by Anne Summers
20–34
35–44
Non-users of oral contraceptives
0.2
0.5
Users of combined contraceptives
1.5
3.9
The risk admittedly is slight, and it can be reduced by using lower doses of the two main components of the Pill, but it is still there and women have died from taking the Pill. But in addition to this comparatively rare side-effect, Professor Carey lists 26 other known side-effects.
Many of these are experienced so commonly by women that it is worth listing most of them:
• glucose tolerance and chemical diabetes (one in eight women develops chemical diabetes within a short time of taking combined oral contraceptives; this is reversible if use of combined preparations is discontinued)
• hypertension (in about 1 per cent of women a rise in blood pressure has been observed with higher dose pills)
• migraine (induces migraine headaches in women who have not suffered them previously and increases the attacks with those women who have)
• some types can exacerbate cardiac disease
• plasma concentration of zinc levels lowered and copper levels increased (similar to that experienced in the last trimester of pregnancy)
• iron metabolism (increase in serum iron, total iron-binding capacity and transferrin in women taking combined preparations)
• thyroid function changes (similar to those that occur in pregnancy)
• liver function is affected (oral contraceptives should not be used by women who have a history of cholestatis jaundice of pregnancy)
• water and salt retention (leads to weight increase)
• leg cramps (muscle spasms similar to those that can occur in pregnancy)
• nausea (likely on commencing course of some preparations, especially with young women who have not been pregnant and women who experience nausea in pregnancy)
• leucorrhoea (increased vaginal secretions and discharges)
• reduction of lactation (experienced when using an oestrogen-based pill)
• fibroids (can be enlarged with high dose of oestrogen)
• cancer (‘Oestrogens are not carcinogenic. However the probability of malignant change is related to the number of cell divisions. Oestrogens by increasing cell division may increase the opportunity for abnormal cell division. If this occurs in the endometrium usually no harm is done provided the endometrium is shed at regular intervals.’32)
• hyperpigmentation of the face (blotches on face, especially during summer)
• depression, chronic fatigue, loss of libido, irritability (Professor Carey lists these as one; in my opinion they should constitute four separate side-effects. Various studies show that 5 to 30 per cent of women experience one or all of these side-effects when taking the Pill; women taking high-dose progestogen preparations are the most susceptible, but the nausea induced by high-oestrogen pills can also lead to depression, irritability, fatigue and loss of libido)
• premenstrual symptoms (breast discomfort, headaches, migraines, a ‘bloated feeling’ and tension result from the action of progestogens)
• weight gains (fat deposit is facilitated by all types of progestogens)
• breakthrough bleeding (likely while taking any hormone preparations, and especially progestogen)
• acne and skin texture (women with tendency to acne should avoid high-dose progestogen preparations)
• menstrual flow (reduced flow occurs in most women on progestogens when these are given over a sufficient length of time to produce a reduction of thickness in the endometrium)
• failure of withdrawal bleeding (occurs most commonly with high-progestogen formulations)
• post-pill infertility (a small number of women can fail to reestablish ovulation and menstruation after even a very short time on oral contraceptives; some undergo spontaneous cure after a variable length of time extending up to two years, while most require treatment).
Many of these side-effects are rare, but none of them can be taken lightly. Even the most ‘minor’ of the symptoms can cause considerable discomfort or anguish to women, while the most commonly experienced ones are sufficient for women to decide that the disadvantages of the Pill far outweigh its advantages. One study cited by Professor Carey reports that one in three women using oral contraceptives stops using them for reasons other than desiring a pregnancy.33
The main reasons for discontinuing to take the Pill were listed by the following percentages of women:
• weight increase – 35 per cent
• headache – 31 per cent
• decreased libido – 27 per cent
• depression – 21 per cent.
We have already seen (in Chapter Four) that depression is practically the female disease of the 20th century. Women already have numerous sociological and personal reasons to succumb to depression without having it foisted on them as a penalty for being able to control their fertility. Similarly, some of the pills that women already swallow to reduce tension, anxiety or depression, such as the much-taken Valium, have as reported side-effects ‘headaches, nausea, skin rashes, decreased libido’34 identical to those of the Pill.
Together, these two most-taken pills place an intolerable burden on already harassed women and spin their lives off into a relentless spiral of trying to avoid compounding their misery. Women can choose all right: between pregnancy and depression, between depression and nausea, between nausea and lost libido, between lost libido and pregnancy, between pregnancy and so it goes on. Yet these side-effects are scoffed at by most doctors who continue to write prescriptions for the Pill as if they were jelly beans, often without taking the woman’s blood pressure, enquiring about her medical history or giving her a pelvic examination. They smoothly assure women that the Pill is the best thing that has ever happened to them, and brutally inform them that they have to endure the side-effects or else risk pregnancy. Other doctors threaten. I have been told by a doctor not to come asking for an abortion just because I am too ‘pig-headed’ to take the Pill. That I might have valid objections to taking it was not considered worthy for discussion.
Most doctors are so pro-Pill that they will not countenance a word against it, yet if they are closely questioned, few possess much knowledge of its side-effects and the dangers associated with taking it. Few have seen, let alone read, Professor Carey’s pamphlet listing the side-effects and the ways to counter some of them.* And if these statements sound rather sweeping and seem not to be backed with hard statistical evidence – this is hardly surprising. Who could – or would – conduct a survey designed to show doctors’ ignorance or lack of feeling? What doctors would cooperate with such a survey? My opinions on this subject have been formed not just from personal experience but from that of a large number of women I have talked to and whose opinions about the Pill and about doctors who prescribe it I have sought.
My generation, aged 30 in 1975, has had the Pill since we were 18. We have had 12 years of trying it. Most of us grew up thinking ‘the Pill’ was synonymous with ‘contraceptive’; we had no experience of any other method but abstinence. Yet I know scarcely any women who still take the Pill. All of my friends and acquaintances have rejected it because they are unable to bear the depression, the weight gain, the constant feelings of irritability, the loss of sexual feelings.
The last reason figures highly in their rejection of oral contraceptives. One of the promises the Pill supposedly holds out to women is that, at last, free from worrying about whether each sexual encounter could produce a pregnancy, they will be able to relax and enjoy sex. What is offered with one hand, however, is cruelly taken away with the other. The Pill, while it protects women from the consequences of sexual relations, all too often stops them wanting any. They are afforded protection from something they no longer desire. No wonder so many women feel cheated, feel that this so-called liberator of women is just one more agent of their oppression.
Yet the P
ill is still promoted to women by doctors who assure their patients that it is the safest and most reliable form of contraception. While the latter claim is true, in the view of a great many women this benefit is negated by the 27 known side-effects, especially the two most sinister ones – depression and loss of sexual feelings – which conspire with so many other facets of patriarchal society to rob them of the power to control what happens to their bodies. Yet many women feel horribly trapped; by not taking the Pill they risk losing that control in the traditional way – becoming pregnant.
The main alternative method of contraception advocated by doctors at present is the intra-uterine device (IUD), which is not so reliable in preventing pregnancy and which causes unbearable cramps in many women. Although more and more desperate women are using IUDs as an alternative to the Pill, they often find themselves equally dissatisfied with this method, and in particular, experience deep revulsion at the barbarity of having to tolerate metal or plastic foreign matter inside their wombs.
While doctors can rightly claim that they can only prescribe what is available and that they have no choice but to advise women who need contraceptives to use either the Pill or an IUD, some other factors need to be considered. Medicine is a solidly male profession, which has shown little concern for the dilemmas women face in trying to protect themselves from unwanted pregnancies. It should not be thought extraordinary to expect that doctors, avowed healers of the sick, would at least experience some qualms about prescribing remedies that are known to have such side-effects. The reason why a pill for men has still not been marketed is that so far all trial versions have had marked side-effects. These included shrinking testes, enlarged breasts, change in liver function, weight increase and alcohol intolerance. With the exception of the last one, these side-effects are almost identical to those experienced by women. They were considered sufficiently deleterious to prevent the male pill from being marketed, but did not stop the female pill from being introduced to millions of women. This decision was a medical one, which also means that it was a male one. It was reached by male researchers and policy-makers (the health department authorities in each country who approve the release of new drugs). It was evidently considered that these side-effects would be intolerable to men but that women, having no choice, would have to endure them.
The main medical criticisms of female contraceptives are those that are voiced when further research reveals that these contraceptives might jeopardise the colonial function women are meant to serve. When the often fatal side-effect of thrombosis was detected in the late 1960s, many doctors stopped prescribing the Pill until a combination that reduced this risk was developed. Since then the only reported medical disquiet concerning the Pill has centred around recent reports that some forms of oral contraceptives could cause infertility.35 It seems that the only time the side-effects of the Pill are taken seriously by the medical profession is when these could permanently impede a woman’s reproductive ability – either by rendering her sterile, or by killing her. All other side-effects are considered to be trivial, or at least endurable – unless, of course, they are expected to be endured by men.
Nor can women easily solve this dilemma by divesting themselves of their reproductive function. It is a salutary index of women’s lack of freedom to determine the uses to which their bodies are put that they are not permitted to become sterile until they have provided the state with a requisite number of progeny. It is virtually impossible for a single woman to obtain a sterilisation until she is at least 30 years of age, and, even then, she will have to shop around for a compliant doctor. Married women of any age, medical condition and with any number of children must have the written consent of their husbands before a doctor will perform a sterilisation. It is not uncommon for a churlish husband to withhold his permission, even when the operation is medically imperative – for instance, on the grounds that the woman would not survive another pregnancy. In such cases, a doctor must be prepared to risk being prosecuted if she or he proceeds with the operation with only the wife’s permission.
The consent of the wife is also required when a husband undergoes a vasectomy. Until about three years ago, vasectomy was virtually unheard of in Australia. Its legal standing was uncertain and it was generally considered by most men, and undoubtedly by many doctors, to be emasculating. It is probably because of the unpleasant side-effects of the Pill that increasing numbers of men are resorting to vasectomies, and at present about 14 000 men are having the operation each year.36 The husband who is sympathetic to his wife’s suffering from the Pill can alleviate her burden by having himself sterilised. But it is also probable that a selfish motive propels many of them to the operating table: once their wives can stop taking the Pill their interest in sex is likely to be revived.
Male sterilisation cannot be seen as a solution to the problem of how women are to regain control of their bodies. It does not give women sexual freedom. It does not give them the freedom to have more than one sexual partner (unless male sterilisation becomes very widespread indeed), nor does it offer any promises for women’s sexual enjoyment. The sterilised man can guarantee not to impregnate a woman but this does not necessarily signify that he is interested in ensuring that she gains pleasure and satisfaction from their sexual activities. Male sterilisation could become a further means of curbing women: a sterilised man whose wife or girlfriend becomes pregnant or who still uses a contraceptive will have definite proof that she has more than one sexual partner.
The availability of contraception, abortion and sterilisation to Australian women is not necessarily an indication of the freedoms they possess. These matters have always been viewed as part of the overall question of population control rather than as part of women’s right to control their bodies. The early family planners in Australia were frankly eugenist and wanted population reduced, especially among the working class, because of their belief that healthy national development was only economically and physically possible in small family groups. This view still informs many advocates of the ready availability of contraception and abortion. The Family Planning Association of New South Wales retains a eugenist plank in its articles of association, and many of the speakers in favour of the Medical Practices Clarification Bill, which was introduced in the Australian Parliament in 1973 in an attempt to legalise abortion in the Australian Capital Territory, couched their arguments in terms of the need for small families if every child is to receive proper mothering. The movement for zero population growth propagates similar notions. In none of these movements or bodies has there been a constantly voiced concern for women’s right to control their bodies. Even these so-called progressive reformers view women as tools to be utilised for wider, national goals.
The key role of the medical profession in this manipulation of women’s bodies (and of their lives) derives from the power it has to determine and regulate the degree of access women have to the means of controlling those biological processes that might impede their ability to be full and free members of society.
Doctors might merely be agents of the patriarchal order but they have a very wide determining power to either ease women’s problems or to exacerbate them. With their concerted backing, it might be possible to stir research scientists into a fast search for an alternative to the Pill and the IUD. Women’s voices alone evoke no response. With their backing, abortions could be made widely available – and the laws outlawing abortion swiftly changed. With their backing, sterilisation could become a matter of individual request. But the medical profession has shown no signs of wishing to mount a campaign for the right of women to control what happens to their bodies.
The medical profession as a colonising agent
A common rationalisation for the inferior status of women is that they are slaves to their biology: ‘Anatomy is destiny’, as Freud once remarked. This rationalisation has acquired the legitimacy of scientific canon, thereby making it difficult for non-scientists to challenge or change.
It is impossi
ble to determine the extent to which women are controlled by their biology, the degree to which hormonal activity or other biological factors determine their behaviour, while a uniform code of behaviour is foisted upon women, and while women only receive status and respectability so long as they conform to that code. At the same time, it is very convenient for a society to maintain that women are governed by their biology when one of their biological functions is of essential value to that society, and when it is realised that the pursuit of other activities might impede or even prevent the performance of that function.
This argument has been used against every advance women have sought to make into the general activities of society. Education for women, votes for women, employment for women, have all been opposed on the grounds that they might physically weaken women and make them incapable of performing their major social function of reproducing the race or (and this was the main fear) that if they engaged in other stimulating activities they might be less inclined to want to devote all, or even any, of their time to bearing and raising children.
These arguments were so patently unjust that they were not able to be maintained once a determined onslaught was made against them, but they have not disappeared. What has happened is that these bald arguments, which stated honestly and openly the intention for which women were subjugated, have been replaced by more subtle and devious means of ensuring that women will comply with what society requires of them. Women are permitted now to do a wide range of things: to receive an education, to participate in politics, to take paid employment. Women’s participation in any of these areas is never quite the same as men’s – there are definite discriminatory differences of status, level of participation and remuneration. This inequality is exacerbated by the fact that women are required to prove that these activities do not prevent them from performing their child-bearing role. The argument has been turned around and posed as a challenge to women: show us that your biology is not all-determining, prove to us that you can share the man’s world and still be feminine, still bear and raise babies, still be a woman.