Reproductive Writes: The Rebranding Of Birth Control

Billboards proclaiming Black Children Are An Endangered Species have appeared across the city of Atlanta in the last couple of weeks. The poster was created by activist groups Georgia Right To Life and the Radiance Foundation. They claim that black women have three times the number of abortions in comparison to white women in the state and that this is indicative of a eugenics-based conspiracy to deplete the African American population. A conspiracy, they argue, that goes right back to the agitator for birth control, Margaret Sanger, who, they say, would have been happy to hear that 40% of African American women's pregnancies are aborted.

The New York Times reported that in 2006 57.4% of abortions were performed on black women, although African Americans make up 30% of the population of Georgia. However, the fertility rate amongst black women, that is the number of births per 1,000 women, remains higher than the national average.

There has been some very astute commentary on this topic, but here I want to focus on some points I have not yet seen covered.

I have written in my blog about a statistic that states 1 in 5 black teenagers use the contraceptive injection, Depo Provera - many more so than white teenagers. This works out as 9% of white teenagers to 18% of black teenagers. This is not necessarily because of their race, but such long-acting hormonal contraceptive methods are administered to higher numbers of low-income women who receive state-funded health care. State governments often provide subsidies to make the injection cheaper and more available to their poorer communities. In comparison to the Pill, the injection is less expensive to provide - it's given every three months - and is seen to have a higher rate of effectiveness.

Depo Provera is currently being promoted to women, alongside the other long-acting methods - the implant, the hormonal IUD Mirena - as the latest, greatest form of contraception. Yet Depo Provera has in fact been around for a long time. It's been used for the chemical castration of pedophiles and sex-offenders for decades. This is because it aggressively wipes out levels of the hormone testosterone, dramatically decreasing libido. Testosterone levels do not only tie to libido, but also energy levels, mood and general well being.

The injection is also popular as a method administered to women in developing countries. There have been reports on the coercive techniques used to increase use of this drug - women given the 'option' of sterilization or the injection, or threatened with unemployment or imprisonment - but many more are not given information on how Depo Provera works or its potential side effects. It has a significant impact on bone density, for example. The injection also, of course, does not protect women against HIV or other STDs. Barrier methods controlled by women such as the diaphragm or the sponge would seem more logical, and to some they do: There is a new one-size-fits-all diaphragm awaiting FDA approval, as well as a new spermicide that could prevent the transmission of HIV.

Barbara Seaman, author of The Doctor's Case Against The Pill, argued in 1969 that the Pill was given 'diplomatic immunity' due on its use for population control. She believed the health of individual women was being sacrificed for this 'greater good.' I see the population control argument for hormonal contraceptives - then the Pill, now the long-acting methods - as based in fallacy. The issue of world poverty does not spring solely from the sheer number of people being born, but also has its foundations in the unequal distribution of resources. Impoverished women, those in developing countries, are more likely to die in childbirth, and certainly find it harder to survive the more children they have, but the injection is a crude fix for poverty that lets us sit back and make no substantial change to how our world is organized.

The promotion of long-acting methods of contraception to young women in the US and Europe has been coupled with negative press surrounding the Pill's effectiveness. The injection is seen as the solution to the unplanned pregnancy problem. 88% of women supposedly forget to take one to three birth control pills within one month. Articles that intelligently discuss the impact of the Pill on women's bodies frequently misguidedly advocate long-acting hormonal methods as an alternative, effectively missing the point entirely.

Increasingly young women are portrayed as living a 'lifestyle' (such a judgement-laden word) that would be better suited to the injection, implant or hormonal IUD, than the Pill - which they need to remember (read: be trusted) to take every day. We are all supposed to be jumping up and down with glee at this whole new exciting range of contraceptive choices, when long-acting methods actually work to put the control mainly in the hands of medical authorities. It is suggested that women don't want to have to think about contraception, when in truth they should be trusted, allowed, and equipped to think a lot more critically.

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Comments

9 comments have been made. Post a comment.

I'm not sure what you're

I'm not sure what you're trying to say here. Depo Provera is unsuitable for who - young women? Low-income women in America? Women in developing countries? Everyone? I'm also not really sure how it relates to the Georgia Right to Life thing. I guess I'm just a bit confused by how the article is written--perhaps you could clarify your main point for me.

All that aside, I fully support birth control being in the control of women; women should have access to all the available information about what they are putting into their bodies, and should have the option to choose whatever method is best for them--but I don't buy that long acting methods "put the control mainly in the hands of medical authorities" more than the Pill does. They both give equal control to "medical authorities," since those are the people who determine what goes into them, how they can be distributed, etc. Where individual control begins and ends is in the woman's decision to take the contraceptive or not. The push for emphasis on long-acting methods is based on evidence that shows that people do tend to forget to take pills occasionally, and the Pill is no exception. 88% is nothing to sneeze at. Long-acting methods are pushed simply because there is a lot less room for human error. You might notice how effectiveness ratings for the Pill are a lot lower when compared with those for the IUD, shot, patch, etc. It's not because the hormones in the Pill are less effective--it's because it's easier for patients to screw up when the hormones aren't being automatically pumped into their body. This is an issue of practicality, not trust. People--not just women, all people--are notoriously bad at remembering to take pills. Doctors know this. Public health workers know this. When you're dealing with a large-scale health issue (e.g. overpopulation in developing countries), you can't give people the benefit of the doubt. It's just too risky.

Besides, how much "control" over this do we really have, anyway? How does taking the Pill every day, instead of getting an IUD, give me more control? I still have only a vague idea of what, exactly, is being put into my body, and a much vaguer idea of how these chemicals will affect my body in 50 years. All I know is that if I take it as prescribed, I (hopefully) won't get pregnant. The average person (who isn't a doctor of a pharmacologist) has no idea how medicine works. They just know what affect it has on them. So what control am I getting? What more choice does this give me, besides the choice to screw things up? I'm not arguing that the Pill is bad. It works for some women, and not for others. Everyone has different needs.

If you want women to have control over their contraception--which they certainly should--give them all the necessary information. Tell them what they're putting into their body, how it works, what the risks are, what the benefits are. And let them choose the contraception they ultimately use. I advocate this completely. What I don't advocate is the creation of some kind of conspiracy theory that holds that doctors have no trust in women's decision-making abilities.

Also, a nitpick--diaphragms don't protect against STIs, either. The ONLY form of contraception that prevents against STIs is the latex or polyurethane condom. And that HIV-killing spermicide you mention sounds dubious to me, but you never know, I guess.

Response

The Georgia billboard campaign was supported by quotations from the advocate for the development of the birth control pill Margaret Sanger, who at the time of her movement did use population control as one of her arguments for its development and distribution. Although I don't believe there is a conspiracy as such against the African American race, as the billboard campaign suggested, I found interest in the way it highlighted the implementation of population control.

To be direct I think the injection Depo Provera is 'unsuitable' for everyone, yes. A drug that was developed for chemical castration is a cruel joke of a contraceptive method. That it is pushed in the US and Europe mainly to teenager girls is particularly concerning as its effect on bone mass is more pertinent at that age. I do not advocate the use of any hormonal birth control methods, as I see that shutting down the ovulation cycle for years at a time has a detrimental effect on women's health and well being.

I entirely agree that the Pill allows medical authorities to take control of women's bodies just as long-acting hormonal methods do. With two important differences - women taking the Pill can stop any day they decide it is making them unwell. A woman on Depo Provera has three months to wait any side effects out. A woman with an implant of hormonal IUD needs a doctor to remove this for them.

I don't agree that the issue of pushing the long-acting methods over the Pill or other non-hormonal methods is merely a practical one. I think it is an issue of trust - that is, trusting women with knowledge of how their bodies work, and their own fertility. If women forget the Pill it is also because we are encouraged to pop this drug like candy with complacency by an environment that normalizes the act to the point of making us not think about what it is we are doing at all. Pharmaceutical companies want the Pill to appear harmless, doctors prescribe it as though it were of no consequence, and women follow suit in this attitude. Studies have actually shown that young women use barrier methods and spermicide far more effectively than the Pill.

I suggest here that overpopulation is not the main reason behind poverty - but the unequal distribution of resources. As such, I do not agree that people in developing countries should be routinely given long-acting hormonal methods as justified by their poverty. Behind this 'health issue' are individual women who have just as much right to make an informed choice on their contraception method as we do. I don't think their right should be sacrificed to the greater good of population control under false justification. I think the mass-medicating of women in developing countries as a cure for poverty is very dubious.

The Pill does not give you more control than a long-acting method. If you have a chance to click on the link to my other blog, you will see that I understand long-acting methods as a more problem-laden option than the Pill in terms of their implementation but not in terms of their effect on women's health. With non-hormonal methods you are letting your healthy body alone, not shutting down the ovulation cycle, and so these give you control, rather than letting yourself be controlled by synthetic hormones.

I understand the diaphragm alone does not protect against HIV - hence why I pointed to a new diaphragm that has been developed to be used in conjunction with the new spermicide that has the potential to prevent transmission of HIV.

I was not suggesting a diaphragm alone would prevent transmission, I was however assuming the argument that there's little use in handing out condoms to women when they have to persuade men to use them who have a very different viewpoint on this method. Education about condoms use is, of course, another important point.

There is currently a study underway to determine whether the injection raises the risk of transmission of HIV, a conclusion previously developed in one piece of research, suggested to be a result of it's effect on the body. As hormonal contraceptives do over time suppress the immune system, I can see how this might be possible.

Also confused

I echo the commenter above; this post kind of lost me. What's the connection to the Georgia billboard? I'd be interested to hear it, but it seems like you're just using it as the thinnest of springboards to completely go off on hormonal birth-control methods.

Also, while it's definitely interesting to note that Depo-Provera is disproportionately prescribed to young African-American women, it is not a new drug -- it was approved by the FDA in 1994 or '95. So your assertion that it is "currently being promoted to women...as the latest, greatest form of contraception" seems both disingenuous and ahistorical. As someone who has a few family members who are women's-health doctors and researchers, and as someone who has used a variety of both barrier methods (diaphragm, cervical cap) and hormonal methods (Desogen, Mirena) over the past decade-plus, I can say that I've never had a doctor so much as mention Depo to me, much less urge it on me.

Also, diaphragms and cervical caps do no more to prevent the transmission of STIs than injections, so that's a bit of a polemic fail there. Finally, I understand that you're very down on hormonal birth control, but do we really know that much more about the long-term effects of powerful spermicides? Seriously, I'm asking.

Response

My assertion of how the injection Depo Provera is promoted to young women has nothing to do with how long the drug has been around - although I did say 'Yet Depo Provera has in fact been around for a long time' here - but how it has recently been marketed as though it were 'the latest, greatest' method to use. Not an unfamiliar trick in the advertising of any product.

As I said, long-acting methods have popped up in all kinds of magazines recently, enthused about as a great alternative to the Pill. In my next post I will discuss an article in Company which did just as I say, suggest that the injection was a new option out there for women tired of having to remember to take a Pill. If women have not had the opportunity to hear about these methods before and all of a sudden they're talked about everywhere then they do come across as 'new' and 'improved' methods.

I think the industry predicts a backlash against the Pill and is hoping to spin the situation to get people onto the injection, implant and hormonal IUD. In the UK there is currently a national campaign by the NHS to make women aware of these long-acting methods, which are promoted as even easier and more convenient than the Pill.

Please see my previous response concerning HIV and diaphragms.

Regarding spermicides - I believe there has been debate recently in Canada regarding the effect of spermicides on women's bodies - mainly in terms of elevated risk of contracting STDs. There are women who find spermicides cause a lot of irritation. It is possible, however, to create natural alternatives - recipes for which are discussed in Alexandra Pope and Jane Bennett's book The Pill: Are You Sure It's For You?

http://www.amazon.com/Pill-Are-You-Sure-its/dp/1741750792

Myself, I'd rather use a barrier method and spermicide - which may have an effect on that area of my body - than a hormonal method that shuts down my ovulation cycle and has an impact on my whole body, sense of well being and quality of life.

Read the linked article instead.

You linked to a much more coherent and reasoned take on this by Pamela Merritt at RH Reality check, so I'd recommend people read that.

http://www.rhrealitycheck.org/blog/2010/02/12/women-color-and-antichoice...

Link

Thank you for linking again to the piece I linked to. Yes, it covers a lot more aspects to the issue of the billboard campaign - it does not, however, cover the points I make here - which is why I wrote this piece rather than a rehash of the other writing on the matter which is already available.

Georgia Right to Life is so misleading

So basically urban black women are becoming pregnant at higher rates than urban white women, thus leading to more black women getting abortions. I don't understand how Georgia Right to Life could ignore this confound. How is this a conspiracy to eradicate the black population? And Holly, you're saying that maybe they could reduce the number of abortions by increasing and widening the distribution of safe, reliable birth control methods like the pill to these women.

Information coming from..?

I see a lot of very interesting questions being raised in this article, but I'm troubled by what I see as unsupported information. For the benefit of your readers, please cite your sources for facts, statistics, etc.

Why is it that black women

Why is it that black women are expected to continue the cycle of poverty, abuse and abandonment by black men? Will we be bullied into having even more children with men who are misogynist, gay, bisexual, incarcerated, uneducated and irresponsible. (Black women continue to have a higher birth rate than white women.) Why are 70% of black households headed by single black women? Why isn't anyone saying that the leading cause of death for sistas of child bearing age is hiv/aids? Will this increase? Why wasn't more thought put into this entire approach regarding black womens' lives and bodies? With everything else that is going on--I just don't think this is a wise move right now....