Contraception: Aftermath and Alternatives
1/1/2016Meg T. McDonnell
In the 1960s, legalized access to hormonal contraception promised to bring women freedom: freedom to limit family size and freedom to have sex without the “worry” of conception. Today, proponents promote another line: contraception as preventative health care, with some groups going so far as to pathologize women who don’t have access to contraception as “at risk for unintended pregnancy.”
According to the Centers for Disease Control and Prevention, nearly 62 percent of U.S. women ages 15-44 are currently using some form of contraception or sterilization. Though multiple forms of birth control exist, the pill remains the most popular, more than 55 years after it was introduced.
Absent from nearly all of the public campaigns in support of contraception, though, are its health risks, which can be life-threatening. Adding to the concern about side effects, some of which are more troubling than others, is the reality that most women are simply not informed.
“Women have a right to know,” said Vicki Thorn, who recently organized a conference titled “The Contraceptive Conundrum: Effects and Side Effects” at Georgetown University. The founder of Project Rachel and the National Office for Post-Abortion Reconciliation and Healing, Thorn has for years collected research about the detrimental effects of chemical contraception.
“Contraception is hardly benign,” Thorn said. “Most forms use steroidal hormones that impact the pituitary gland, which is the master gland in the body, and there’s much fallout in terms of health issues.”
The side effects of the pill and other forms of hormonal contraception can range from blood clots, headaches, weight gain, nausea, and irregular or diminished periods, to mood swings, loss of libido, depression and other psychological repercussions. Some of these side effects can significantly alter a woman’s lifestyle — leaving her feeling helpless and confused at her inability to control her emotions and even her physical appearance.
Some potential side effects are particularly alarming. Studies dating back to the 1990s have shown increases in breast cancer related to the pill. A study published in the journal Cancer Research in August 2014 suggests that use of some types of oral contraception within the past year increases breast cancer risk by 50 percent. Pills containing higher doses of estrogen lead to even greater risk.
While some side effects are rare, many are not, explained Dr. Marguerite Duane, adjunct associate professor at Georgetown University and a family physician.
“You can go onto any Facebook page or any groups for birth control and see many women complaining about all the awful effects of the birth control pill: mood swings, weight gain and the psychological symptoms like depression and anxiety,” said Dr. Duane, who assisted with the “Contraceptive Conundrum” conference.
The purpose of the conference, which was hosted at Georgetown’s Edmund D. Pellegrino Center for Clinical Bioethics in August, was to educate attendees about contraception from a scientific perspective. Topics ranged from a pharmacist discussing nutrition deficiencies caused by the pill to a post-doctoral researcher discussing how contraception affects women’s brains. Other speakers noted that the side effects of contraception are not limited to women’s health; they include behavioral changes as well.
Participants included doctors, researchers, graduate students and even a number of parents of women who had died due to contraception. Among them were the parents of Erika Langhart, who died in 2011 at age 24 due to pulmonary embolisms caused by NuvaRing, one of the more recent and controversial forms of hormonal birth control.
Karen Langhart, Erika’s mother, told Vanity Fair in a January 2014 feature story that her daughter was meticulous about risks, but was unaware of the risks of this device. And her story is not unique. NuvaRing has been the subject of high profile class action lawsuits and cited as the cause of numerous women’s deaths.
The Huffington Post reported in 2013 that the Food and Drug Administration (FDA) had advised Organon, a pharmaceutical company manufacturing NuvaRing, to warn users of the drug’s serious risks.
“Organon executives adamantly opposed such a statement,” the article said. “An elevated [blood clot] warning label would have been a huge blow. Such a warning might have discouraged women from using NuvaRing and made doctors less inclined to prescribe it — significantly cutting into the potential return on investment.”
Pharmaceutical companies that produce contraception are financially motivated to influence medical education as well, explained Dr. Duane.
“The reality is,” she said, “if millions of women started learning how to chart their cycle and fertility, and stopped using hormonal contraceptives, pharmaceutical companies would stand to lose billions of dollars.”
According to Dr. Jeremy Kalamarides, medical director of the Vitae Clinic in Austin, Texas, women are often prescribed contraception instead of receiving the medical care they need.
“Over and over again, I find women frustrated with the fact that what they thought was being treated is actually not being treated at all by hormonal contraception,” Dr. Kalamarides said. “They come in and say, ‘Can you please give me something different?’”
For Dr. Kalamarides, a member of Father Michael J. McGivney Council 5967 in Austin, his interest in contraception alternatives started when he and his wife were preparing for marriage in 1994.
“I was thrown for a loop by the fact that [the reproductive system] is the only system in the human body that we turn off when it’s working correctly,” he said.
A biology student at the time, Kalamarides’ interest in the topic led him to become an OB-GYN. He then studied NaProTechnology at the Pope Paul VI Institute for the Study of Human Reproduction in Omaha, Neb., and established a medical practice that does not prescribe contraception.
AN EDUCATION IN FERTILITY
Beyond the potentially dangerous side effects related to women’s health, hormonal birth control has resulted in a number of sociological consequences as well.
“The pill was a technological shock that profoundly altered the mating market by lowering the ‘cost’ of sex,” explained Dr. Duane, pointing to research done by the Austin Institute for the Study of Family and Culture.
At the Austin Institute and elsewhere, sociologists have argued that sex has become a nearly universal precondition for being in a romantic relationship in modern society; contraception’s ability to “safeguard” against pregnancy has made it so.
“It’s been well documented in particular how women date and how men date because of contraception,” said Dr. Kalamarides. “It contributes to young people getting married later in life and social distortion in the premarital process.”
A growing body of research indicates that contraception even alters a woman’s ability to choose a more genetically suited spouse.
A 2011 Wall Street Journal article noted, “The type of man a woman is drawn to is known to change during her monthly cycle — when a woman is fertile, for instance, she might look for a man with more masculine features.”
But contraception suppresses fertility and its corresponding hormones, which can lead to a woman choosing a different spouse than she would otherwise. Conversely, a woman does not attract the same men when her fertility is suppressed.
“Women tend to exhibit subtle cues when they are ovulating, and men tend to find them more attractive at this time,” the WSJ article explained.
For years, Thorn has shared the findings of this research in talks to young people. “This is a big deal,” she said. “If you’re serious about marriage, then both men and women should know this.”
Of course, proponents of contraception do not think that any of these risks warrant giving it up — since unintended pregnancy is a “risk” to be avoided.
Still, no matter how “protected” people think they are from pregnancy, contraception is not foolproof. Since the legalization of birth control, the sexually permissive culture that contraception has facilitated has contributed to a rise in the nonmarital pregnancy rate from 5 percent in 1960 to 40 percent today. Additionally, more than 85 percent of abortions performed in the United States involve single mothers.
And not only does contraception facilitate relationships that make abortion more likely, but hormonal contraception itself can have an abortifacient effect; by thinning the lining of the uterus, it can prevent a newly conceived embryo from being implanted.
“Everyone knows that conception is the moment when sperm and egg unite, but for utilitarian purposes, some professional groups associate ‘pregnancy’ with implantation,” Dr. Kalamarides explained. “Many doctors don’t go over informed consent about how birth control works. But when women find out that it can potentially cause very early miscarriage, most are sincerely not interested anymore, or at least would like to try something else.”
Many are skeptical, however, that viable alternatives to hormonal contraception exist.
“The problem is,” Dr. Duane said, “there is this presumption that if you’re not on birth control, you will be pregnant.”
As a result, relatively few women ever learn how to read and understand when they are fertile. To help bridge the knowledge gap, Dr. Duane co-founded and serves as director of FACTS — Fertility Appreciation Collaborative to Teach the Science of fertility awareness-based methods.
“Our mission is to educate our medical colleagues about the evidence-based fertility awareness methods, because medical students, residents and physicians are not learning about them,” Dr. Duane said. “When women who are interested in these methods go to doctors who don’t have information, they stop talking to their doctors about this very important part of health care.”
Nonetheless, the science of fertility awareness, including NaProTechnology, continues to advance and become more widely known.
“Nationally and in the Church, we have not done enough to promote alternatives,” Dr. Kalmarides said. “But I see a lot of hope, because there is a growing number of doctors who are receiving training and using natural family planning in their practices.”
The fact remains, Dr. Kalmarides added, that teaching modern fertility awareness methods serves patients much better than both contraception and assisted reproductive technology.
“It is better, and it will help more people, whether you are avoiding pregnancy temporarily, trying to achieve pregnancy or treating underlying conditions,” he said. “And when women gain understanding of their fertility, they feel an enormous sense of relief and are empowered. That is what happens when you keep love and life together.”
MEG T. MCDONNELL is executive director of the Chiaroscuro Institute and a journalist in Washington, D.C.