Birth Control’s Invisible Mommy Majority
I went to the doctor—a new doctor, actually, since we’d changed insurance and had to switch physicians. As checkups go, it was a bit uncomfortable. Unlike my old practice, where they take action only if, say, you drop a body part in the waiting room, this new gal was on her game.
First, she busted me on my three-glass-a-night Chardonnay habit. Then she followed up with a series of passive-aggressive questions about my general health. (Sample: “As your physician, I’m happy with your body mass index. How do you feel about your weight?”) Then we got to the female stuff. She flipped through the pages of the file sent over by my old doctor. Two births, two miscarriages, a few stubborn ovarian cysts, and a fifteen-year merry-go-round of vaginal infections. A thrilling read, I’m sure.
I still had just the one sexual partner? Her pen paused over the file. Uh, yeah, that would be my lawfully wedded husband of about two million years. And were we still sexually active? Yes, I said, resisting the urge to add, define “active.” And we were still using—she double-checked the file—the diaphragm? She smiled up at me so brightly I felt sure she was about to burst out laughing.
Yes. Okay. I’m forty-four years old and I still use a diaphragm. Feel free to lean over with that Sharpie and draw a big L for Loser right on my forehead.
What do you think of when you imagine diaphragm sex? Hot, spontaneous quickies in the middle of the day on top of the new HE washer? Parking the kids at Grammy’s and booking a dirty weekend away, the kind where you don’t even care what city you’re in because you’re not planning on ever leaving the hotel room?
It’s entirely possible to do those things using the diaphragm as your method of birth control. Possible, but not probable. No, the venerable diaphragm, that cheery latex dome with its alarmingly over-springy coil, its demure petal-pink clamshell housing, its absurd beige “flesh” color (I defy even the most militant feminists among us to tell me the color of the inside of their vaginas. It’s dark in there, people!) … no, the diaphragm conjures up visions of exhausted missionary-style coupling in the dark on a random Wednesday night with one ear cocked anxiously for the patter of little feet. That’s diaphragm sex. Or that’s its reputation, anyway.
* * *
Lying awake after just such a marital encounter (one of us had allergies acting up, the other was freaking about work and couldn’t relax), I started wondering about mothers and birth control. Was it my fault I was still using the same method I picked out when I walked into the Planned Parenthood clinic in Ithaca, New York, at the dawn of the ’80s? Or has there been a kind of eerie silence about the whole topic, a distinct lack of progress, a pall over the land even?
We’re a capitalist/consumerist society, I don’t deny it. So why isn’t Big Pharma kissing my butt? I’m a marketer’s dream: like many other mothers, I’m an educated purchaser with a steady income, the primary decision-maker for my household of four plus one domestic animal. I have sex regularly, I need reliable birth control that doesn’t trash my health—come at me, baby, show me the goods!
Companies are constantly trying to hawk mothers new personal care stuff they’ve invented or invested in: ten different kinds of diapers, a dozen varieties of toothpaste, countless new ways to tame the menstrual flow, stop various body odors, soften scales, whiten, brighten, and exfoliate. Pharmaceuticals have developed new medicines to treat depression, head off migraines, settle the stomach, soothe us to sleep and keep us there for the night, and, yes, help our men-folk get it up and keep it there.
Yet in twenty-odd years just once has somebody managed to pitch me better birth control—the beloved Sponge—only to rudely yank it off the market while I was distracted birthing my first baby. (It’s back, by the way, as of last fall, but too late to stem my crankiness.)
Is it the products—is there simply nothing new to offer, no better way to stop egg from meeting sperm? Is it me—am I somehow missing the marketing message? (Entirely possible: I’m a cynical consumer, a miserable shopper and a mule about what I do choose to buy.)
Or is it mothers—are we considered some kind of invisible, or perhaps untouchable, market? As women with children, mothers bring a unique perspective to bear on the topic of family planning. On the one hand, having seen that life comes out of us, we might feel less insistent than before that we be able to artificially start and stop the fertility process at will. On the other, knowing better than anyone how hard it is to birth, nurse, nurture, and raise a human being, we’re arguably the most motivated users of birth control.
Could it be that our saintly halo of motherhood obscures the fact that we’d like to be able do the nasty without repeating the baby part every time? This last bit would be particularly ironic, considering birth control was made legal—in this country anyway—thanks to tireless efforts of Margaret Sanger, who championed its use specifically as a way to help the mental, physical and emotional well-being of “sick, harassed, broken mothers.”
But once birth control broke out of its marriage bonds during the swinging ’60s and women’s-libbed ’70s, maybe mothers’ concerns got left on the dusty pharmaceutical shelf. Is birth control, like, say, fashion, now considered the province solely of the young, nubile, and childless? Drifting off at last to sleep, I thought it might be worthwhile to dig through the detritus of our consumer-centric culture to figure out what part, if any, moms play these days in family planning.
* * *
When asked about how women find out about and choose new methods of birth control, doctors, nurse practitioners, reproductive rights advocates and even pharmaceutical marketers tend piously to intone, “That’s a decision best made between a woman and her doctor.” Oh yes. The very phrase conjures up comforting visions of serious, quiet consultation between a mom and her health-care pro on just what the perfect contraception is for that precise moment in her reproductive life.
I have two problems with this scenario. First, women’s health care providers can be and often are influenced by the bombardment of literature, free samples, and logo-encrusted office tchotchkes (Post-It notes, light-up ballpoint pens and so on) promoting whichever birth control method the pharmaceuticals are currently?pushing, all of which?reduces significantly your?chances of having a frank discussion about older, lower-profile?(or maybe that should be “lower profit margin”) methods.
Second, I’m sure somewhere in this land there are new mothers who don’t arrive for that first four-or six-week post-partum office visit exhausted, lactating, overwhelmed, fighting depression, jiggling a possibly colicky infant in one arm while trying to keep a jealousy-enraged sibling from committing infanticide in the office. Those women, I’m sure, get the fully informed story on their myriad birth control options.
For the rest of us—and I speak here as someone who wept through her entire post-partum checkup, pre-occupied as I was with slow-to-heal stitches of a number so staggering it can’t be shared in polite society—that office visit might not be the most opportune moment to make decisions that are literally life-altering.
If you’re one of those moms who missed out on the full rundown, here, cribbed directly from vast, deep and authoritative resources of the Planned Parenthood web site, are your choices for birth control as of summer 2006: the Pill, the Ring (NuvaRing), the Patch (OrthoEvra), implants (Implanon), the Shot (Depo-Provera), POPs (Progestin-only birth control pills, sometimes called the mini-Pill), the hormone-releasing IUD (Mirena), the non-hormonal IUD (ParaGard), the diaphragm, the Cap (FemCap), the Shield (Lea’s Shield), the male
condom, the female condom, the Sponge, spermicides, fertility-awareness methods, male sterilization, female sterilization, emergency contraception (Plan B), continuous abstinence, continuous breast-feeding (Lactational Amenorrhea Method), outercourse, withdrawal.
That’s a lotta choices, there’s no argument there. What’s notable for mothers?
Well, first of all, hormones are still all the rage. Joining the venerable oral contraceptive (the Pill), which is by far and away the leading method of reversible birth control in the United States, are the Patch, which you change once a week, the Ring, which you change once a month, the Implant, which lasts for up to three years, and Mirena, a hormone-releasing IUD that can be kept in place for as long as five years—all new ways of delivering hormones into your system.
Are hormonal forms of birth control safe for mothers? Study after study after study says yes (as the editors of the activist women’s health tome Our Bodies, Ourselves point out, the birth control pill is the most intensely researched medication in history). But there is a “but.” New mothers who return to the Pill, or another combined-hormone method using estrogen, soon after giving birth will interrupt lactation, points out Leon Speroff, M.D. at Oregon Health & Sciences University in Portland, Oregon.
And estrogen, present in the Pill, the Patch, the Ring, the Implant, and the Depo-Provera shot crosses into a baby’s body via breast milk. Health activists like Judy Norsigian, co-author of Our Bodies, Ourselves, caution that we don’t yet know enough about what kind of changes it may or may not cause to the baby.
For those reasons—cessation in breast milk and an uncertainty over the long-term effects of estrogen on infants—breastfeeding mothers are generally counseled to choose estrogen-free birth control methods, says Susan Wysocki, president and CEO of the National Association of Nurse Practitioners in Women’s Health, based in Washington, D.C.
The second bit of news: The IUD is back from the dead. Increasingly, what those new moms are being advised to try, says Wysocki, is intrauterine contraception—either Mirena, which contains progestin or the hormone-free copper ParaGard.
For anyone—like me—who came of birth-control consciousness in the 1970s or 1980s, the idea of any IUD being sold in the United States is anathema. Because IUDs ran the risk of perforating the uterus or causing severe pelvic infection, they used to be offered to women who had already had one child, on the (offensive) premise that, should her fertility be permanently impaired, at least the injured mom had managed to pop one kid out.
Worse, it turned out that one brand of IUD, the Dalkon Shield, was liable to wick bacteria up into the uterus, causing thousands of women to suffer severe pelvic infections. Twenty women died, the manufacturer declared bankruptcy, and all IUDs were pulled out of the American market.
Flash forward thirty years and it’s a whole different ballgame. New, improved, and, according to both manufacturers and a wide range of health professionals, safe IUDs are back on the market and once again being aggressively marketed to moms. Consider this warm-and-fuzzy language from the makers of Mirena:
You have enough to do with a family and full life. You don’t have time to think about birth control … You don’t want to waste any of the little precious time you have for intimacy. Especially if it’s spent fumbling with condoms or dealing with diaphragms to pre- vent pregnancy. Mirena long term birth control lets you be spontaneous. For up to five years, you can enjoy birth control freedom and intimate moments whenever the mood strikes (and the kids are in bed).
Notwithstanding that nasty side-swipe at the diaphragm, the reasons for marketing IUDs to moms are backed this time around by some sounder medical reasoning. IUDs should be used by women who are at low risk for sexually transmitted infections—that is, women who have just one sexual partner, like, you know, most moms. IUDs are usually easier to insert in women who have had babies already; they’re best for women who want long-term but still reversible contraception; and, owing to the upfront costs associated with insertion, which must be done in a health professional’s office, they make most sense economically for women who’ll keep them in two-and-a-half years or more, according to Wysocki. Who fits those categories best? Mothers.
But the biggest news since I last hit a Planned Parenthood outlet: Emergency contraception is now available. When I was in my early twenties and just starting to play the please-God-don’t-let-me-be-pregnant game, there was only before and after when it came to birth control. If you messed up on the before part—either by not using any contraception or having your method fail on you—you had a baby, had an abortion, or dodged the bullet (that time, at least).
Now women have a third, in-between option: emergency contraception. If you’ve been too busy these past few years looking for binkies under the crib to follow the headlines, you could easily have missed the news that the emergency contraception pill Plan B, the progestin-only pill taken within a hundred twenty hours (five days) of unprotected intercourse, is now legally available in all fifty states. (You can also use certain combinations of regular birth control pills as emergency contraception or have an IUD inserted within five days of unprotected sex.)
In the press and in its own marketing materials, Plan B seems aimed squarely at the twenty-something market, at young Sex-in-the-City-types who had one too many Mojitos and woke up with a problem on their hands.
But I wonder why it isn’t promoted more to mothers. A woman with an infant, a toddler, and a kindergartner on her hands is just as likely to mess up her Pill prescription as a single working girl who has at least nights and weekends to take care of her bodily needs.
And consider these two facts: According to the National Center for Health Statistics’ National Survey of Family Growth (NSFG), in 2002, twenty-one percent of women fifteen to forty-four years of age reported their most recent birth was “mis-timed”—meaning, the baby was wanted, just not then. Twelve percent of that total were deemed by the women to be “seriously mistimed”—that is, occurring two or more years too soon. The study doesn’t specify, but at least some of those mistimed babies are likely be moms with birth control mess-ups on their hands.
And this, which we do know about mothers specifically: Sixty percent of women having abortions are already mothers, according to Lawrence Finer, director of domestic research at the Guttmacher Institute, a non-profit reproductive-health research organization. Sixty percent! That figure alone certainly puts to rest the idea that emergency contraception is needed only by young and/or childfree women.
Even though its advocates argue than Plan B can go a long way toward preventing some abortions, the EC pill has had a long hard battle toward legitimacy. In some states, pharmacists who object to Plan B on moral grounds are being encouraged not to fill prescriptions. And politics inside the FDA have long delayed hearings that would pave the way for Plan B to be available over the counter (at press time, it looked like the hearings were finally going to go forward). Politics aside, for mothers, Plan B is news we can use.
* * *
Talk of politics and Plan B brings up an ugly realization many of us mothers might not have had the time in the past couple of years to properly contemplate: Whatever method we’re using, we had better really trust it, because our backup options are under serious attack.
Like a lot of other women, I try to stay up on the issues, but it’s hard to know where to channel your outrage and still have energy left over for the parts of your life you can control, like love and joy and the cleaning up of the kitchen at the end of the day.
So sure, I knew about South Dakota, which this spring passed a ban on nearly all abortions—including rape, including incest—in an effort to push the issue up to the Supreme Court. And I knew in a vague sort of way that pharmacists were being encouraged to refuse to fill Plan B prescriptions.
But I admit it, I was shocked when I started reading past the headlines and got caught up in a hurry on what’s been going on with women’s reproductive rights in this country. The New York Times Magazine‘s “Contra-Contraception” (May 7, 2006) by Russell Shorto details the truly shocking efforts by some religious and political groups on the far right to oppose contraception—any contraception, even within a marriage. Jack Hitt’s “Pro-Life Nation,” also in the Times Magazine (April 9, 2006), details life in El Salvador, where every single type of abortion is illegal, no exceptions, and women are thrown in jail for having back-alley abortions.
The Atlantic‘s June 2006 cover story by Jeffrey Rosen maps out what will happen in the U.S. if (and some on both sides of the issue now say “when”) Roe v. Wade is overturned. (Picture fifty states, each battling over its own definition of when life begins and what a woman’s say in that process should be.) Cynthia Gorney’s June 26, 2006 piece in The New Yorker digs into the hearts and minds of South Dakotans after the abortion ban was passed there and finds deep ambivalence.
Dana L’s wrenching personal essay in the June 4, 2006 Washington Post, “What Happens When There Is No Plan B?” chronicles how her inability to get hold of emergency contraception in time forced her into having an abortion. The excellent, ongoing coverage of the various chips and blows to birth control in Salon’s Broadsheet column online.
To be sure, not all mothers, not even all feminist mothers, support abortion. But a staggering majority of people support the right to use contraception: Ninety eight percent of all women who have had intercourse use some form of birth control at some point in their lives (according to the NSFG).
Clearly, a lot has happened while we’ve been off birthing our babies. But what will it take to turn the average already overwhelmed mom into a contraceptive activist?
Our Bodies Ourselves‘ Judy Norsigian is fairly blunt, and fairly pessimistic, in gauging the political involvement of regular Americans. “The problem here is an assumption that this is a right that won’t be taken away. Right now people don’t believe it could happen,” she says. “We’re going to see limited activist activity until access to abortion is pretty much taken away,” she predicts.
Nancy Keenan, president of NARAL Pro-Choice America, knows of at least one group of mothers who are taking notice. “We’ve been talking with women who were very active in the reproductive-choice movement, perhaps in college, before they had a family,” she reports. “Now they’re married, working, raising children who are in middle school or high school or grown and out of the house, and they’re saying, what happened to all that I worked for when I was so active so many years ago?”
Keenan says mothers have two good reasons to keep their head in the reproductive game. First, mothers need to be aware that the political emphasis on abstinence-only sex education and limited access to birth control for young people creates a miasma of misinformation that can put their teenagers at risk for STDs, AIDS, and unwanted pregnancy.
Second, she says, is simply this: “We need to stand up for the values of privacy and personal freedom, and there’s a responsibility that comes with those. We have an obligation to stand up for that freedom.”
For those who can’t, don’t want to or aren’t ready to trade Prego-strolling for placard-carrying, Keenan offers an easier path to activism—voting. Not just in presidential elections but in the upcoming mid-term elections, and in other state and local elections, where many reproductive battles are currently being waged and most certainly will, in a post-Roe world, be fought.
“Even women in predominantly pro-choice states like New York and California cannot assume they’ll forever be protected,” Keenan says. “You cannot assume that someone else will be protecting your reproductive choices.”
* * *
As the only female child of a Catholic father so opposed to birth control he wouldn’t let us fix the cat, I had to go elsewhere to find info on contraception when the time came. Where I went was Our Bodies, Ourselves, not the new colorized version, but the old newsprinty one with the young, cool-looking feminists with the long straight hair and the no bras, carrying signs telling the government to keep their laws of our bodies.
All these years later, I realize how much that book influenced both my personal decisions and my politics. The young me chose the diaphragm for some good reasons: thanks in part to Our Bodies, Ourselves‘ deep reservations about the Pill, back when estrogen doses were sky high and side effects were multiple, I wanted contraception that was as chem-free and low-impact as possible. (Special shout out here to all the moms who use natural family planning, a truly chem-free alternative that requires more math than this English major can handle).
The older me still wants those same things, which is why, in the end, I’ve stuck with my dorky diaphragm all these years. On a personal level, obviously it’s time for the devoted father of my children to step up to the plate and get the big V.
On a political level, things aren’t so clear cut. I started out wondering why mothers don’t have better birth control and wound up thankful we have any at all. I guess it’s time to re-engage, however reluctantly, in the same-old fight from three decades—keep yer laws off my bod. If you need me, you’ll find me on top of my HE washer, exercising my constitutional rights.
Author’s Note: Lying on the couch late one night, watching Sex in the City reruns on Lifetime, I nearly spit out my Chardonnay when Carrie announced to the other girls that her diaphragm was stuck. Wait, Carrie Bradshaw uses a diaphragm? Never mind that particular detail makes no sense, plot-wise, in the show. I say, welcome to the sisterhood.
Brain, Child (Fall 2006)