Last year, I broke up with hormonal birth control. Specifically, I stopped taking the Pill -- after nine continuous years of carrying around those little purple packets. I decided to stop taking the Pill to give my body a break, and to get to know my natural cycle without the influence of artificial hormones. I reaped those benefits soon after quitting hormonal birth control (HBC), but little did I know that the process would further strengthen and radicalize my already robust feminism.
I started taking the Pill when I was fifteen years old. A typical teenager, I suffered from acne, and topical treatments didn’t provide my reddened, embarrassed cheeks any significant relief. My dermatologist suggested the Pill as a method to regulate my hormones and thereby control my breakouts. Birth control is less extreme than oral acne medications like Accutane, she reasoned, and my progressive mother had no issues with me taking it. The doctor wrote the prescription and predicted that my acne would improve in a matter of a few months, if not weeks. Mercifully, my skin did clear up. Enjoying my relatively unblemished complexion, I took the Pill carefully every day, even though I wasn’t worried about pregnancy at that point. When I started having sex at age eighteen, I just kept taking the Pill for contraceptive purposes.
And I kept on taking it. I was in a long-term monogamous relationship, and the Pill provided a stable, worry-free birth control method for my partner and me. It wasn’t until 2016, nine years after I’d filled my first prescription, that I started to wonder about the medication I’d been taking every single day of my entire adult life (and then some).
In all the time I took the Pill, none of my doctors asked me about side effects, or whether I wanted to consider other contraceptive options. One gynecologist warned me about my increased risk of blood clots and told me to make sure to get up and walk around on long-haul flights. Other than that, none of my medical providers ever had a meaningful conversation with me about hormonal birth control—until, that is, I told one I wanted to stop taking it.
Before I continue, it is crucial to note that I was extremely privileged to be able to make this choice in the first place. Even in 2018, despite Roe v. Wade and the Affordable Care Act (ACA), many people are still unable to access the contraception they need. In particular, low-income women, Black women, and Latina women still face significant barriers to birth control access. Furthermore, the Trump administration’s repeated attacks on the ACA, Medicaid, and health providers like Planned Parenthood, have presented a massive threat to the reproductive health of women of color over the past year. For example, even though the ACA itself remains intact, the Department of Health and Human Services under the Trump administration rolled back the federal birth control mandate, allowing employers to refuse to cover contraceptive services based on religious or moral beliefs. Protecting access to birth control is more important now than ever.
My work at a public health center only confirmed to me the need for better contraceptive access:many of our lower-income patients experienced difficulties getting the birth control they needed, for not only pregnancy prevention but a host of other health considerations, such as PMDD and uterine fibroids. As an insurance navigator at this clinic, I saw firsthand the complicated processes that clients on publicly-funded healthcare had to navigate to access contraception. It’s also important to mention that women are not the only people who need and use contraception, and the reproductive health of LGBTQ+ people is similarly threatened by historic discrimination and recent attacks on birth control access.
As a white woman who has always had private health insurance that covers various birth control methods and devices, I have had much better access to contraception than most. The key to good reproductive health is choice, which we can only truly have with the resources, education, and information that create meaningful access to birth control and reproductive healthcare. Though I had the resources, what I was lacking was information.
There are both health benefits and risks associated with hormonal birth control, and this is the conversation that I wish one of my doctors had taken the time to have with me. The side effects of hormonal birth control are severely understudied, and this lack of scientific research is itself an indicator of the medical community’s insufficient prioritization of the reproductive health of women and LGBTQ+ people.
The research that does exist on the Pill is mixed. Some studies have linked it to increased risk of several chronic diseases, including depression and breast cancer. There are a variety of potential negative side effects; that said, the Pill is generally considered to be safe for most people. Furthermore, the Pill reduces the risk of certain diseases, such as ovarian cancer, and has a number of health benefits as well. It’s important to remember, too, that birth-related complications can present a significant health risk; use of the Pill for contraceptive purposes mitigates against those risks as well.
All this is to say that the decision to take hormonal birth control is a complex one, that depends on the individual’s access, lifestyle, health, and a number of other factors. My concern is not with hormonal birth control itself - in fact, I’m extremely grateful that I had and continue to have uninterrupted access to it should I choose HBC as my preferred contraceptive method - but rather, that the medical system did not provide me with everything I needed to make an empowered, informed decision about my own reproductive health.
When I told my gynecologist I was considering ditching the Pill for mental health reasons - the first time any doctor had ever discussed the possibility with me - she nodded knowingly and told me that many of her patients experience mood disorder side effects from hormonal birth control. My own depression and anxiety went undiagnosed throughout my adolescence, and I wonder if the Pill exacerbated my mental illness. At age fifteen, I didn’t understand that my experiences of anxiety and depression were medical conditions, and I certainly didn’t know to pay attention to any possible side effects when I started taking the Pill. It just seemed like no big deal. In this way, I benefited greatly from the work of feminists who came before me: my doctors willingly prescribed the Pill, my family’s insurance covered it, and my mother supported me taking it. In this sex-positive environment, I had always thought of starting the Pill as a rite of passage, an inevitability that I happened to reach a little early, thanks to my skin woes.
As I mentioned, I don’t feel as though the choice to start hormonal birth control was entirely mine, and therein lies the problem. At the age of fifteen, I was old enough to start taking a daily medication such as the Pill, and so I was also mature enough to have a frank and serious conversation with my medical provider about its potential ramifications for my health. Though the Pill is rightfully widely available, it is still a daily medication that alters our body and brain chemistry, and should be treated as such. There are benefits and risks to be weighed, as is the case with any medication. My doctors’ many failures to give me this information, over multiple years and at multiple junctures, fundamentally shaped my feminism. Nowadays, I’m much more proactive with my health and always ask doctors about medication they suggest prescribing to me, but at the young age of fifteen I didn’t know how to practice that vigilance.
I used to think that feminism meant tossing the Pill at whomever wanted it without question. When I heard vague comments about its health risks from friends or acquaintances, I assumed their skepticism was a result of internalized misogyny designed to limit their sexual freedom. Down with patriarchy! Little purple packets for all! Right?
As I researched the many potential health risks and benefits of hormonal birth control, however, I began to realize that a truly feminist approach to hormonal birth control must be a considered one, that is, one in which the patient is supported to make an informed choice. A progressive approach to reproductive health is one that protects bodily autonomy and prioritizes health, and this necessitates a holistic engagement with the question of its effects on any given patient. Access to the medication is not enough; we also need the right information to make our own decisions about whether to take it. In a way, the Pill gave me freedom; in another, the utter lack of information given to me actually boxed me in, preventing me from considering my full range of options. Had any one of a number of my doctors talked to me about the possibility that the Pill might increase my risk of mental health issues, including depression, I might have decided to wait out my acne. I might have sought out mental health treatment sooner. I might have been much more mentally healthy during my teen years. There’s no way for me to know now what might have happened, but I do know that my choice, as an uninformed one, was unfairly constrained.
Once I had this realization, my entire worldview shifted. That may sound dramatic, but it’s true. Rather than espousing a flimsy feminist idea of reproductive health—one that starts and stops with basic material access—I began to embrace a more radical feminism grounded in true bodily integrity and autonomy. I started to question what I put into and onto my body. I turned a critical eye to the patriarchy’s influence over health and medical fields, and educated myself on the many ways in which they fail women, gender-nonconforming folks and people of color. I learned to refuse to be weighed at the doctor, since my eating disorder history makes knowing the number extremely unhealthy for me. I grilled my new gynecologist about the psychiatric effects of hormonal birth control, and she acknowledged that it probably worsened my depression. I researched alternative methods that would work for my brain and body. I finally recognized what feminist artists have said many times over with respect to reproductive health: our bodies are battlegrounds, in the most immediate, tangible and powerful ways. A seemingly mundane task like taking my daily birth control pill is never neutral; everything, from the industry that puts the packet into my hands, to my socially conditioned ideas about how and when to take it, is enmeshed in gender politics.
Most importantly, going off the Pill helped me realize that treating certain feminist assumptions as sacred can actually hurt us. For the longest time, I didn’t even think to question the Pill, because to do so felt anti-feminist. But we should be critical. We should be reflective towards ourselves, our movement, our accepted truths. That questioning is far from anti-feminist; in fact, it’s the most radical act we can undertake in the service of feminism and our own well-being. Reproductive justice means we have the information and access to choose how to manage our own reproductive health. For me, that meant deciding to go off the Pill. For someone else, it might mean starting hormonal birth control. But whatever the choice, it must be ours.
Sarah Doyel is a freelance writer, activist, and health justice advocate making the connection between wellness and social change. She blogs as the Feminist Vegan and can be found at www.thefeministvegan.com.