In praise of the Pill

There is only one thing that I don’t like about the Pill, and that is that you can’t buy it over the pharmacy counter. So I get cross when this wonderful drug becomes mired in health scares, legal battles and general dark cynicism, as it seems to every year.

More than 100 women are currently bringing a £10million compensation claim in the London High Court against the manufacturers of the ‘third-generation’ Pill – the brands Femodene, Minulet, Tri-Minulet, Marvelon and Mercilon. These women claim that they suffered potentially lethal blood-clots after taking these pills, and are joined by the families of seven women who died.

This class action is being brought under the Consumer Protection Act 1987, which makes manufacturers of defective products liable for injury they cause, even if they were not negligent. Those bringing the action claim that the third-generation Pill is defective because it is riskier than its predecessor, the second-generation Pill, and there was no warning of an increased risk (1).

What’s really going on here? There seems to be evidence that women who take the third-generation Pill are slightly more likely to develop deep-vein thrombosis (blood clots) than those who took the second-generation Pill. But the risk remains tiny. The incidence of thrombosis among women taking the third-generation Pill is considered to be 25 per 100,000 women per year, compared to 15 per 100,000 users of the second-generation Pill and five per 100,000 women who use no contraceptive pill at all (See the Don’t Panic button). According to these figures, then, if you take the Pill your chance of getting blood clots is about one in 4000. And while the newspapers accompany their Pill stories with ghoulish tales of women killed or badly disabled by thrombosis, most blood clots don’t even cause any symptoms, and only a very small proportion are fatal.

If we were talking about something like multivitamin tablets or herbal remedies, a ratio like this might make you think twice before popping the pills. But we’re not talking about an optional extra here – we’re talking about the Pill. And while the relative health risks are negligible, we are in grave danger of forgetting just how effective and essential the Pill really is.

The Pill remains the most effective form of reversible contraception. If you don’t want to get pregnant, you take it; if you want to get pregnant, you stop. Consider that the thrombosis risk facing pregnant women is about 60 per 100,000 – not to mention the other dangers still associated with pregnancy, and the misery of an unwanted child – and it puts the Pill risk into perspective.

Thanks to the widespread provision of safe, legal and effective abortion, an unwanted pregnancy can always be ended – indeed, in England and Wales in 2000, almost one quarter of pregnancies were terminated by abortion (the data excluded pregnancies ending in miscarriage) (2). But while abortion is often necessary, it is obviously more painful, costly and time-consuming than the Pill.

Since the Pill first came on the market in the 1960s, it has provided women with a safe and effective way of controlling their fertility. Have we forgotten what a breakthrough this is? To be able to have sex without consequences, without having to rely on nature, superstition, the relative unreliability of condoms or the whims of a man – the Pill aided the process of making motherhood a choice for women, a process which opened up a world of choices about marriage, work, love and lifestyle. Whatever the Pill’s faults, 50 years on from the time it was first synthesised it remains the best form of contraception that we have; and it seems unlikely that, without it, the struggle for women’s equality would have come so far, so fast. So why, rather than celebrating the Pill, are we so quick to find fault with it?

The reaction against the Pill reflects all that is backward-looking in today’s society. Take the health scares, for example. It is impossible not to sympathise with women who have suffered thrombosis, or with the families of those who have died. But there is something deeply irrational about the attempt, represented by the current court action, to punish contraceptive manufacturers for a risk that is so small, particularly when compared to the risk facing women whose contraception fails.

Nobody forces women to take the Pill – they do so because they know that the consequences of not doing so are likely to be dire. It is hard to see what could be achieved by the drive to make companies highlight every potential risk, other than simply panicking women – about the unlikely chance that they will get blood clots, or, if they come off the Pill, the more likely chance that they will get pregnant. This litigation-happy climate puts companies on the defensive, and frightens women.

Today’s anti-Pill sentiment also reflects the prejudices of the environmental movement – namely, that the Pill is unnatural, and therefore problematic. This is also irrational, and does women no good. What is natural, of course, is that sex leads to pregnancy – the very situation that women have spent generations trying to control. If a bit of temporary messing around with hormones enables us to experience life to the full – well, good for it! You could argue that the less-controversial condoms are more objectionably unnatural (or at least, more objectionable). And even what used to be called the rhythm method – that complicated superstitious-mathematical process whereby Catholic women planned their sex lives around less fertile times of the month – is several steps beyond the instinctual, natural methods of the animal world. If we still experienced sex as natural, we wouldn’t be enjoying it.

The worst thing, however, about the reaction against the Pill is the way it has become incorporated into the sex wars, as a fable about male irresponsibility. In the argument that the Pill is bad because it puts the onus of birth control upon women, feminism has come full circle. The very best thing about the Pill was how it took fertility control out of the hands of men and the gods, and put it under women’s control. Now, however, the notion that pregnancy is the woman’s problem, and that preventing pregnancy is therefore her responsibility, is seen as a way of letting men off the hook. Hence the idea that, from a healthy-equal-relationship point of view, there is some spiritual merit to making men wear condoms; hence the call for some kind of male Pill.

Yet pregnancy is the woman’s problem – it affects her physically, and women still take most of the responsibility for children. Something like free 24-hour nursery care might change that situation, but the male Pill certainly won’t. And given that this is the case, it makes perfect sense for women to sit in the driving seat when it comes to contraception. ‘It’s not fair!’ goes the cry – but popping a Pill every day for three weeks of the month is hardly hard work. Have women really got so little to worry about that this everyday activity has become a burden that their partner needs to share? How did we go from a situation where women demanded more control over their fertility to one where they plead with their menfolk to speak the language of the Vagina Monologues?

The male Pill will be a great thing, not least because it gives men the equal ability to avoid instigating an unwanted pregnancy. But when the most powerful argument for it is its use as a method of behaviour modification – encouraging men to share the load when it comes to family planning – the whole thing makes me distinctly queasy. The female Pill made possible such a thing as casual sex. Now, we’re all uptight.

Read on:

ECPs: swallow the facts, by Ellie Lee

spiked-issue: Abortion

(1) Drug firms face £10m claim over pill, Guardian, 5 March 2002

(2) Pregnancy among over-40s up 41%, Guardian, 1 March 2002