this unsettling binary of Good Pill versus Evil Pill.

Good Pill 

The pill's initial distribution in 1961 symbolised far more than hormonal intervention. Rather, it symbolised, and continues to symbolise, bodily autonomy. As basic as it sounds, a woman's right not to get pregnant was a novelty in the mid-twentieth century, with contraception predicated upon a man's decision to use (or not to use) condoms. Up until this point, marriage and sex were expected to go hand-in-hand. Unsurprising, really, with the risk of pregnancy constantly hanging overhead, meaning any child born out of wedlock might have to rely on the mother's unequal wages. Wage equality between men and women still hadn't been formalised in the US, or in Australia, which made it difficult for women to raise children without the security of their husband's paychecks. For women, pregnancy was a lifelong commitment-not just to their child, but to their partner. Because of this, they tended to be a lot more cautious in their choice and quantity of sexual partners, lest they be condemned to the financial burden and social stigma of single motherhood. Even as a married woman, you'd have to put your entire life on hold to raise a child- your studies, career, or other personal aspirations--whether or not you felt ready to sacrifice those things. On that note, abortion rights in Australia were sparse or otherwise overruled by the Offences Against the Person Act (1861) until the early twenty-first century.

It should come as no surprise that the contraceptive pill played a huge part in second-wave feminism and continues to function as a feminist tool today. Not only do women have the power to avoid unwanted pregnancies, but, with modern-day adjustments to the pill's prescription, we have the power to stop menstruating altogether. Hormonal contraceptives-not just the pill, but the IUD, the implant, the patch, et cetera-offer women an entirely new means of controlling their menstrual cycles. They offer us avenues to alleviate period pain, reduce acne, regulate bleeding patterns, and even prevent certain cancers. The pill is radical in its innovation towards women's comfort and sexual mobility--no longer tethered by the threat of pregnancy or reliant upon men to alleviate that threat, thereby quashing patriarchal standards of sex. And, more broadly, quashing patriarchal control over women's bodies.

Evil Pill

But the pill did not begin with these modern feminist intentions in mind. Margaret Sanger, one of the pill's earliest and noisiest advocates, was especially renowned for her eugenicist leanings. She relied heavily on the eugenics movement in the US during the 19205-1930s to bolster her case for hormonal contraception, claiming the pill would help curb "weak" populations. Or, more specifically, marginalised populations--preventing lower-class women, disabled women, and women of colour from having children. It seems unsurprising, then, that the first medical trials for the pill were conducted on 200 at-risk Puerto Rican women in 1956. None of the women had given their informed consent. In fact, they were never even told what the pill was for. Three of these women died before the trial's end, but, deprived of the right to a complete autopsy, their deaths were never officially linked to the pill's administration.

Despite these deeply fucked up trials, the FDA approved the pill in 1960. It's taken a lot of twists and turns since then, with estrogen and progesterone levels dropping substantially to reduce the reported side effects (the most lethal of which being blood clots), but its eugenicist origins remain. And, with those eugenicist origins, an enduring legacy of medical trauma.

Today, that legacy manifests in several everyday experiences for people with periods. Firstly, there's a lot of misinformed consent: young people with periods are
generally put on the pill as the very first course of action for any menstrual-related concerns, and there's minimal (if any) discussion about what the pill actually is, let alone What the other options might be. Secondly, there's a lot of negligence: women and people with periods are regularly dismissed by medical practitioners when they complain
about their menstrual issues, and the various side effects of hormonal birth control are often overlooked. Finally, there is not enough coverage for women's reproductive health under Medicare--particularly for hormonal contraceptives that are not subsidised under the PBS (Pharmaceutical Benefits Scheme) and for people who suffer from chronic conditions like COS and endometriosis.

And by the way, why should the burden of these hormone-altering drugs be placed wholly on people who menstruate, when so many of us suffer from its adverse side effects? It seems only fair that we figure out a corresponding contraceptive option for people who don't menstruate. (In fairness, scientists are actually working on this. It's still a study in progress, but the progress is not insubstantial.)

Middle ground

The contemporary discourse around hormonal birth control, overwhelming though it may be, comes from a place of healing, because a lot of the attached history still feels like a big open wound. That said, embracing that healing and acknowledging the pill's problematic legacy doesn't have to be an exercise in paranoia. Instead, it can be an incentive to learn and understand all the available options for people with periods. And not just an individual incentive, but a greater medical incentive: doctors have a responsibility to make their patients feel aware, informed, and secure in their birth control decisions. More than that, when complaints are raised, doctors have a responsibility to listen. Hormonal contraceptives are not the problem, but rather, the patriarchal standards of medicine from which they are prescribed--founded upon sexist notions that people with periods are overly sensitive, if not outright hysterical. And then, of course, there are the eugenicist standards from which women's contraceptive medicine derives, which continue to favour white, able-bodied women (see: PMC7559206) over everyone else.

Fuck that. I refuse to be ashamed of my reproductive health. I refuse to be comfortable with my discomfort. Hormonal birth control is not inherently good or evil, nor is it a one-size-fits-all, especially when we account for the vast spectrum of race, ability, sexuality, and gender identity. It's a decision-one that we all have the right to make, to unmake, and to understand

The following piece interrogates oral contraceptives designed for people who menstruate. Although much of the language used refers to women', it must be acknowledged that non binary and non-femme identifying people are equally impacted by this issue. Birth control is a complicated, nuanced topic that affects different people in different ways. Please keep this in mind while reading.