Speaker 1: My name is Aaron Welsh and I am co host
Speaker 1: of this podcast Will Kill You. I have been taking
Speaker 1: some form of birth control since I was eighteen years old,
Speaker 1: so fifteen years now, and I've tried the various ones
Speaker 1: I've tried, you know, the combination oral contraceptive, I've done nuverarring,
Speaker 1: and I currently have a hormonal IUD. I started taking
Speaker 1: birth control because well, it was a combination of things.
Speaker 1: One was my periods were so bad that I was
Speaker 1: like laid out in my house for two days at
Speaker 1: least every month just in horrible pain, couldn't leave. And
Speaker 1: also because I didn't want to get pregnant. And as
Speaker 1: soon as I started taking the oral contraceptive I it
Speaker 1: was like night and day, like the pains were so
Speaker 1: much less, my periods almost disappeared. It was like I
Speaker 1: was so so grateful to be able to just like
Speaker 1: function normally, is what it felt like. And I've been
Speaker 1: really fortunate and that I haven't had very many problems,
Speaker 1: and all these various forms have continued to do the
Speaker 1: trick for me. So you know, I don't want to
Speaker 1: get pregnant. And the birth control that I've taken has
Speaker 1: been very effective in that way, and so I'm I'm
Speaker 1: really grateful for, you know, for having access to birth
Speaker 1: control and continued access to birth control, and I hope
Speaker 1: that it stays that way.
Speaker 2: My name is Aaron Alman Updike, and I am the
Speaker 2: other co host of this podcast, Will Kill You. And
Speaker 2: I first started birth control when I was twenty, which
Speaker 2: was about twelve years ago, and I started exclusively to
Speaker 2: try and prevent getting pregnant. It was very effective. I
Speaker 2: started on like a combination oral pill. I never had
Speaker 2: any real issues with it. I tried. I think I
Speaker 2: had to increase my dose like one and then I
Speaker 2: did have one very stressful year where my insurance got
Speaker 2: wonky and I wasn't able to get access to birth control,
Speaker 2: and that was very stressful because I very much didn't
Speaker 2: want to become pregnant. But I was able to get
Speaker 2: back on until I decided a few years ago to
Speaker 2: start trying to get pregnant. So I'm really grateful that
Speaker 2: I was able to make that decision when it was
Speaker 2: right for me and my partner and our family. And
Speaker 2: then after I had my baby, I got the copper IUD,
Speaker 2: which is a non hormonal option of contraception and that's
Speaker 2: been really great for me too. I one year in
Speaker 2: and I'm still not pregnant, so that's nice. Yeah. I
Speaker 2: also am just really grateful I had, you know, only
Speaker 2: one year when I wanted and needed access to birth
Speaker 2: control and I didn't have it, and that was a
Speaker 2: really really stressful year. So I can't imagine, like never
Speaker 2: having access to it, how different my life could have been.
Speaker 3: Hi, I'm Aaron Welsh again.
Speaker 2: I'm Aaron owen Updyke one more time.
Speaker 1: And this is this podcast will kill you.
Speaker 2: Those were our birth control stories.
Speaker 1: It was. It was a strange feeling to be in
Speaker 1: the first and account chair. I don't know if I
Speaker 1: liked it. Let's not do it again, deal.
Speaker 2: Okay, So welcome everyone to our sixtieth episode.
Speaker 1: Our sixtieth episode. It's unbelievable that we've made it this far,
Speaker 1: I feel, and sadly, we have to note it is
Speaker 1: our season finale, so this is the last episode of
Speaker 1: season three.
Speaker 2: Not all sad. That's also it's exciting too, like.
Speaker 1: Woohoo, Yeah, yeah, it's exciting, Like I can't I look
Speaker 1: back and I'm like syphilis was a year ago?
Speaker 3: How wow?
Speaker 1: It just feels like a lifetime yeah, yeah, Hey.
Speaker 2: That's funny. We started with syphilis and we're ending with
Speaker 2: birth control.
Speaker 1: Ha ha, I know, I like it.
Speaker 2: So this wasn't the episode that we had planned for
Speaker 2: our season finale. We had planned a very very different episode, yes,
Speaker 2: but in light of recent events, especially the passing of
Speaker 2: Justice Ruth Bader Ginsburg and the impact that that's inevitably
Speaker 2: going to have on reproductive rights in the United States,
Speaker 2: we decided to focus this episode on birth control.
Speaker 1: We decided that we wanted to honor the incredible amount
Speaker 1: of work that the Notorious RBG did during her time
Speaker 1: on the Supreme Court. And so, yeah, we're we're really
Speaker 1: excited for this episode. I mean, we had been planning
Speaker 1: on doing something like this in the future eventually, Yeah,
Speaker 1: but now seemed like as good a time as any,
Speaker 1: if not the most important time.
Speaker 2: But speaking of time, before we jump into the episode,
Speaker 2: it is in fact quarantiney time.
Speaker 1: It is. You are absolutely correct about that, You are
Speaker 1: exactly right about that. What are we drinking this week?
Speaker 2: We're drinking notorious.
Speaker 1: That's right, in honor of notorious RBG. Erin what is
Speaker 1: in notorious?
Speaker 2: Well, of course, in order to properly honor RBG. It's
Speaker 2: a wine cooler or wine spritzer. I don't know what
Speaker 2: you call it, what's the fancy term for it. We
Speaker 2: aren't using what is it opus one or something? Is
Speaker 2: her particular brand of wine. We can't afford that, No,
Speaker 2: just use whatever wine you can afford.
Speaker 1: Yes, and we will post the recipe for Notorious as
Speaker 1: well as our non alcoholic placey rita. Oh, that's gonna
Speaker 1: be another fun one to make a non alcoholic wine.
Speaker 1: We'll post those recipes on our website, this podcast will
Speaker 1: kill You dot com as well as on all of
Speaker 1: our social media channels, which you can find links to
Speaker 1: through our website as well. Yep, Well, Aaron, do we
Speaker 1: have more business? Oh? Actually, I don't know why I
Speaker 1: asked you. I have a couple pieces of business.
Speaker 2: Oh okay.
Speaker 1: This was more of just like a couple of things
Speaker 1: that a bunch of people had reached out to us about.
Speaker 1: So the first part is in relation to our herpes episode.
Speaker 1: And you know, in the episode, I had asked about
Speaker 1: stigma against genital herpes in other countries and whether it existed,
Speaker 1: and multiple people reached out to us from a bunch
Speaker 1: of different countries and said no, no one even thinks
Speaker 1: about it here, like it's not a second thought, and
Speaker 1: that if there is any stigma, it seems to be
Speaker 1: lifted from American TV shows or movies that like either
Speaker 1: joke about it or make fun of it or call
Speaker 1: it out or something like that. So wow, there you go. Cool,
Speaker 1: And then I mean, it is it is great that
Speaker 1: there's like no stigma in other countries, so just let's
Speaker 1: be more like that. And then the other thing is
Speaker 1: that our last episode was Thelidamide, and apparently there's a
Speaker 1: major storyline or plotline on Call the Midwife about thelidamide,
Speaker 1: and Aaron, you and I watched like so much of that,
Speaker 1: but I guess we still.
Speaker 2: Yeah, we must not have made it that far. But dang,
Speaker 2: I can't believe we miss that.
Speaker 1: I know, I know, So I'm going to have to
Speaker 1: start watching that again. It's on Netflix. It's a fun show. Okay.
Speaker 2: Anyway, all right, well then is that all? Shall we
Speaker 2: dive in?
Speaker 1: Let's dive in.
Speaker 2: Okay, we'll take a quick break first. Aaron you already
Speaker 2: said that we're excited to talk about this, but I
Speaker 2: have to just say, talking about birth control, it's one
Speaker 2: of the things that makes me most excited, and it's
Speaker 2: one of the things that I look forward to the
Speaker 2: most in becoming a doctor is getting to talk about
Speaker 2: birth control with future patients. Like I love reproductive health counseling.
Speaker 1: Okay, some minute, I know this about you, Aeron, and
Speaker 1: I know that about you.
Speaker 2: Like, I am so excited. I think my breath is
Speaker 2: going to be like shaky, so I need to just
Speaker 2: calm down.
Speaker 1: It does like I think it was us having to
Speaker 1: do the first hand accounts, but I feel like this
Speaker 1: is our first time podcasting or something like, Yeah.
Speaker 2: It feels that way. I'm nervous. Okay, But before I
Speaker 2: can start talking about birth control, I want to back
Speaker 2: up because, uh, we have to kind of talk about
Speaker 2: the menstrual cycle and some general basic anatomy before we
Speaker 2: can talk about how birth control affects your body. Okay,
Speaker 2: I love it. Foundations foundations Okay, Okay, I'm going to
Speaker 2: start off really basic here because a lot of people
Speaker 2: with a uterus don't really know their own anatomy since
Speaker 2: it's internal. So in general, in people with a uterus,
Speaker 2: we have two ovaries and then Filippian tubes, which are
Speaker 2: what kind of collect the eggs that is connected to
Speaker 2: the uterus itself. The inside lining of that uterus is
Speaker 2: called the endometrium, and then the bottom of the uterus
Speaker 2: is called the cervix. I feel like that's an important one.
Speaker 2: And then you have the vaginal canal, and then the
Speaker 2: outside world. Okay, the outside world does that work? All right?
Speaker 2: So then let's talk about the menstrual cycle, because this
Speaker 2: is the thing that happens about every month or so
Speaker 2: in most people who have a uterus. We're going to
Speaker 2: go over the specific phases and hormones that are involved
Speaker 2: in a second, but the cycle essentially begins weirdly with
Speaker 2: the start of menstruation. So the start of like vaginal bleeding.
Speaker 2: Isn't that weird that that's where we start it? I mean,
Speaker 2: is it's just arbitrary, right, It's totally arbitrary. That's just
Speaker 2: that's where we start it. And then it ends with
Speaker 2: the kind of resumption of menstration like the next cycle,
Speaker 2: or with implantation of a blastocyst, which would then be
Speaker 2: called pregnancy. So at the beginning day one of your
Speaker 2: menstrual cycle, you're bleeding, probably, and at this point in time,
Speaker 2: almost all of the hormone levels in your body are
Speaker 2: pretty low, and there are a complex series of feedback
Speaker 2: loops between three organs or parts of organs, the hypothalamus
Speaker 2: in your brain, the pituitary which is also in your brain,
Speaker 2: and then your ovaries themselves, and all three of these
Speaker 2: release hormones that result in the endometrial lining, so the
Speaker 2: lining of your uterus proliferating and expanding, and then follicles
Speaker 2: in your ovaries maturing, and then eventually egg release right ovulation.
Speaker 2: So if day one is the start of menstruation, that
Speaker 2: will usually last anywhere from two to seven days, and
Speaker 2: then the process of follicle maturation, so basically eggs getting
Speaker 2: ready to be released in your ovary is happening at
Speaker 2: this time. So your brain is releasing two hormones FSH
Speaker 2: and LH that are causing that follicle too mature. This
Speaker 2: phase is called the follicular phase. Get it okay, pollicle okay.
Speaker 2: And through this time period, your estrogen levels are slowly rising,
Speaker 2: So they start off kind of low and then they
Speaker 2: slowly start to rise. Around day fourteen, but this can
Speaker 2: vary from like twelve to twenty days. Estrogen levels will
Speaker 2: surge and that causes another hormone LH to surge, and
Speaker 2: those two hormones surging is what triggers ovulation, okay, and
Speaker 2: then after ovulation, the egg is released from those ovaries,
Speaker 2: it has to travel down the Filippian tube. And now
Speaker 2: you're in the next phase, or the luteal phase of
Speaker 2: your menstrual cycle. And what's happening during this phase is
Speaker 2: that where the egg was released from in your ovary
Speaker 2: develops into what's called the corpus ludium, and this secretes
Speaker 2: yet another hormone, progesterone, and so now it's also going
Speaker 2: to be secreting estrogen, but progesterone is going to rise
Speaker 2: much more than it has up to this point in
Speaker 2: the cycle. So now you have steadily high progesterone and estrogen.
Speaker 2: This is going to prevent any further eggs from maturing.
Speaker 2: It's going to stabilize the lining of your uterus, that endometrium,
Speaker 2: so that if that egg is fertilized, it can implant
Speaker 2: in the endometrial lining and a pregnancy can take place.
Speaker 2: If that egg is not fertilized, then after fourteen days,
Speaker 2: that corpus lutium degenerates, essentially drone drops and the menstrual
Speaker 2: cycle starts over aka, you bleed from your vagina.
Speaker 1: Okay, So can I start with the questions? Yes, instead
Speaker 1: of asking how, even though I really want to ask how,
Speaker 1: Like these things work on a molecular and like a
Speaker 1: larger I guess level, can you tell me why we
Speaker 1: have a menstrual cycle?
Speaker 2: Oh Arin, I'm so glad that you asked that question.
Speaker 1: You have some animals don't, like rabbits, will ovulate only
Speaker 1: after like only after copulation, Aaron.
Speaker 2: Not only do some animals don't, the vast majority of
Speaker 2: other animals do not menstruate. You. Just if you think
Speaker 2: I'm excited about birth control, you should not have asked
Speaker 2: me this question. Let me tell you all about it. So, Okay,
Speaker 2: that process that I said of building up the endometrial lining, okay,
Speaker 2: that process where it gets thickened the blood supply increase,
Speaker 2: That is called decidualization. Okay, that's what That process is called,
Speaker 2: building up the thickening of that lining in preparation for
Speaker 2: implantation of an embryo. In humans and a couple of
Speaker 2: other primate species four species of bats, one species of
Speaker 2: spiny mouse, and the elephant shrew. This process happens spontaneously.
Speaker 2: So the question is not why do we menstruate? We
Speaker 2: men stright because spontaneously every month, our uterus is like, hey,
Speaker 2: gotta build up this real thick lining, gotta get things
Speaker 2: ready before there's an egg that's been released, before there's
Speaker 2: an embryo that's been created, Like we do that for
Speaker 2: no reason, just ready to get it ready. And we
Speaker 2: don't know exactly why that happens, but that is what
Speaker 2: then leads to menstruation. Yeah, isn't that fascinating?
Speaker 1: We don't, well, that's what I mean, Like, why does
Speaker 1: this why does this build up happen? Like or why
Speaker 1: is it? Like, oh, let's get ready, let's let's expend
Speaker 1: all of this like energy and stuff into creating this lining,
Speaker 1: and we shed it.
Speaker 2: We don't even resorb it like a lot of other
Speaker 2: species that have estras cycles, they'll resorb that lining if
Speaker 2: implantation doesn't happen. It's a really, really good question. Some
Speaker 2: of the evolutionary hypotheses have to do with like how
Speaker 2: deeply the placenta invades into our endometrium, So having like
Speaker 2: an extra thick lining can help prevent more invasive placentation. Okay,
Speaker 2: but it's not entirely clear. We have right now, just hypotheses.
Speaker 2: We don't have solid answers to that question, okay, but
Speaker 2: it is all triggered by those specific hormones, right, So
Speaker 2: it's all hormonally driven, and that whole cycle of menstruation
Speaker 2: can last anywhere from like twenty five to thirty five days.
Speaker 2: And one thing that I think is important about that
Speaker 2: is that that variation in length occurs in follicular phase,
Speaker 2: so that first phase when the follicle is developing, not
Speaker 2: during the luteal phase. So the period from ovulation to
Speaker 2: menstruation is almost always right about fourteen days, maybe twelve
Speaker 2: to fifteen. It's a much narrower window.
Speaker 1: Okay.
Speaker 2: That's how a normal menstrual cycle pretty much functions. I'm
Speaker 2: not going to touch on all the different ways that
Speaker 2: that can go wonky, there's a lot. But how do
Speaker 2: oral contraceptive pills the pill interact with this cycle and
Speaker 2: how do they prevent pregnancy? Oh, it's so fun So
Speaker 2: the oral contraceptive pill, the pill that most people are
Speaker 2: familiar with, is a combination pill that includes both estrogen
Speaker 2: and progesterone. Okay, and there's a lot of different forms
Speaker 2: of synthetic progesterone. Ignore them all for now. Both of
Speaker 2: these in combination are then going to be present when
Speaker 2: you take this pill at higher levels than they would
Speaker 2: be during a normal follicular phase of your cycle. So
Speaker 2: what they do is, by the constant presence of a
Speaker 2: higher level of especially progesterone, you inhibit ovulation from ever occurring, right,
Speaker 2: because ovulation depends on a surge of estrogen, So a
Speaker 2: rapid increase in estrogen, which triggers a rapid increase in LH.
Speaker 2: By having relatively higher levels of progesterone and estrogen, your
Speaker 2: body never sees that surge and therefore never ovulates.
Speaker 1: Mm hm.
Speaker 2: Isn't that incredible?
Speaker 1: I mean the I guess, like simplicity may not be
Speaker 1: the right word, but like it does seem beautifully like obvious.
Speaker 2: Yeah, I mean relatively yeah. Yeah, yeah, And I'm simplifying
Speaker 2: this cycle. But you know that's fine.
Speaker 1: Well, but I know, I just mean, like the way
Speaker 1: the mechanism of action of the birth control pill. Yes,
Speaker 1: and it's just like, oh, we are going to just
Speaker 1: use this trick that already exists, Like this is just
Speaker 1: something that the body already does, and we're just going
Speaker 1: to kind of lean into it a bit more.
Speaker 2: Right, Yeah, and so in these combined oral contraceptive pills,
Speaker 2: it's really the progestin, the progesterone, that's most effective at
Speaker 2: inhibiting ovulation. The addition of estrogen does help to ensure
Speaker 2: that ovulation doesn't occur, but it also helps to stabilize
Speaker 2: that endometrium in a way that can prevent irregular bleeding,
Speaker 2: so like breakthrough bleeding. And so it helps to regulate
Speaker 2: menstrual cycles because you can have like this constant level
Speaker 2: of estrogen and then you take it away for a
Speaker 2: certain number of days and then boom, you're going to
Speaker 2: shed that lining mm hm. And so that's kind of
Speaker 2: the most In the United States, that's the most commonly
Speaker 2: used form of contraception is the combined OCP. Now, these
Speaker 2: pills also do a few other things that become more
Speaker 2: important in other forms of contraception. The presence of progesterone
Speaker 2: helps to thicken the cervical mucus. So remember the cervix
Speaker 2: is the bottom portion of the uterus. It's the top
Speaker 2: of the vaginal canal. So that's the entry way for
Speaker 2: sperm to get in to the uterus. So by thickening
Speaker 2: the mucus that's present there. It makes it really really
Speaker 2: difficult for sperm to actually get into the uterine cavity,
Speaker 2: and if sperm can't get in, then fertilization can't take place. Now, Aarin,
Speaker 2: you said you've used the neuvera ring before. Have you
Speaker 2: ever used the patch?
Speaker 1: No, I haven't used the patch. I thought about it
Speaker 1: for a bit, but no.
Speaker 2: So the neeuver ring and the patch are basically the
Speaker 2: same as combination oral contraceptives. They're estrogen and progesterone, so
Speaker 2: they work the same way. Now, there are a lot
Speaker 2: of other forms that I'll go through just really quickly
Speaker 2: because I don't want to, like spend thousands of years,
Speaker 2: even though I absolutely could.
Speaker 1: We should do a mini series.
Speaker 2: Yeah, so you mentioned Aaron progesterone only pills, and those
Speaker 2: still exist today. It's often called the mini pill, which
Speaker 2: I think is okay, silly because I think it's the
Speaker 2: same size pill.
Speaker 1: I mean, I assume so, yeah.
Speaker 2: But it's only progesterone instead of progestine and estrogen. Now
Speaker 2: a question is why would you want this as an option. Well,
Speaker 2: it turns out that even though estrogen is great in
Speaker 2: a lot of ways and does make like cycles more
Speaker 2: regular and things. Estrogen of these two hormones, is associated
Speaker 2: with higher risk of complications, especially a higher risk of
Speaker 2: blood clots. Now, a caveat is that the increased risk
Speaker 2: of blood clot by taking oral combined conscious reception is
Speaker 2: far less than the increase in risk of blood clot
Speaker 2: that you get by becoming pregnant, like right, way, way less, Okay.
Speaker 1: Well, so that that's why blood clots kind of like
Speaker 1: came to the mind first when people were looking at
Speaker 1: potential side effects, because they were like, oh, if this
Speaker 1: essentially mimics pregnancy in a way, then what are some
Speaker 1: of the things that we see during pregnancy? Do we
Speaker 1: see that during this pill?
Speaker 2: Exactly right, So there is a small increase in risk
Speaker 2: of blood clots with combination contraception. So the maneuver ring
Speaker 2: the patch and the pill again, it's much less than
Speaker 2: the risk of pregnancy. But for some people, actually myself included,
Speaker 2: I started having migraines with aura, so I am now
Speaker 2: and future contraindicated from combination therapy. But there are a
Speaker 2: lot of other options that don't include estrogen, and they
Speaker 2: are just as effective. Okay, So the mini pill is
Speaker 2: just progestin. It usually is lower doses than the amount
Speaker 2: of progestin in combination pills, which I think is interesting. So,
Speaker 2: although they do help to inhibit ovulation, they do so
Speaker 2: a little less consistently than combination pills do, but they
Speaker 2: do a wonderful job of drastically changing the cervical mucus.
Speaker 1: Oh okay, so much environment exactly.
Speaker 2: So that the sperm are really unable to penetrate the
Speaker 2: cervix and make it into the uterus. Okay, even if
Speaker 2: sperm are able to get through this really thick, sticky
Speaker 2: cervical mucus, their motility is absolutely ruined, so that even
Speaker 2: if they make it into the uterus, like, they're never
Speaker 2: going to be able to fertilize an egg, even if
Speaker 2: you happen to ovulate.
Speaker 1: That's really cool.
Speaker 2: Yeah, one downside with progestin only pills, because we always
Speaker 2: have to talk about downsides, is that it's a narrow
Speaker 2: window of effectiveness compared to estrogen containing pills.
Speaker 1: Right, So, like the exact hour exactly is really important
Speaker 1: that you take the pill.
Speaker 2: Right, So with a combination pill, like you need to
Speaker 2: take it every day, but if you don't take it
Speaker 2: at the exact same time every day, that's Okay. With
Speaker 2: progestin pills, they really are effective for about twenty three hours,
Speaker 2: so you need to take it at the same time
Speaker 2: every day, so that can be a lot harder to remember.
Speaker 1: And are you going to later talk about like what
Speaker 1: effective means like proper use and effectiveness and blah blah blah,
Speaker 1: bus break those things down in all different forms of
Speaker 1: contraceptional yeah, absolutely, okay, perfect.
Speaker 2: Okay, So there's like kind of three other forms of
Speaker 2: contraception I want to touch on really briefly, and then
Speaker 2: we'll go through the effectiveness of all these types. Okay, excellent.
Speaker 2: So the next one is called depo Privera. It's probably
Speaker 2: a brand name, and I wish I would have said
Speaker 2: the generic, but whatever. This is a long acting injectable
Speaker 2: form of progestin progesterone. So it does exactly the same
Speaker 2: things that the progestin only pills do. It's better at
Speaker 2: inhibiting ovulation than progestin only pills, So deepot shots are
Speaker 2: really good at blocking ovulation so you're not going to ovulate.
Speaker 2: They're really great at changing the cervical mucus so that
Speaker 2: sperm can't get in, and deepo privera also remember that
Speaker 2: estrogen in the combined pill helps to stabilize the lining
Speaker 2: of the uterus so that you, you know, don't have
Speaker 2: breakthrough bleeding and you have like that kind of a thing.
Speaker 2: With deepo privera and a lot of the progestin only contraceptives,
Speaker 2: it diminishes the proliferation of that uterus so that you're
Speaker 2: just not building up a lining to begin with. Yeah.
Speaker 2: The only downside with the deepot privera is that, unlike
Speaker 2: pretty much which every other form of contraception, fertility takes
Speaker 2: longer to increase back to baseline after you stop using it.
Speaker 2: And that's because it's so long acting, so it inhibits
Speaker 2: ovulation for a lot longer than the twelve to thirteen
Speaker 2: weeks in which you should get your shots regularly. Okay, gotcha, Okay,
Speaker 2: And then we have my favorite. But these are all
Speaker 2: great options, and those are the long acting reversible contraceptions, Larks.
Speaker 2: There's two kinds. There's the IUD and there's the implant. Okay, gotcha,
Speaker 2: you know this already, erin.
Speaker 3: I know this.
Speaker 2: So the IUD is a little T shaped plastic device
Speaker 2: that is inserted through the cervix into the uterus. There
Speaker 2: are several different brands on the market right now, Aarin,
Speaker 2: we have two different brands in our bodies.
Speaker 4: We do.
Speaker 2: Some of them contain progestin. So again, just progesterone, which
Speaker 2: is going to act too thicken your cerviro cole mucus,
Speaker 2: inhibit sperm motility, not let them get in. It's gonna
Speaker 2: thin the lining of the uterus. Okay. These ones can
Speaker 2: also help to suppress ovulation. These ones in the US
Speaker 2: are approved for either three or five years, so you
Speaker 2: put it in and then three or five years go by,
Speaker 2: you don't have to think about your birth control.
Speaker 1: What Yes, it's like a slow cocker. Set it and
Speaker 1: forget it.
Speaker 2: And then there's the implant, which in the US is
Speaker 2: like the next spleanon I think is the only one
Speaker 2: we have. It's the same exact thing. It's a little
Speaker 2: piece of plastic. It's just shaped like a rod and
Speaker 2: it goes right underneath the skin of your arm. It
Speaker 2: works literally the exact same way. It releases progestin over time,
Speaker 2: it does all the same things to your cervix. And
Speaker 2: then finally there's the copper IUD, which is the only
Speaker 2: non hormonal form of birth control that I've talked about
Speaker 2: thus far, and that is a plastic T shaped little thing,
Speaker 2: but it's covered in coils of copper white. I don't
Speaker 2: know who thought of this, it's incredible, But copper ions
Speaker 2: happen to cause inflammatory changes in the lining of your uterus,
Speaker 2: the endometrium that have spermicidal activity, so it kills the
Speaker 2: sperm if they make it into the uterus, and if
Speaker 2: that's not enough, if not all sperm die. These ions
Speaker 2: also block the activation of enzymes in the heads of
Speaker 2: sperm that are necessary for fertilization to take place.
Speaker 1: It blew my mind that just like a little bit
Speaker 1: of copper can do all.
Speaker 2: That, just a little bit of copper I clue my mind. Yeah,
Speaker 2: it's really incredible. So, because the copper id doesn't have
Speaker 2: these hormonal effects, it's not going to have a big
Speaker 2: effect on your cervical mucus, it doesn't have an effect
Speaker 2: on your ovulation cycles, it doesn't have an effect on
Speaker 2: you building up an endometrial lining because it's not interfering
Speaker 2: with your hormones whatsoever. So the biggest side for a
Speaker 2: lot of people with copper IUDs is that they because
Speaker 2: you have this kind of constant inflammation in your uterus.
Speaker 2: It can lead to more bleeding. So if you already
Speaker 2: have really heavy periods, some people don't like the copper
Speaker 2: id because then they have heavier periods potentially. Okay, I
Speaker 2: want to sum it up a little bit and then
Speaker 2: we'll talk about the effectiveness of all these different ones. Okay, Yeah,
Speaker 2: And actually I want to post this really great graphic
Speaker 2: that's from Reproductive access dot org that has all these
Speaker 2: different forms of contraception and their effectiveness with typical use.
Speaker 2: So in summary, we have the pills as well as
Speaker 2: the maneuvera ring and the patch. With perfect use, those
Speaker 2: options are actually like ninety eight ninety nine percent effective.
Speaker 2: They're super effective.
Speaker 1: That's amazing. Well, I mean perfect use.
Speaker 2: Though perfect use, Okay, So with typical use they're about
Speaker 2: ninety to ninety three percent effective. So that's still pretty
Speaker 2: dang especially if you compare that to the condom, which
Speaker 2: with typical use is about eighty five to eighty seven
Speaker 2: percent effective. So you're getting an additional you know, three
Speaker 2: to six percentage points of effectiveness, which is pretty great
Speaker 2: important boost. Yep. Now, the deepot privera, so the shot
Speaker 2: is about ninety six percent effective with typical use. Again,
Speaker 2: we're reaching over ninety eight ninety nine with perfect use,
Speaker 2: So that's if you got it exactly on time every time.
Speaker 2: The larks so iud's explan on these are over ninety
Speaker 2: nine percent effective. Wow, they are equivalent to a tubal ligation,
Speaker 2: so having your tubes tied in forms of effectiveness. And
Speaker 2: they are reversible and don't require surgery, and in the
Speaker 2: case of the implant it doesn't even require a pelvic exam.
Speaker 1: Huh.
Speaker 2: And another thing that I want to really point out
Speaker 2: and highlight here is that every one of these birth
Speaker 2: control options that I mentioned are contraceptives, so they are
Speaker 2: preventing pregnancy from ever happening. These do not serve as
Speaker 2: a bard of fashions, which means they do not prevent implantation.
Speaker 2: You can still get pregnant even with an IUD in place. Okay.
Speaker 2: And there is a lot of misinformation out there right now,
Speaker 2: especially about IUDs, saying that they kill embryos, which is
Speaker 2: not true. No, So an abortifatient is something that we
Speaker 2: can use to induce an abortion, So terminate a pregnancy
Speaker 2: after the point of implantation, right. Implantation in the wall
Speaker 2: of the uterus is the scientific and the legal definition
Speaker 2: of the start of pregnancy.
Speaker 1: So the egg has been released and fertilized and implants
Speaker 1: in implants.
Speaker 2: Exactly, IUDs do not block implantation period, which is why
Speaker 2: you can still in theory, though it's very rare get
Speaker 2: pregnant while using an IUD while having an IUD in place.
Speaker 2: All of the IUDs block fertilization from taking place.
Speaker 1: Right, and so it's right just preventing the sperm from
Speaker 1: ever meeting exactly.
Speaker 2: That's what all of these contraceptive options are doing. Whether
Speaker 2: they do that by preventing ovulation so there's no egg there,
Speaker 2: whether they do that by blocking by changing the cervical
Speaker 2: mucus in a way that makes it impossible for sperm
Speaker 2: to penetrate the uterus, or whether they do it by
Speaker 2: changing the environment of the uterus such that the sperm
Speaker 2: can then they basically either die or are so adversely
Speaker 2: affected that they're unable to fertilize the egg.
Speaker 1: Okay, gotcha, Okay, I think yeah, I think that's a
Speaker 1: really important point to make.
Speaker 2: It is and clarify it is, and that is also
Speaker 2: true for the last form of contraception I haven't touched
Speaker 2: on and that is emergency contraception. So this is essentially
Speaker 2: just a pill that is a high dose of progesterone.
Speaker 2: It's fifty eight to ninety four percent effective. That's a
Speaker 2: huge range. And the reason is because it functions to
Speaker 2: block ovulation.
Speaker 3: Huh.
Speaker 2: So if you have already ovulated by the time you
Speaker 2: take that contraception, it's not going to be effective. It
Speaker 2: has no effect on fertilization and no effect on implantation,
Speaker 2: which is so important because there was so much misinformation
Speaker 2: about this out there, and that's why the emergency contraceptive
Speaker 2: pills that, by the way, legally should be available over
Speaker 2: the counter to anyone over I think age thirteen in
Speaker 2: the United States without a prescription, male or female. By
Speaker 2: the way, they are most effective if they're taken as
Speaker 2: soon after an unprotected sexual encounter as possible, right.
Speaker 1: Right, rather than like having to get signed parental permission
Speaker 1: or prescription from the doctor or whatever else.
Speaker 2: Yeah, exactly.
Speaker 1: Yeah.
Speaker 2: So that's it, Aaron, That is contraception and how it works.
Speaker 2: Does that answer your questions? Do you have more?
Speaker 1: I mean, yeah, I probably have more in there, but
Speaker 1: I'm I'm just processing. Now. Do you want to hear
Speaker 1: about the history of birth.
Speaker 2: Control, Yes, I do. How did we come up with it?
Speaker 2: How long have we even had access to it? I
Speaker 2: don't know the answer to that question.
Speaker 1: Okay, let's take a quick break first.
Speaker 2: Okay.
Speaker 1: The history of birth control or reproductive control is massive,
Speaker 1: as you might expect, like absolutely massive and enormously complicated.
Speaker 1: And the motivation behind the fight for reproductive rights hasn't
Speaker 1: always been the same, and nor have its opponents always
Speaker 1: had their same justifications. So what I want to do.
Speaker 1: My goal for this section is to try to understand
Speaker 1: how we got to where we are today by examining
Speaker 1: some of the past struggles for reproductive rights, particularly in
Speaker 1: terms of birth control, and then focusing more narrowly on
Speaker 1: the development of the hormonal birth control pill. Awesome, and
Speaker 1: a quick caveat before I begin. There are a million
Speaker 1: different ways to tell this story, but no one wants
Speaker 1: to sit here for a million years, and so I'm
Speaker 1: going to focus primarily on the US for birth control history.
Speaker 1: And I would love to talk about the global history
Speaker 1: of each and every contraceptive, but nobody wants an episode
Speaker 1: that long. Nobody, Okay, So I think there's this common
Speaker 1: misconception that birth control methods emerged out of the twentieth
Speaker 1: century as a result of an increase in scientific technology
Speaker 1: and a loosening of the puritanical morals that had shaped
Speaker 1: many of our earlier policies and laws.
Speaker 2: But not so, really, not so not so.
Speaker 1: In fact, up until the nineteen fifties, the most common
Speaker 1: methods of birth control had been with us for hundreds,
Speaker 1: if not thousands of years.
Speaker 2: Is it like pulling out?
Speaker 1: Well, okay, that is one of them, but there are
Speaker 1: other ones too. Vaginal sponges, condoms, withdrawal methods, diaphragms, even
Speaker 1: like early forms of IUDs had all been in use
Speaker 1: like it since the ancient world.
Speaker 2: Oh. Also, fertility tracking is another.
Speaker 1: Yeptive exactly, although it took a really long time for
Speaker 1: that to emerge in medicine because doctors never wanted to
Speaker 1: study women's periods because they were yaki.
Speaker 2: They're so yaki mighty.
Speaker 1: There's a famous quote by Heinlen Robert Heinland, which is
Speaker 1: that every generation thinks it invented sex. Each generation is
Speaker 1: totally mistaken. And I think the same could be said
Speaker 1: for birth control. And I think the other thing that's
Speaker 1: really important is that the sheer variety of all these
Speaker 1: different methods and the ingenuity the creativity that went into
Speaker 1: making them shows just how important birth control has always
Speaker 1: been to humans. Yeah, birth control was not invented by
Speaker 1: the scientists and doctors of the twentieth century. It was
Speaker 1: tested and practiced by women who passed their knowledge of
Speaker 1: folk medicine from generation to generation. Early in human history,
Speaker 1: when humans lived primarily in small nomadic groups, family size
Speaker 1: was really important because it was much easier to feed
Speaker 1: and pack up and move a small family compared to
Speaker 1: a large one, and so it's not surprising that these
Speaker 1: groups regularly practiced various forms of contraception and abortion. And then,
Speaker 1: with the agricultural Revolution one of our favorite themes to
Speaker 1: discuss on the podcast, larger family sizes were not only
Speaker 1: more possible to support, but they were even economically advantageous
Speaker 1: because more people then could work the land.
Speaker 2: Yeah.
Speaker 1: And then, combined with the high infant mortality due to
Speaker 1: the increase in infectious diseases that the agricultural revolution brought on,
Speaker 1: this led to many of these agricultural societies producing ideologies
Speaker 1: that banned birth control entirely. Wow, isn't that interesting? I
Speaker 1: never really thought about it that way.
Speaker 2: Absolutely fascinating, yeah, and horrifying and horrifying.
Speaker 1: In the last five hundred years or so, the growth
Speaker 1: of cities and industrialization meant that in many places, large
Speaker 1: families no longer held the same economic advantage as they
Speaker 1: had in early farming societies. Children started to cost more
Speaker 1: than they contributed, which I know is like a horrible
Speaker 1: like it sounds like a very horrible way to look
Speaker 1: at it, But this is just sort of like sociologically,
Speaker 1: sort of the trend in what happened.
Speaker 2: Also, they're very expensive.
Speaker 1: Children are expensive. They're very expensive. And this shift, this,
Speaker 1: you know, the increase in cost of children is reflected
Speaker 1: in a slow decline of the birth rate, particularly in
Speaker 1: urbanized areas. But this drop in the birth rate did
Speaker 1: not correspond to a loosening of those ideological standards. If anything,
Speaker 1: things became even stricter during the Victorian era, which sharply
Speaker 1: defined how proper women should behave, and there were moralistic
Speaker 1: policies such as the Comstock Law enacted in eighteen seventy three,
Speaker 1: which forbade sending obscene matter through US mail, including but
Speaker 1: not limited to birth control devices or even information about
Speaker 1: birth control. What side note, And I know that like,
Speaker 1: this episode is long and I should probably just cut this,
Speaker 1: but I really wanted to tell you that the namesake
Speaker 1: of the law, Anthony Comstock, as a teenager, masturbated so
Speaker 1: obsessively that he thought he might be driven to suicide
Speaker 1: by it. And he blamed it on the magazines and postcards,
Speaker 1: the sexy magazines and postcards, and so he made it
Speaker 1: his life's mission to prevent their distribution.
Speaker 2: Oh my god, just because he couldn't stop masturbating.
Speaker 1: Yeah, Jesus well, and was probably told that it was
Speaker 1: wrong to masturbate.
Speaker 2: Yes, right, and it's immoral and blah blah.
Speaker 1: Blah, oh right. That is so awful, I know. But
Speaker 1: these types of policies, like the Comstock Law, they weren't
Speaker 1: just a relic of the times. They were a response
Speaker 1: to a growing rebellion against this type of thought, and
Speaker 1: they were fighting a losing battle. So the roots of
Speaker 1: the modern birth control movement really began in voluntary motherhood,
Speaker 1: which is a concept and movement that originated out of
Speaker 1: the woman's suffrage movement of the late nineteenth century, and
Speaker 1: at its outset, it opposed all methods of birth control. Devices,
Speaker 1: behavior and restraint were the only approved proper methods. But
Speaker 1: this movement also dared to suggest that women could be
Speaker 1: sexual subjects rather than objects, that women were capable of
Speaker 1: sexual desire for pleasure itself, not just to become pregnant.
Speaker 1: At the heart of it, the voluntary motherhood movement was
Speaker 1: about a woman's right to say no, to refuse her husband,
Speaker 1: her wifely duty. And this movement, I know. And this
Speaker 1: movement was preceded by and already existing drop in birth
Speaker 1: rates in the US. So in the late seventeen hundreds,
Speaker 1: American women had on average eight live births one hundred. Yeah.
Speaker 2: Oh I'm sorry, my face just like, oh no, it's
Speaker 2: a lot.
Speaker 1: That's a lot of pregnancies to go through.
Speaker 2: Yes, squeezing my vagina.
Speaker 1: One hundred years later that number was three. It was
Speaker 1: down to three.
Speaker 2: Wow.
Speaker 1: So what can explain this? It's not restraint. The answer
Speaker 1: is birth control, its contraception, its abortion. Yeah, and sure
Speaker 1: some methods or devices were improved during that time, but
Speaker 1: it was not really about a lack of technology, but
Speaker 1: rather a suppression of that technology. Nevertheless, people found a
Speaker 1: way around that, for instance, euphemistic advertisements that warned Portuguese
Speaker 1: female pills not to be used during pregnancy, for they
Speaker 1: will cause miscarriage or stimulates menstruation when late or irregular.
Speaker 1: Those were hidden messages to those in the know. Yep, okay. So,
Speaker 1: rolling into the nineteen hundreds, morality ruled over medicine, at
Speaker 1: least in the US, physicians saw themselves as guardians over
Speaker 1: the sexual purity of their patients. Gross, absolutely disgusting.
Speaker 2: I am infuriated.
Speaker 1: M I mean yep, that.
Speaker 2: Sentence, Aaron is one of the most gross.
Speaker 1: Is it worse than the female organism?
Speaker 2: I don't know if it's worse than the female organism,
Speaker 2: but it's up there. It might be worse.
Speaker 1: Oh my gosh.
Speaker 2: Okay.
Speaker 1: Well, and this inflated self importance of theirs led them
Speaker 1: to make decisions for their patients not just based on
Speaker 1: medical reasoning, but also morals. A break from the dominant
Speaker 1: stance on birth control is bad came in nineteen twelve
Speaker 1: from the president of the American Medical Association, Abraham Jacoby.
Speaker 1: He advocated for a campaign for industrial health access to
Speaker 1: birth control, and requiring STI testing before marriage, which is
Speaker 1: problematic very There had been growing support for birth control
Speaker 1: throughout the US, including from the medical community, but the
Speaker 1: fact that the president of this moral respected institution was
Speaker 1: calling for the separation of sex and reproduction. Was both
Speaker 1: sort of this culmination of decades of debate as well
Speaker 1: as a revitalization of the birth control movement or what
Speaker 1: would become the birth control movement. Okay, people were also
Speaker 1: simply talking about sex. More Ford's concept that sex was
Speaker 1: good and repression was bad had reached the US and
Speaker 1: had led people to question their assumptions about sex, and
Speaker 1: a new set of beliefs, unfortunately housed in the objective
Speaker 1: terminology of biology, began to take hold. Eugenics. Yeah, yeah, yeah,
Speaker 1: real quick, just in case people haven't heard of eugenics
Speaker 1: or have heard of it but don't know what it is.
Speaker 1: It has really old roots, but the modern eugenics movement
Speaker 1: began around the late eighteen hundreds and was a set
Speaker 1: of beliefs or policies which stated that people can be
Speaker 1: classified as having either superior or inferior genetics like just
Speaker 1: incredibly subjectively, and that those deemed inferior should not be
Speaker 1: allowed to reproduce. If it sounds like Nazi talk, it's
Speaker 1: because it is. Nazis got many of their ideas from
Speaker 1: US eugenics policies.
Speaker 2: Cool.
Speaker 1: Eugenics became popular when it did because with the incredible
Speaker 1: advancements in medical science and technology, people were living much
Speaker 1: longer and the global population had greatly expanded, and so
Speaker 1: this led to a lot of fears and talk of
Speaker 1: overpopulation and discussion about what to do with it. Okay,
Speaker 1: back to birth control. Eugenics had a commonplicated relationship with
Speaker 1: birth control. It was pro in some cases and anti
Speaker 1: in others. Essentially, who should be able to use birth
Speaker 1: control was a concern of the whole society and not
Speaker 1: for an individual to decide.
Speaker 2: Oh dear God.
Speaker 1: Uh huh so. Teddy Roosevelt was a huge eugenicist and
Speaker 1: very anti birth control. Great He said that smaller families
Speaker 1: were a sign of moral disease and that women who
Speaker 1: avoided having children were criminal against the race, the object
Speaker 1: of contemptuous abhorrence by healthy people.
Speaker 2: I I have aaron, I have so many feelings right now,
Speaker 2: I honestly can't deal with them.
Speaker 1: I know, just sit back, let it wash all over you,
Speaker 1: and then take a nap.
Speaker 2: Oh God, well.
Speaker 1: It's gonna get worse.
Speaker 2: I know, it always does with you, always does.
Speaker 1: Race suicide quote unquote became a talking point and a
Speaker 1: passion of his for the next five or so years.
Speaker 1: Which race was the one committing suicide wasn't specified, but
Speaker 1: it's pretty implied that Roosevelt and others wanted wealthy, educated
Speaker 1: white people to have more children and poorer people, especially
Speaker 1: people of color, to have fewer. This is eugenics. Falling
Speaker 1: birth rates, particularly among the wealthier and more educated, was
Speaker 1: attributable to birth control because the most effective methods were
Speaker 1: the most expensive and required seeing a doctor, and so
Speaker 1: women using birth control were specifically condemned as selfish or
Speaker 1: displaying unladylike ambition, denying their true purpose in life, which
Speaker 1: was motherhood. I know, rage noises, but this didn't result
Speaker 1: in the proponents of the birth control movement championing it
Speaker 1: as an inherent right of women to have agecies over
Speaker 1: their own bodies, nor were they shamed into giving it up. Rather,
Speaker 1: this resulted in an unfortunate alliance between the birth control
Speaker 1: movement and the eugenics movement.
Speaker 2: Oh no, yeah, oh yes God.
Speaker 1: The answer to quote race suicide, they said, was greater
Speaker 1: access to birth control by the poorer classes. This provided
Speaker 1: a more palatable reason for people, particularly people in power,
Speaker 1: to support birth control rather than hey, women like sex
Speaker 1: two and may not want to be continuously pregnant, but honestly,
Speaker 1: it's none of your business, so I'm going to do
Speaker 1: what I want to do. That was not the reason.
Speaker 1: That was not what they wanted to hear, right, they
Speaker 1: wanted to hear here's a solution to the problem that
Speaker 1: you see. And it's important to note that the eugenics
Speaker 1: movement in the early nineteen hundreds in the US was
Speaker 1: not some fringe group. Was also global, like a lot
Speaker 1: of countries had eugenics you know movements. It was huge
Speaker 1: and it greatly acted policy. For instance, by nineteen fifteen,
Speaker 1: thirteen states had compulsory sterilization laws. By nineteen thirty two,
Speaker 1: twenty seven states had them.
Speaker 2: I mean, Aarin, this just sounds like you're talking about
Speaker 2: twenty twenty quite honestly, Like it doesn't sound any different,
Speaker 2: and I'm getting really.
Speaker 1: Oh absolutely, I mean, like forest or coer. Sterilizations have
Speaker 1: been happening for as long as the first person was
Speaker 1: able to figure out how to remove sterilized, yeah, to
Speaker 1: figure out how to sterilize. And these policies were by
Speaker 1: no means limited to the US. There were plenty of
Speaker 1: international organizations seeking to reduce birth rates in other countries,
Speaker 1: particularly developing ones. During this time the rise of eugenics,
Speaker 1: the birth control movement gained an outspoken leader, enter Margaret Sanger.
Speaker 1: Growing up, Sanger had been taught to speak her mind,
Speaker 1: and when she moved to New York City after finishing
Speaker 1: nursing school, she met people whose radical ideas at least
Speaker 1: radical during the time, would completely change her life, in
Speaker 1: particular the socialist leader Eugene Debs and the famous feminist
Speaker 1: Emma Goldman, who became her mentor and from whom she
Speaker 1: would learn so much more about the voluntary motherhood movement.
Speaker 1: As a nurse in New York City, Sanger spent much
Speaker 1: of her time serving poverty stricken regions where there was
Speaker 1: a lot of overcrowding, there were high rates of infectious disease,
Speaker 1: and like no one was getting adequate nutrition, and one
Speaker 1: experience in particular made a huge impact on Saanger. There
Speaker 1: was a woman named Sadie who had been told by
Speaker 1: her doctor that she shouldn't get pregnant again because she
Speaker 1: would likely die, and so as a solution, her doctor
Speaker 1: recommended that she sleep on the roof so her husband
Speaker 1: wouldn't bother her Sadie got pregnant because who's going to
Speaker 1: sleep on a roof for your whole life, and then
Speaker 1: died after an abortion attempt.
Speaker 3: Jesus.
Speaker 1: This death was a pivotal moment for Sanger. She vowed
Speaker 1: that she would do whatever she could to ensure that
Speaker 1: women had the right to contraception. The next year, in
Speaker 1: nineteen thirteen, she began writing a series of educational articles
Speaker 1: about sex and reproduction titled What Every Girl Should Know.
Speaker 1: Of course, the Comstock Act prevented the distribution of many
Speaker 1: of these articles, and Sanger was arrested for her involvement,
Speaker 1: but instead of showing up to court, she skipped town
Speaker 1: went to Europe for a couple of years, where her
Speaker 1: radical education continued, and her time there also led to
Speaker 1: her narrowing her focus on contraceptives rather than women's liberation overall,
Speaker 1: which is sort of At the beginning, she was much
Speaker 1: more about equality in the workplace and equal rights, and
Speaker 1: then she was persuaded to just focus on contraception. In
Speaker 1: the books I read for this, Sanger is described as
Speaker 1: being kind of in the right place at the right
Speaker 1: time time. She was a huge fighter. She was very outspoken,
Speaker 1: but this fight. The fight for access to contraceptive seemed
Speaker 1: to be simply waiting for a leader to head the charge.
Speaker 1: Sanger coined the term birth control in nineteen fifteen, and
Speaker 1: in nineteen sixteen she opened the first birth control clinic
Speaker 1: in Brooklyn Wow. There, she and her sister and a
Speaker 1: team of nurses handed out condoms and what were essentially
Speaker 1: early diaphragms, and the clinic was under constant threat of
Speaker 1: closure because it was illegal, and it did get closed
Speaker 1: a few times. But Sanger wasn't discouraged easily, and for
Speaker 1: a few years she continued the operation of her birth
Speaker 1: control clinics and the grassroots movement to increase awareness of
Speaker 1: birth control. But beginning in the nineteen twenties, she began
Speaker 1: to form some powerful allies with physicians, politicians, and eugenicists.
Speaker 2: Oh gosh.
Speaker 1: Sanger is painted alternatively as being a eugenicist herself, or
Speaker 1: just someone who saw the value in this powerful alliance.
Speaker 1: Based on her own writings, I'm inclined to believe the former.
Speaker 1: She had written that certain people should be sterilized and
Speaker 1: that criminals, illiterate sex workers, and drug addicts should be
Speaker 1: separated from the rest of society.
Speaker 2: Oh Dear.
Speaker 1: Throughout the nineteen twenties and thirties, the birth control movement
Speaker 1: gained a lot of momentum. More clinics were opened, and
Speaker 1: more people got behind the idea that perhaps women should
Speaker 1: have some control over their family size. The Great Depression
Speaker 1: also played a role in this. Women were increasingly seeking
Speaker 1: out employment to help support their family, and for many
Speaker 1: of them this meant moving out of the home and
Speaker 1: into big cities, becoming financially independent. The idea of hey,
Speaker 1: maybe I don't want kids right now and that's okay
Speaker 1: was becoming more and more common, and during this time
Speaker 1: eugenics fell out of favor in the US as it
Speaker 1: rose to prominence in Nazi German. It was replaced or
Speaker 1: maybe just repackaged as population control, with both international and
Speaker 1: national programs offering incentives for those willing to have an
Speaker 1: IUD put in or to be sterilized, and finder's fees
Speaker 1: for those who could find someone willing to have either
Speaker 1: procedure done. But generally speaking, at least privately, people were
Speaker 1: finding that they didn't need as much of a justification
Speaker 1: for birth control for themselves. World War Two and then
Speaker 1: the threat of nuclear holocaust during the Cold war lent
Speaker 1: a sort of you know, get it while getting's good
Speaker 1: vibe to the times, and Alfred Kinsey's titillating research began
Speaker 1: making headlines and got people talking even more about sex,
Speaker 1: even though his findings were super flawed and biased, but
Speaker 1: they were a crucial step forward in chipping away some
Speaker 1: of the shame associated with sex in the US, and
Speaker 1: during these decades, Sanger was still hard at work on
Speaker 1: her goal of making birth control accessible to women. The
Speaker 1: first clinic from nineteen sixteen had grown into many more
Speaker 1: across the country, organized first as the American Birth Control League,
Speaker 1: which later became the Birth Control Federation of America, which
Speaker 1: then changed its name to the Planned Parenthood Federation of
Speaker 1: America in nineteen forty two.
Speaker 2: Huh, there you go. Wow.
Speaker 1: Though Planned Parenthood began as a place where contraceptives or
Speaker 1: info about contraceptives could be obtained, it gradually turned into
Speaker 1: a medical facility that provided much much more counseling, family planning,
Speaker 1: medical procedures, et cetera. And by making contraception more accessible,
Speaker 1: it basically paved the way for the feminist movement of
Speaker 1: the nineteen sixties, which is kind of I also think
Speaker 1: it's ironic because at the beginning they would only provide
Speaker 1: contraceptives to married women.
Speaker 2: Married.
Speaker 1: Yeah, but this brings me to one of the biggest
Speaker 1: developments in birth control history and the main focus of
Speaker 1: this episode, the birth control pill. The Pill. Aaron talked
Speaker 1: a bit about different classifications of birth control based on
Speaker 1: how they work, but there's another way that you could
Speaker 1: group them. Which person in a sexual relationship was responsible
Speaker 1: for its use? Oh yeah, and whether using it is
Speaker 1: obvious to the other person or if its use could
Speaker 1: be concealed if necessary.
Speaker 2: Oh my gosh, yeah huh.
Speaker 1: A magic bullet contraceptive had been dreamt about by Margaret
Speaker 1: Sanger for decades. Something one hundred percent effective with minimal
Speaker 1: side effects, that could be easily obtainable, affordable, and allowed
Speaker 1: a woman to be completely in control of her body.
Speaker 1: She had also listed the help of a philanthropist and
Speaker 1: feminist named Catherine McCormick, who graduated from MIT in nineteen
Speaker 1: oh four with a biology degree, the second woman ever,
Speaker 1: I think, to graduate from MIT, and McCormick would essentially
Speaker 1: fund the entire creation of the pill, like it was
Speaker 1: basically all from her Wow. Sanger had approached researchers to
Speaker 1: try to realize her dream, but she was repeatedly turned
Speaker 1: down because it was disreputable work.
Speaker 2: Disreputable, that is.
Speaker 1: Until she met Gregory Pinkis in winter nineteen fifty. Pinkus
Speaker 1: was a bit of I don't know if iconoclast is
Speaker 1: the right word. He was a brilliant scientist with a
Speaker 1: bad reputation. His work on in vitro fertilization in rabbits
Speaker 1: had led to him being compared to Victor Frankenstein, and
Speaker 1: basically any reputable research institution refused to hire him, so
Speaker 1: he started his own research center like you do, the
Speaker 1: Worcester Foundation for Experimental Biology. After his meeting with Sanger,
Speaker 1: he realized that creating a birth control pill could not
Speaker 1: only get him the scientific respect he felt he deserved,
Speaker 1: but it would also earn him fame for tackling what
Speaker 1: he felt was a pressing global issue overpopulation. Agreed to
Speaker 1: look into the possibility of a birth control pill, and
Speaker 1: he even knew where to start. Back in nineteen thirty seven,
Speaker 1: a few researchers from the University of Pennsylvania had published
Speaker 1: a paper titled The Effect of Progesterine and Progesterone on
Speaker 1: Ovulation in the rabbit, which described how progesterone injections could
Speaker 1: prevent ovulation. Pinkus and another researcher at the lab named M. C.
Speaker 1: Chang set out by first repeating the experiment described in
Speaker 1: the paper. Things went as expected, so then they started
Speaker 1: to play around a bit. What if a progesterone pellet
Speaker 1: was lodged under the skin of the rabbit, And does
Speaker 1: this also work in rats who ovulate spontaneously like humans,
Speaker 1: as opposed to rabbits who ovulate after copulation? Yes, it does. Indeed,
Speaker 1: all told, things were looking very promising for Pinkus and Chang.
Speaker 1: The next step was simply to test out the procedure
Speaker 1: on humans, so Pinkus teamed up with a doctor who
Speaker 1: specialized in infertility named John Rock. Together, they sought out
Speaker 1: dozens of women seeking help for difficulty in conceiving. They
Speaker 1: didn't tell them about the study that they were to
Speaker 1: be a part of, which was not required by US
Speaker 1: law at the time, nor did they ask for any
Speaker 1: kind of consent, nor did they pay the women.
Speaker 2: Oh my god.
Speaker 1: They just told them to take pills, take their temperature daily,
Speaker 1: collect their urine, and take some vaginal smears.
Speaker 2: So they took women who were actively wanting to become
Speaker 2: pregnant and having difficulty, and they made it to make
Speaker 2: sure that they were not going to become pregnant.
Speaker 1: So it was they were told that the pills that
Speaker 1: they were taking would prevent them from becoming pregnant, but
Speaker 1: what it might do afterwards was regulate their ovulation such
Speaker 1: that their likelihood of getting pregnant is increased following the
Speaker 1: end of the study.
Speaker 2: Some tiny relief.
Speaker 1: Yeah yeah, oh well, okay, scratched that relief because they
Speaker 1: also went to asylums to bump up their studies.
Speaker 2: Cool yeah, yep, yep, yep, yep yep.
Speaker 1: Sounds about right, mm hmm, like lots of them, and
Speaker 1: it was just not no one was informed outside of
Speaker 1: like the head of the of course.
Speaker 2: Cool yeah cool cool.
Speaker 1: And so Pinkus loaded up these women with extremely high
Speaker 1: doses of progesterone. So I don't think you mentioned the
Speaker 1: like what a pill is what they do now, but
Speaker 1: this is between two hundred and fifty and three hundred milligrams.
Speaker 2: Daily and that's a lot.
Speaker 1: Is what's in a like a pill today.
Speaker 2: They vary a lot depending on the synthetic progesterone used,
Speaker 2: but it's like, I don't know, one, maybe two, depending
Speaker 2: on the type. Ye yep, yeah. Yeah.
Speaker 1: Of the sixty women who were enrolled in the study
Speaker 1: without their knowledge, about half dropped out due to the
Speaker 1: demanding requirements or because the side effects were just too much.
Speaker 2: Yeah.
Speaker 1: The results of the study were mixed, so four women
Speaker 1: became pregnant after it was over, suggesting that it might
Speaker 1: help people who have difficulty in conceiving. But about fifteen
Speaker 1: percent of the participants continued to during the study, which
Speaker 1: was too high to be an effective method of contraception
Speaker 1: in Pinkus's eyes. More research needed to be done to
Speaker 1: bring down that number to make it more effective. But
Speaker 1: where were they going to get the sample sizes that
Speaker 1: they needed to do these studies?
Speaker 2: Oh, some more terrible aaron For.
Speaker 1: Pincus, The answer was Puerto Rico. So Puerto Rico had
Speaker 1: already been subjected to extensive medicalized torture from the US.
Speaker 1: In the post World War two years, thousands upon thousands
Speaker 1: upon thousands of sterilizations were performed, both with and without consent.
Speaker 1: It was, in fact, like the one of the most
Speaker 1: common procedures after a delivery was sterilization.
Speaker 2: Without probably without ever consent yeah.
Speaker 1: So it was like the most common form of birth
Speaker 1: control essentially of like yeah.
Speaker 2: Oh well you had a baby, you're done. Clip clip, yeah.
Speaker 1: I mean, and these were like, these were policies implemented
Speaker 1: by the US, and there was like it was an
Speaker 1: active program to try to oh yeah yeah, but it
Speaker 1: wasn't just an annoying amount of urine collecting that the
Speaker 1: women would have to face. In their preliminary study, only
Speaker 1: five of the seventy women involved reported no side effects.
Speaker 1: The rest experienced things ranging from breast soreness, change in
Speaker 1: pigment or size of nipples, nausea, vomiting, vaginal discharge, increased
Speaker 1: or decrease libidos lactation, et cetera.
Speaker 2: These are all pregnancy complications.
Speaker 1: Shocker, No one involved in the research seemed to really
Speaker 1: care about these side effects, so he proceeded with the studies,
Speaker 1: also beginning to experiment with synthetic progestines, which were more
Speaker 1: powerful than natural progesterone and worked better than progesterone when
Speaker 1: taken orally. But despite the initial promising results of the pill,
Speaker 1: Pinkus was still facing difficulties in retaining people in the study,
Speaker 1: so he decided to change things up a bit maybe
Speaker 1: instead of just like keeping people in the dark and
Speaker 1: not telling them anything about what they are involved with.
Speaker 1: What if we actually recruit women who want to try
Speaker 1: out a contraceptive pill. What a concept?
Speaker 2: What if we try informed consent? Is that about the
Speaker 2: conclusion he came to.
Speaker 1: Yeah, And it turned out that that was like a
Speaker 1: way to get people involved. People were like, oh, yeah,
Speaker 1: actually I am interested in this and not having to
Speaker 1: be sterilized after I give birth Jesus. But still the
Speaker 1: participants experienced unpleasant or severe side effects, which caused many
Speaker 1: to drop out. And even though Pinkus was convinced that
Speaker 1: the side effects were mostly in the women's heads, they
Speaker 1: were severe enough to be costing him a good sample size.
Speaker 1: So he started to play around with combinations. So first
Speaker 1: he added an antacid or changed the dose, but it
Speaker 1: didn't really make a difference. And then he and Chang
Speaker 1: made a discovery the progestin that the company, the pharmacocal
Speaker 1: company Cyril had provided was actually contaminated by a small
Speaker 1: amount of estrogen and it had just slipped under the cracks,
Speaker 1: So that must be causing the side effects, right, So
Speaker 1: then when he gave women the pure progest in, nausea
Speaker 1: and breakthrough bleeding became even worse. Okay, let's add a
Speaker 1: little bit of that estrogen back in. Too much and
Speaker 1: there'd be breast tenderness and nausea, too little on your
Speaker 1: back to breakthrough bleeding. Eventually he found a sweet spot.
Speaker 1: They were back on track to getting this pill to market. Cyril,
Speaker 1: the company that had produced the synthetic progestin, applied for
Speaker 1: FDA approval to market this birth control pill that they
Speaker 1: were calling Navid, but not for contraception, for infertility and
Speaker 1: menstrual irregularities. Interesting mm hmm, And in July nineteen fifty seven,
Speaker 1: the first packs of Navid or a Novid I'm not
Speaker 1: really sure, were prescribed to women for those purposes, but
Speaker 1: also for whatever the doctor wanted to give them for. Yeah,
Speaker 1: that's how flabile use. Yeah, that's how it works, and
Speaker 1: so that included contraception. In nineteen fifty eight, there were
Speaker 1: still seventeen states in the US that had laws banning
Speaker 1: the sale, distribution, or advertisement of any kind of contraception.
Speaker 1: In Massachusetts, where the pill was developed, it was a
Speaker 1: felony to sell or prescribe, or hand out or provide
Speaker 1: information about contraceptives. What uh huh oh, my gracious, but
Speaker 1: things were changing, and part of that change was not
Speaker 1: just the early signs of the sexual revolution, which I
Speaker 1: talked a little bit about in the Herpes episode. It
Speaker 1: was politicians realizing that their voters wanted access to birth control.
Speaker 1: It was also corporations like Cyril realizing how much profit
Speaker 1: they could make through the legal sale of contraceptives. It
Speaker 1: was an untapped market, and socially, what had in previous
Speaker 1: decades been a moral majority had decreased to a small
Speaker 1: but vocal minority, largely made up of the Catholic Church.
Speaker 1: When articles published in popular magazines such as Time or
Speaker 1: Life highlighted the drug, there wasn't the roaring backlash that
Speaker 1: they had expected to accompany this news. They merely presented
Speaker 1: this drug as almost a welcome innovation. Of course, these
Speaker 1: articles barely mention the side effects or long term safety,
Speaker 1: but following their publication, there was a rush for the pill.
Speaker 1: So by nineteen fifty nine, which is when anovid or
Speaker 1: novid is on the market only as a treatment for
Speaker 1: infertility or irregular periods, and estimated five hundred thousand women
Speaker 1: were taking the drug. Wow, so word it had gotten out.
Speaker 1: Though there may not have been a lot of outcry
Speaker 1: directly on the pill's release, there was still plenty of
Speaker 1: debate about contraception in politics. Some advocated for funds to
Speaker 1: be used in international aid programs to supply contraception, which
Speaker 1: of course smacks of eugenics, particularly because in one proposal,
Speaker 1: for instance, the reasoning was that otherwise we face quote
Speaker 1: communist political and economic domination. Oh my god, what gross. Meanwhile,
Speaker 1: the pill was up for approval at the FDA, not
Speaker 1: for its sale, which it already had, but to be
Speaker 1: able to advertise for it as a contraceptive pill as
Speaker 1: a birth control pill. This was a totally different process,
Speaker 1: and a very new one, because rather than the pill
Speaker 1: being used to treat a condition, it was being taken
Speaker 1: by healthy people, and so its safety standards were totally different.
Speaker 1: The FDA agent handling their application took his time with it,
Speaker 1: a Lla Francis Kelsey. He wanted to know whether there
Speaker 1: was an elevated risk of cancer or blood clots associated
Speaker 1: with long term use, and so he decided to send
Speaker 1: out a questionnaire to sixty one doctors that had experienced
Speaker 1: prescribing the drug. Ultimately, even though some doctors said, I
Speaker 1: don't think it's ready. I think they are to many
Speaker 1: side effects. The decision that most doctors came to was
Speaker 1: that the pill had far fewer side effects and was
Speaker 1: much safer than an unwanted pregnancy.
Speaker 2: Than any pregnancy, than any especially an unwanted pregnancy or
Speaker 2: an unplanned pregnancy.
Speaker 1: And also, the FDA was not there to decide whether
Speaker 1: a drug should be approved or rejected based on moral, religious,
Speaker 1: or political grounds. Their job was simply to decide whether
Speaker 1: it did what it was supposed to do and whether
Speaker 1: it was safe while it was doing it. And so
Speaker 1: for this, Enevid was approved as the first oral contraceptive
Speaker 1: on May ninth, nineteen sixty Wow. Its use grew steadily,
Speaker 1: and within a few years it was not known as
Speaker 1: enevid but just the pill, which, with that simple name
Speaker 1: highlighting just how incredibly important it had become like the pill,
Speaker 1: the pill. I mean, everyone knows.
Speaker 2: When you say the pill. Yeah.
Speaker 1: By nineteen sixty five, so five years after its release
Speaker 1: as a contraceptive, and estimated six point five million American
Speaker 1: women were using it, and lower dose pills became available
Speaker 1: and more affordable. The pill didn't start a movement, but
Speaker 1: it surely played a role. Women were able to have
Speaker 1: greater agency over their own bodies than they ever had before.
Speaker 1: They were free to pursue a greater variety of career opportunities,
Speaker 1: and they were also free to not do those things.
Speaker 1: The pill simply gave them the choice. In nineteen seventy,
Speaker 1: women made up ten percent of first year law students
Speaker 1: and four percent of first year business students. In nineteen eighty,
Speaker 1: those numbers jumped up to thirty six percent and twenty
Speaker 1: eight percent.
Speaker 2: Wow.
Speaker 1: In large part a lot of people reason is because.
Speaker 2: Of the pill.
Speaker 1: Yeah, and also overall like the second wave feminist movement.
Speaker 1: But okay, a quick note about the timing of our episodes.
Speaker 1: I just wanted to say, in nineteen fifty nine, to
Speaker 1: the same year that the birth control pill was up
Speaker 1: for approval to be advertised as a contraception, the litamide
Speaker 1: was also up for approval, and it made me think
Speaker 1: about whether the birth control pill would have been approved
Speaker 1: so quickly if it had happened a year after the litamide,
Speaker 1: for instance.
Speaker 2: Very interesting.
Speaker 4: Yeah.
Speaker 1: Also, a listener commented on one of our Instagram posts
Speaker 1: that she's doing a thesis in which she talks about
Speaker 1: how apparently in the Soviet Union this time. They tried
Speaker 1: to recreate the birth control pill there, but they didn't
Speaker 1: put enough resources into its development, and so there were
Speaker 1: some horrible side effects associated with it, and a lot
Speaker 1: of women confused that birth control pill with polidamide, and
Speaker 1: so they assumed that they were the same, and so
Speaker 1: the use of hormonal birth control pill like really dropped
Speaker 1: and emotion became the main form of birth control. Oh wow,
Speaker 1: So she's still writing the thesis, but she said she's
Speaker 1: going to send it to us when she's done.
Speaker 2: Oh my gosh, I'll be so interested to read that.
Speaker 3: I know.
Speaker 1: Okay. So, despite wrapping up here, despite the open arms
Speaker 1: with which many people welcomed the birth control pill, it
Speaker 1: did not stop being controversial. Long term health risks such
Speaker 1: as blood clots, heart attacks, strokes, and cancer were found
Speaker 1: to be associated with the high doses of estrogen in
Speaker 1: early versions of the pill, and people advocated for safer
Speaker 1: doses and pointed out that these side effects would never
Speaker 1: have been deemed acceptable in a version of male birth control.
Speaker 2: Oh, we can talk more about that if you want.
Speaker 1: Oh good. And then there was the enormously racist practices
Speaker 1: that emerged from the development of family planning clinics in
Speaker 1: predominantly black neighborhoods, for instance, incentivizing these long acting reversible
Speaker 1: contraceptive implants or shots or the iud's, so a lot
Speaker 1: of those were preferentially given to black women than they
Speaker 1: were to white women. Later analysis showed that there was
Speaker 1: disproportionate prescription of those forms of birth control pill between
Speaker 1: black people and white people, or people of color and
Speaker 1: white people. You know, like, that's and that's not even
Speaker 1: to mention the force sterilization of thousands upon thousands of
Speaker 1: black and Native American women. Yes, and then there's some
Speaker 1: more bad news, so like the Dalkon Shield IUD scandal,
Speaker 1: in which many women were hospitalized or died due to
Speaker 1: infections related to that IUD, and it was pulled from
Speaker 1: the market. That Dalkon Shield was pulled from the market
Speaker 1: much much like, way too long after it should have been,
Speaker 1: And this led to an enormous decline in other IUDs
Speaker 1: as well, out of fear of lawsuits and out of
Speaker 1: fear of the women who were like, well if I
Speaker 1: put this in here, am I gonna like is this
Speaker 1: going to hurt me? But throughout the nineteen seventies, there
Speaker 1: were some positive developments. In nineteen seventy two, the Supreme
Speaker 1: Court legalizes birth control for unmarried people Loretta lynbs I
Speaker 1: know Loretta Lyn's song. The pill is released in nineteen
Speaker 1: seventy five, and sterilization procedures become stricter, requiring informed consent
Speaker 1: and a waiting period.
Speaker 2: Oh, nineteen seventy five, except in twenty twenty if you're
Speaker 2: in Georgia.
Speaker 1: I mean, at least okay, nowadays it's it's illegal. Then
Speaker 1: it wouldn't have been, right, Yeah, which is so depressing.
Speaker 1: I mean, it's depressing. It's layers of depressing upon depressing,
Speaker 1: upon rage, and nihilism. Since the release of the first
Speaker 1: control pill, there has been overall incredible progress made, both
Speaker 1: in terms of technology like better IUDs and emergency contraceptives,
Speaker 1: as well as in social perspectives on the right to
Speaker 1: access contraceptives. The birth control movement became more about the
Speaker 1: individual rights of a woman to have agency over her body,
Speaker 1: rather than a tool for eugenics or population control. That's
Speaker 1: not to say that those perspectives are gone, nor should
Speaker 1: the origin story of the birth control movement be forgotten,
Speaker 1: but even more important to remember or pay attention to
Speaker 1: is the justifications that people use to restrict access to
Speaker 1: birth control. Only when birth control became a representation of
Speaker 1: women's liberation and a woman's right to decide for herself
Speaker 1: what to do with her life and was no longer
Speaker 1: a justification for racist population control programs, did the outcry
Speaker 1: against it begin to grow. Think there's a very unusual
Speaker 1: timing there. Birth control doesn't go against nature. We have
Speaker 1: been practicing it four thousands upon thousands of years. Hormonal
Speaker 1: birth control pills mimic what our bodies do during pregnancy.
Speaker 1: Why not a similar outcry against condoms? If there was
Speaker 1: a male birth control pill, would there be as much
Speaker 1: debate over whether it was natural or moral? I highly
Speaker 1: doubt it. Restriction of reproductive rights isn't about what's natural
Speaker 1: or healthy. It's about control. It's about putting people in
Speaker 1: boxes narrowly defined by those in charge. This pushback against
Speaker 1: reproductive rights has picked up a terrifying amount of momentum
Speaker 1: in these past few years. Aaron, why don't you bring
Speaker 1: us up to speed on birth control today?
Speaker 2: Okay, I think I'm gonna need a quick break first.
Speaker 2: Same so we can touch briefly on male contraception if
Speaker 2: you like, just to kind of get started.
Speaker 1: Yeah, I'm very curious about this.
Speaker 2: Yeah, there are currently two forms of contraception available that
Speaker 2: target males, and that is the condom and of eseectomy.
Speaker 2: That's it. Cool cool condoms I mentioned briefly earlier. They're
Speaker 2: about eighty seven percent effective with typical use. The biggest
Speaker 2: benefit of condoms is that they protect against other STIs
Speaker 2: as well, which the vast majority of other contraception options don't.
Speaker 2: So that's a real huge benefit of condoms.
Speaker 1: Right, important thing to remember.
Speaker 2: Also, yes, definitely vasectomy. It's very effective, but it's a
Speaker 2: little bit invasive and for the most part at this
Speaker 2: point at least, it's not reversible, at least not reliably.
Speaker 1: So okay, so there's not like the snip snap snip
Speaker 1: snap from the office.
Speaker 2: Yeah, not quite. There has been a lot of research
Speaker 2: to try and develop like gels, injectible gels that would
Speaker 2: then be able to be reversible, like you inject a
Speaker 2: gel that causes occlusion of the vast deference which is
Speaker 2: where the sperm would exit, and then be able to
Speaker 2: inject something else to like dissolve that essentially. But they
Speaker 2: are they're not like on the market at this point,
Speaker 2: are okaying. There aren't a lot of non hormonal male
Speaker 2: contraceptive options that have really been under that advanced level
Speaker 2: of clinical investigation, so not large scale studies of those
Speaker 2: yet they're mostly in animal models.
Speaker 1: Okay.
Speaker 2: Now, Hormonal mail contraception methods include being androgen, so testosterone
Speaker 2: administration with or without the addition of a progestin in
Speaker 2: various forms so like short acting injectibles, long acting injectibles,
Speaker 2: little subcutaneous implants kind of like an explanon, as well
Speaker 2: as pill forms have all been studied. They are in
Speaker 2: fact very effective.
Speaker 1: Soever, what's the hold up?
Speaker 2: Yeah, they have the risk of certain side effects. There
Speaker 2: was actually, I think one of the largest studies of this,
Speaker 2: and I will link to a review article that kind
Speaker 2: of updates all of the research on male contraception. That's
Speaker 2: from twenty nineteen, so it's a really comprehensive, up to
Speaker 2: date article. But in two thousand and eight to twenty twelve,
Speaker 2: there was a really long term phase two clinical trial
Speaker 2: of an injectible combination of testosterone and progestine, so a
Speaker 2: four year study that was to be very effective, and
Speaker 2: seventy four percent of male participants and eighty percent of
Speaker 2: their female partners said that they were satisfied or very
Speaker 2: satisfied with their birth control method, so this injectable, and
Speaker 2: eighty five and eighty eight percent, respectively said that they
Speaker 2: would use this method of contraception if it was available. Now,
Speaker 2: the side effect profile included weight gain, changes in libido
Speaker 2: either increased or decreased, an increase in acne, an increased
Speaker 2: risk of hypertension so high blood pressure, and increases in
Speaker 2: abnormal liver function tests, as well as a slight increase
Speaker 2: in moderate to severe depression. Now, one thing to point
Speaker 2: out is that those are essentially exactly the same side
Speaker 2: effects as female targeted combination oral contraceptive pills. Okay, Another
Speaker 2: thing to point out is that in this study only
Speaker 2: six percent of participants discontinued the study due to these
Speaker 2: side effects.
Speaker 1: Which is a far cry from at least in the
Speaker 1: early years of birth control studies like fifty percent or more. Yeah.
Speaker 2: Yeah, But especially because of the increase of moderate to
Speaker 2: severe depression, this study was ended a bit early and
Speaker 2: it was not approved. Now, one big difference that I
Speaker 2: do have to mention is that in females, because contraceptives
Speaker 2: are actively preventing pregnancy and pregnancy itself is an extremely
Speaker 2: risky state of being, not just during pregnancy, but childbirth
Speaker 2: and postpartum. There are so many increased risk that increases
Speaker 2: your risk of hypertension, preclanthia, stroke, Gosh, you can die
Speaker 2: by hemorrhage. There are so many ways that you can die,
Speaker 2: blood clots, everything, Right, So in preventing pregnancy, you have
Speaker 2: a bit more risk that you might be willing to
Speaker 2: take before you exceed the benefit, if that makes sense.
Speaker 2: So your risk benefit profile is different when you are
Speaker 2: targeting females preventing pregnancy versus preventing males from getting somebody
Speaker 2: pregnant because they are not directly affected by pregnancy.
Speaker 1: That's interesting. Yeah, I didn't really consider that, right.
Speaker 2: I think that that's really important to keep in mind.
Speaker 2: But in terms of what people want, males are very
Speaker 2: interested in contraceptive methods that they would be able to take,
Speaker 2: like overwhelmingly. Yeah, So I think that that's important too. Okay,
Speaker 2: So that's that globally, IUDs are by far the most
Speaker 2: common method of contraception, reversible female contraception in the globe.
Speaker 2: Over one hundred and sixty eight million people worldwide, use
Speaker 2: an IUD as their form of contraception. In the US,
Speaker 2: that's not the case. Combination oral contraception is the most
Speaker 2: common by far, and for a really long time, like
Speaker 2: you mentioned, especially after those lawsuits in the eighties, iud's
Speaker 2: got a really bad rap in the United States. But
Speaker 2: in the last few years, the rates of long acting
Speaker 2: reversible contraception use has been steadily increasing. So in two
Speaker 2: thousand and eight, the overall LARK use was about six percent,
Speaker 2: and in twenty fourteen that had increased to fourteen percent,
Speaker 2: which is really incredible because again these are much more
Speaker 2: effective forms of contraception. Okay, and over roughly that same
Speaker 2: time period, So from two thousand and eight to twenty eleven,
Speaker 2: when we saw this increase in long acting reversible contraception use,
Speaker 2: that is the first time in recent decades that the
Speaker 2: unintended pregnancy rate actually declined. Really, in twenty eleven, it
Speaker 2: had declined to forty five percent from fifty one percent
Speaker 2: in two thousand and eight. Huh, and twenty eleven is
Speaker 2: the most recent data I could find on this. So
Speaker 2: that also means that forty five percent of pregnancies in
Speaker 2: this country are unintended, which either means unwanted or wanted later,
Speaker 2: like not wanted right now.
Speaker 1: That is a higher number than I thought.
Speaker 2: Uh huh, and forty percent of unintended pregnancies and in
Speaker 2: abortion in this country. So in twenty fourteen, the availability
Speaker 2: of family planning services, including contraceptive coverage, helped to avoid
Speaker 2: over two million unintended pregnancies that would have occurred without
Speaker 2: access to contraceptive coverage. Additionally, public funding for contraception in
Speaker 2: twenty ten results in ten point five billion dollars of
Speaker 2: cost savings. That's nearly six dollars of savings per dollar
Speaker 2: spent on contraceptive coverage. And if you take into account
Speaker 2: additional family planning services like STI screenings, HIV screenings, cervical
Speaker 2: cancer screenings, it's like thirteen billion dollars of saving by
Speaker 2: investing in family planning services.
Speaker 1: Wow.
Speaker 2: Yeah. Contraceptive use is linked to increases in educational attainment
Speaker 2: and wage earning, and coverage of this contraception like buy
Speaker 2: insurance companies, saves women over a billion dollars a year
Speaker 2: in out of pocket spending.
Speaker 1: That's a lot of money.
Speaker 2: Yeah. Yeah. And so even though we've seen some improvements
Speaker 2: in terms of the uptake of long acting reversible contraceptive use,
Speaker 2: and in two thousand and eleven a reduction in the
Speaker 2: rate of unplanned pregnancies. Reproductive rights in this country are
Speaker 2: not just on the ballot, they're being actively stripped away.
Speaker 1: Oh yeah.
Speaker 2: So in twenty ten is when Obama signed the Affordable
Speaker 2: Care Act, which required coverage of preventable health services and
Speaker 2: screenings like SDI screenings and cervical cancer screening. And then
Speaker 2: the next year it also required that employers and insurers
Speaker 2: provided women with coverage at no cost for all FDA
Speaker 2: approved contraception, all of those ones that we talked about.
Speaker 2: So the first time that this law was challenged, it
Speaker 2: went up to the Supreme Court in twenty fourteen. You
Speaker 2: probably remember everyone the Hobby Lobby case. Oh God, okay.
Speaker 2: In that case, the Supreme Court ruled in favor of
Speaker 2: Hobby Lobby in a five to four decision, saying that
Speaker 2: in a family owned company with particular religious beliefs, they
Speaker 2: could deny coverage of their employees' contraception. Then in twenty eighteen,
Speaker 2: Trump issued an even broader ruling saying that almost any organization,
Speaker 2: including nonprofits, private companies, non governmental institutions, anyone who claims
Speaker 2: a religious or moral objection to birth control is not
Speaker 2: required to provide it to their employees. And here's what
Speaker 2: I think is really important two things. First of all,
Speaker 2: under the original ACA, the original Affordable Care Act, religious
Speaker 2: entities like churches or mosques were already exempt from having
Speaker 2: to provide contraceptive coverage. So religiously affiliated nonprofit institutions like universities, hospitals,
Speaker 2: and charities were not exacts empt. But under the original ACA,
Speaker 2: they could issue a formal request for exemption to the
Speaker 2: government or their insurance provider, so that it would be
Speaker 2: the insurance company itself that would have to front the
Speaker 2: cost and cover the contraceptives for employees. Okay, so like
Speaker 2: a religious university or hospital wouldn't have to pay for
Speaker 2: its employees to have birth control, but those employees could
Speaker 2: still be covered directly from the insurance provider. But somehow
Speaker 2: that was considered unacceptable, and so this new Trump ruling
Speaker 2: insisted that these organizations had the right, based on religious
Speaker 2: or moral grounds, to completely deny access to contraceptive coverage
Speaker 2: for their employees. And in July of this year, the
Speaker 2: Supreme Court ruled essentially in favor and punted it back
Speaker 2: to lower courts. Of this extremely broad base restriction. There
Speaker 2: were only two voices in dissent, and guess what they were,
Speaker 2: both women, shocking the late Justice, the late Justice Ruth
Speaker 2: Bader Ginsburg and Justice Sonya Sodamayor. And what's very frustrating
Speaker 2: is not, I think just that this happened, but also
Speaker 2: that these companies were allowed to cite blatantly untrue statements
Speaker 2: as their reasoning for objecting to birth control, not only
Speaker 2: claiming that birth control itself is against their particular religious beliefs,
Speaker 2: but claiming that the forms of birth control they were
Speaker 2: objecting to are capable of destroying embryos and causing abortions,
Speaker 2: which is simply not true.
Speaker 1: How was that allowed?
Speaker 2: I truly don't know. Erin Again, there has been extensive
Speaker 2: research on this and nothing to support the idea that
Speaker 2: emergency contraceptives, oral contraceptive pills, hormonal IUDs or implants ever
Speaker 2: act as an abortive fashion. And the only circumstances under
Speaker 2: which copper IUDs may is if they are used in
Speaker 2: the context of emergency contraception, and even then they act
Speaker 2: to prevent implantation, which is the scientific and legal definition
Speaker 2: of the start of pregnancy. So yeah, not only are
Speaker 2: contraceptives not acting as abortive fashions, but access to contraceptive
Speaker 2: coverage reduces the rates of abortions.
Speaker 1: All of these rulings, all of the quote unquote logic
Speaker 1: just reveals one thing that it's only ever been about
Speaker 1: control over people's bodies.
Speaker 2: Yeah, period, because the thing is that allowing people to
Speaker 2: choose when and if to have children, and this doesn't
Speaker 2: get enough coverage, but how far apart to space their pregnancies,
Speaker 2: which is really important, and what form of contraception they
Speaker 2: want to use. Allowing people to have these options, it
Speaker 2: has benefits for moms, it has benefits for babies, It
Speaker 2: has benefits for families. It has helped to further women's equality,
Speaker 2: educational attainment, wage earning, It results in better pregnancy and
Speaker 2: neonatal outcomes, and again it reduces abortion rates. So there
Speaker 2: truly is no reason to hinder or block access to
Speaker 2: safe and effective, comprehensive Comprehensive that means all the options
Speaker 2: that are available contraceptive coverage. So one of the things
Speaker 2: that we hoped to do in this episode was to
Speaker 2: provide you all with information about how these birth control
Speaker 2: options work because I think that that it's hard to
Speaker 2: know that information sometimes you know so because I know
Speaker 2: you care about the people in your life that can
Speaker 2: benefit from access to contraceptives and comprehensive reproductive healthcare. I
Speaker 2: think the most important thing that we all need to
Speaker 2: do is please vote.
Speaker 1: Vote.
Speaker 2: This is a long episode to ask you to vote.
Speaker 1: It's the most important thing right now is to vote.
Speaker 2: Anyways, that's all I got erin.
Speaker 1: I mean, we got a lot erin.
Speaker 2: We sure do? Oh you do sources?
Speaker 1: Man, Yes, I do have a couple of sources. So
Speaker 1: I've read a couple of books. One is The Moral
Speaker 1: Property of Women, A History of birth control Politics in
Speaker 1: America by Linda Gordon, and that has gone through several
Speaker 1: revisions and iterations. And I read the one from two
Speaker 1: thousand and two, and then by Jonathan Iig. I think
Speaker 1: it's ig The Birth of the Pill, How four pioneers
Speaker 1: reinvented sex and launched a revolution. That's from twenty sixteen.
Speaker 1: And then finally, Our Bodies Ourselves dot org website has
Speaker 1: a brief history, a brief timeline of birth control, and
Speaker 1: so I extracted especially some of the later points from there.
Speaker 2: Awesome I have a number of articles about the mechanism
Speaker 2: of action of contraception, as well as that review article
Speaker 2: on developments in mail contraception which was from twenty nineteen,
Speaker 2: and also on the Gutmacher Institute website. That is an
Speaker 2: organization that does a lot of research on reproductive rights
Speaker 2: and they have some great stats, so I have a
Speaker 2: link to a couple of their articles as well. You
Speaker 2: can find all of our sources from this episode and
Speaker 2: every single one of our episodes from all three seasons,
Speaker 2: that's sixty episodes on our website this podcast will kill
Speaker 2: You dot com.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our sixty episodes.
Speaker 2: And thank you to you listeners. This has been a
Speaker 2: fun three seasons. We will be coming back with season
Speaker 2: four in a few weeks. We don't have a particular date,
Speaker 2: so make sure that you're subscribed so that you don't
Speaker 2: miss it when we dress a new season.
Speaker 1: Absolutely well until next season, wash.
Speaker 4: Your hands, you fill the animals and vote and vote
Speaker 2: U