The Truth About the Pill

A new book argues that hormonal birth control is sexist and dangerous. Don’t believe it.

In Sweetening the Pill, author Holly Grigg-Spall makes a series of seemingly contradictory claims about the capitalist-medical-feminist bloc that is supposedly bullying women into taking the pil. Above, third-generation contraceptive pills in Lille, France, in 2013.

Photo by Philippe Huguen/AFP/Getty Images

Years before she founded Planned Parenthood, pioneering feminist Margaret Sanger dreamed of a “magic pill” that would put women in charge of their own fertility. As a visiting nurse in New York City’s tenements, Sanger saw women struggling with unwanted pregnancies, botched abortions, and more children than they could take care of, thanks to husbands who wouldn’t cooperate on birth control. A woman who relies on a man for birth control, Sanger wrote in 1920, is “exploited, driven and enslaved to his desires.” In the early 1950s, Sanger joined forces with philanthropist Katharine McCormick to coordinate the research program that would drag that magic pill into existence.

Sanger lived to see the 1960 launch of Enovid, the first oral contraceptive pill, and its success vindicated many of her hopes for women’s liberation. The pill ushered in a new era of educational and professional attainment for women. As a discreet, highly effective, and fully female-controlled form of birth control, the pill allowed women to plan their families, space their births, and even delay childbearing long enough to establish themselves in careers.

In her new book Sweetening the Pill: or How We Got Hooked on Hormonal Birth Control, Holly Grigg-Spall offers what she calls a “feminist critique” of hormonal contraception. She argues that the so-called liberating force  of the pill has been illusory. She claims that the pill keeps women in the thrall of patriarchal capitalism and destroys their health in the process. The addiction allusion in the title is not a metaphor—Grigg-Spall is convinced that the pill is an addictive drug.

It would be tempting to dismiss the author as an isolated crank, but she is part of a disturbing effort to reduce women to their biological functions in the name of feminism. Sexists have been trying to reduce women to incubators since time immemorial, but recently some self-proclaimed feminists have jumped on the bandwagon, arguing that true liberation means being left alone to experience feminine bodily functions like ovulation, childbirth, and breast-feeding in all their natural glory. To these “feminists,” tampons and epidurals are keeping women down. And now, the birth control pill is, too.

Grigg-Spall’s argument rests heavily on her own bad experience with Bayer’s Yasmin (which she blames for turning her into an emotional wreck) and comments on various websites dedicated to sharing pill horror stories. She indignantly anticipates that readers will dismiss these anecdotes: “I was sick, and then, I was well,” she writes. “That this is not enough evidence of the pill’s impact reveals so much about why women are encouraged to take this drug in the first place.” In other words, she accuses her critics of being sexist if they won’t accept her cherry-picked testimonials as proof that the pill harms all women.

Actually, there are good reasons to be suspicious of uncorroborated anecdotal evidence about the effects of drugs on our bodies. Millions of American women take the pill every day, so it’s a statistical certainty that some of them will have symptoms like depression, headaches, and weight gain, which are among the afflictions most commonly blamed on the pill. The only way to separate true side effects from coincidence, selective recall, and the power of suggestion is to conduct controlled clinical trials. Double-blind, placebo-controlled trials have not found modern birth control pills to cause more depression, headaches, or weight gain than a placebo.

There’s no question that some women experience side effects on the pill. Perhaps the best known and most serious of these is an increased risk of blood clots. The pill approximately doubles a woman’s risk of a blood clot, but her absolute risk remains low. On the pill, a woman’s annual risk of developing a clot rises from about 1 to 5 women out of 10,000 to 3 to 9 in 10,000. Bayer’s controversial Yaz and Yasmin pills probably push the risk of blood clots even higher (10 to 22 in 10,000). Even so, the risk of a blood clot on the pill is a fraction of the risk of a blood clot during pregnancy or the postpartum period. Are these acceptable risks? As a pill taker, they are to me, but every woman has to make up her own mind.

You might assume that women take the birth control pill for, well, birth control, but Grigg-Spall thinks she sees a more sinister agenda. “Women do not choose … hormonal contraceptives because these things are necessary or convenient for them or because they consciously need or want to,” she asserts. Instead, according to the author, “Women are encouraged to suppress their monthly ovulatory cycle in order to not miss any days of work or so as they can remain sexually available or experience only one-note moods.”

Sweetening the Pill frames hormonal contraception as a societywide assault on ovulation and menstruation orchestrated by the capitalist system and its handmaidens in the medical establishment and feminism. Grigg-Spall ascribes the pill’s popularity to a misogynist culture that expresses its contempt for the female body by squelching its natural cycles with artificial hormones.

If capitalism, medicine, and feminism sound like strange bedfellows, that’s because they are. Grigg-Spall makes a series of seemingly contradictory claims about the capitalist-medical-feminist bloc that is supposedly bullying women into taking the pill: 1) The pill is popular because it turns women into emotionally stable and industrious workers who never miss a day of work or bleed on the shop floor and because the economy needs women’s “passivity, anxiety and emotionality.” 2) The pill is the modern-day equivalent of the 19th-century practice of “female castration,” which was used to desexualize women, and the pill is promoted as part of a feminist scheme to make women more alluring and available to men. 3) The pill kills female libido, and the pill fuels the supposed epidemic of sluttiness known as “raunch culture.”

Does the pill masculinize, ultrafeminize, or unsex women entirely? Grigg-Spall  claims all of the above!

She complains that sex-positive feminists push the pill in a nefarious bid to make women more “sexually available” to men. This is an old feminist argument that has never made any sense. You could just as well say that the pill makes men more sexually available to women, because it allows us to enjoy their charms whenever we want. Sure, if a woman is on the pill and chooses to tell her boyfriend, she can’t beg off sex with the excuse that she might get pregnant. But so what? Any method of birth control makes women “sexually available” to men by taking the pregnancy excuse off the table, even the combo of fertility awareness and condoms that Grigg-Spall advocates as an alternative to the pill. If women are being pressured into sex they don’t want, the problem is rape, not birth control.

Sweetening the Pill offers an insultingly reductive account of what it means to be female: “If we shut down the essential biological center of femaleness, the primary sexual characteristics, then can we say that women on the pill are still ‘female’?” Grigg-Spall muses, casting ovulation as the sine qua non of femaleness. If so, postmenopausal women, pregnant women, girls, ovarian cancer survivors, and transwomen aren’t really female.

Grigg-Spall notes that men have been reluctant to embrace vasectomies and other forms of birth control that block the production or release of sperm because they regard them as a threat to their masculine identity. She wonders why women are willing to accept drugs that block ovulation without complaint. The answer, of course, is that men who define masculinity in terms of their ability to sire hypothetical unwanted children are pathetic and women shouldn’t emulate them.

Grigg-Spall claims that hormonal birth control has become the only socially acceptable option for women, thanks to the collusion of greedy pharmaceutical companies and sex-positive feminists, but the statistics refute her. About 80 percent  of American women will try the pill, but only 17 percent of U.S. women of reproductive age are on the pill at any given time. According to Grigg-Spall’s own statistics, only 28 percent of women who use birth control are on the pill. That’s a healthy plurality, but it’s nowhere near a majority, even if you factor in other kinds of hormonal contraception.

Stripped of feminist jargon—because, remember, she’s arguing from a feminist perspective—Grigg-Spall’s health case against the pill comes down to this: The pill is bad because it suppresses our natural ovulatory cycles, which must remain undisturbed. “On the pill no woman’s body is capable of functioning at its optimum level,” Grigg-Spall claims. She is aghast that some women use the pill to suppress their periods altogether. In her view, women who don’t want periods are victims of internalized misogyny who reject an authentic feminine identity rooted in ovulation. It’s ironic that in the 1950s, women who complained of period pain were told that their misery was a purely psychosomatic affliction born of their rejection of the female role. Grigg-Spall has recycled the same sexist reasoning under the guise of feminism.

Grigg-Spall relies heavily on Miranda Gray, a “life coach” who offers “womb blessing attunements” and lectures on tarot cards and the healing power of crystals. Gray claims that women have dramatically different cognitive and emotional capacities at different stages of the menstrual cycle. In fact, even after decades of research, scientists have had a surprisingly difficult time pinning down consistent relationships between the normal menstrual cycle and mood or performance. But no matter: Gray urges women to tailor their work schedules to match their menstrual cycles and not push themselves to excel at tasks that are at odds with their cycle. For example, she says women should take advantage of their preovulation phase to “understand complex ideas,” because that’s when our frail and inconstant lady brains are best suited to the task. Grigg-Spall reports that she takes two days off every month for the worst of her period, during which time she is “intolerant of any pressures on [her] to do anything [she doesn’t] enjoy or personally choose to do.” How nice.

Grigg-Spall argues that the capitalist system is sexist for not letting all women organize their lives around their menstrual cycles without penalty. If the natural menstrual cycle made women as inconsistent as Grigg-Spall says, that would be a good reason to exclude women from occupations that require consistent focus and attention to detail. Do you want a surgeon who’s only at the top of her game at certain times of the month or a diplomat whose emotional intelligence might be “off” the week of a missile crisis? You can see why her claim that hormones rule women’s brains has profoundly anti-feminist implications.

Some of Grigg-Spall’s assertions about the pill’s health risks are downright dishonest. She mentions that combination pills have been designated as a Level 1 carcinogen by the World Health Organization, on the same list as asbestos and tobacco. But she doesn’t tell you that the same list includes sunlight and dried fish or that being on the list says nothing about how likely a substance is to cause cancer or whether we should avoid it. The list is based on the strength of the evidence, not the strength of the carcinogen. Sometimes we’re very sure that a substance is a very weak carcinogen. Some studies have found that long-term birth control pill usage slightly increases a woman’s risk of breast cancer, but other studies have found no association. If there is an increased risk, it only lasts as long as a woman is taking the pill; this is significant because breast cancer is rare in premenopausal women, so a small increase in relative risk translates into a very small increase in absolute risk. Whereas long-term pill use before menopause cuts a woman’s risk of ovarian cancer by up to half for the rest of her life. Grigg-Spall tries to dismiss the ovarian cancer benefits on the grounds that breast cancer is more common than ovarian cancer, but she fails to note that premenopausal breast cancer is also rare: 95 percent of first-time breast cancer diagnoses are in women over 40.

If the pill is so miserable, why is it so popular? Grigg-Spall is forced to posit a conspiracy between feminists and health care providers to keep women ignorant of nonhormonal birth control. She claims that leading women’s health organizations such as Planned Parenthood fail women by not teaching about alternatives to hormonal contraception. This is untrue. You can read about fertility awareness, surgical sterilization, copper IUDs, and other nonhormonal contraceptive options on Planned Parenthood’s website. If Planned Parenthood hates nonhormonal contraception, why are they always handing out condoms?

Grigg-Spall also claims that there’s a feminist omerta in effect that prohibits criticism of hormonal birth control. Yet, by her own admission, feminist organizations such as Our Bodies Ourselves and the National Women’s Health Network begged the Food and Drug Administration to take Bayer’s Yaz and Yasmin off the market because of their propensity to cause blood clots.

Sweetening the Pill is poorly researched, shoddily argued, and fundamentally incoherent. So why am I even expending energy addressing it? Because a feminism based on the fetishization of bodily functions is no feminism at all. Grigg-Spall condescends to the millions of women who take the pill, claiming that we are dupes of pharma and feminism. The question is not whether there are trade-offs to the birth control pill, but whether the benefits justify the risks. Hormonal birth control isn’t for everyone, but for many women, the benefits of reliable, convenient, female-controlled contraception and the spontaneous sex life it allows are well worth the small potential downsides. The choice should be left to women and their doctors, not hijacked by ideologues.