The Business of Birth Control (2021), by Abby Epstein
She did it again. Thirteen years after “The Business of Being Born”, filmmaker Abby Epstein, once again paired with executive producer Ricki Lake, is back with another thought-provoking documentary on female health. The focus now is birth control, more especifically the hormonal pill. The pill revolutionized women’s lives in the 1960s and, ironically, gave birth to a multi-billion dollar industry. Nevertheless, the pill has a racist history and a miriad of side effects that are not often discussed — and it never stopped being under attack.
The credits roll over three kinds of images: images of bodies dancing frantic rhythms, images of people marching and images of pills being fabricated. It’s almost as if the dance and the march are consequences of the pill. And in a way they are: the pill was approved by the FDA on May 9th, 1960. The following years were the years of the sexual revolution, the second wave of feminism, hippie culture and free love. For the first time, women had control over their reproductive lives, and could decide when — and even if — they were going to have children.
Historically, contraception has been closely linked to eugenics. Margaret Sanger, famous advocate for birth control, was a staunch believer of eugenics. The pill was tested in Puerto Rico, in an already oppressed population, and the results were manipulated so the new drug could receive approval. Black women were used as guinea pigs to test new contraceptives. The benefits of the pill were benefits for society, but the risks were for each individual. Since the very first moment, the side effects of the pill were questioned, and, because of this, most pills started being sold with labels that listed the side effects.
The pill — as well as any other hormonal contraceptive — has manufactured hormones that mimic the hormones present in the ovulation cycle. The pill stops the menstrual cycle by preventing ovulation, and this causes other effects, because estrogen and progestin interfere with the woman’s whole body. Some pills contain a “placebo week”, a week of pills with reduced or no hormones. During this week women will experience a withdrawal bleeding, similar to menstruation (but not the same as menstruation, because no egg was released, remember?).
In 2016, a study from a Danish university linked the use of the pill to an increased risk of developing depression. Hormonal birth control also seems to be linked to cases of stroke, blood clots, heart attack and pulmonary embolism. Lawsuits have been settled by millions of dollars, and the lobby allows the pill — and also the hormonal Nuvaring — to still be sold everywhere.
The biggest problem is the indiscriminate prescription of the pill, even for teenagers. Any problem — from heavy periods to PCOS and mood swings — seem to be solved by putting a menstruating person on the pill. Prescriptions are given in quick appointments with doctors, with these doctors rarely taking time to discuss side effects or even to explain how the pill works. Symptoms of more important issues — like fibroids, that affect more black than white women — are often ignored by the doctors, and the pill is seen as a one-size-fits-all solution. Informed consent is found nowhere in most doctors’ appointments — and, the documentary makes it clear, the problem is not with the doctors, but with the mysoginist medical system as a whole.
What really allows people who menstruate to make informed choices is body literacy, something I bet you’ve never heard of. Knowledge is power, and there are few things as powerful as knowing how your body works — because we’re not machines and not all bodies work the same. The good news is that body literacy is not elitist and can be learned by anyone. The bad news is that we’re still far from educating people about their own bodies — mind you that there are still many places where sex ed chooses to keep people ignorant about how their bodies work for religious reasons.
The documentary only briefly cites two other hormonal contraceptives — the Nuvaring and the implant — and chooses to frame the hormonal pill as synonym of birth control. Although the pill is used by millions of women, we can’t forget that there are other, non-hormonal contraceptives, such as the copper IUD, the diaphragm, spermicide and, of course, condoms.
Something else that the documentary fails to address is the many times conservatives have attacked birth control. The documentary only mentions that the left — and the idea of “right” and “left” in American politics is quite a shady one — gets mad when the pill is questioned, because, for them, the more options of birth control in the market, the better. But there is the conservative menace. The IUD has been target of fake news that say it causes abortion, and the same happened to the hormonal pill and the morning-after pill: both were called “life-ending drugs”. We can’t ignore these threats, because it’s clear that anti-abortion groups won’t stop at prohibiting abortion: they want to stigmatize and ban birth control as well.
The documentary can, then, be used by the conservatives as another “proof” that birth control is dangerous. But this is not the lesson learned in “The Business of Birth Control”: the lesson is that the medical field is sexist and harms women. First, there is the question: why the burden of family planning has to be carried only by the woman? We know that hormonal pills for men were tested but not approved because of “collateral effects”. Why are effects like those, or even worse, accepted for women? If medical laboratories and pharmaceutical industries are controlled by men, why would they care about how women are affected by the pill? And why would they spend money on research about the effects of hormonal birth control?
“The Business of Being Born”, Epstein’s debut documentary, is about childbirth in the United States and how it became a true commodity, with more and more women giving birth in hospitals with obstetricians and through C-sections, instead of at home with a midwife. It was a documentary that sparkled a conversation about the C-section epidemic and the possibility of having safe, planned home births.
Like its predecessor, “The Business of Birth Control” asks questions but does not offer all the answers. As stated in the documentary, a new era for reproductive justice is upon us, and the documentary comes to sparkle debates about hormonal birth control and to add new words to our daily vocabulary: “body literacy” and “informed consent” should now be part of empowering conversations everywhere.
