New Book on Birth Control Overlooks Evidence

By Rachel Walden — September 11, 2013

The new book “Sweetening the Pill: or How We Got Hooked on Hormonal Birth Control” by Holly Grigg-Spall has generated a lot of discussion and critical response — with good reason.

Grigg-Spall argues that the birth control pill is actually making us sick, and feminists don’t want you to know this.

As a feminist women’s health organization that puts a premium on evidence-based information, we disagree.

As noted in the most recent edition of “Our Bodies, Ourselves,” modern oral contraceptives, which are among the most intensely researched pills in history, are safe for most users. That’s not to say the pill is for everyone — as with any medication, some people’s bodies don’t react well — but in general the pill is an excellent option for many women.

Women who use oral contraceptives are at increased risk of having a blood clot; however, the overall risk is still very low (about six women in 10,000 over the course of a year). In fact, the risk is much higher for women who are pregnant or who have recently had a baby. In addition, the pill carries a number of long-term health benefits, including lowering the risk of ovarian and endometrial cancers.

Our Bodies Ourselves has consistently monitored the safety aspects of the pill and has been critical when the evidence has called for it. OBOS has, for example, helped to spread awareness about the safety concerns of newer drospirenone-containing contraceptive pills like Yasmin and Yaz, and has questioned the FDA’s review of these drugs, which carry higher risks for blood clots (about 10 women in 10,000 taking contraceptives with drospirenone over the course of a year) than older versions of the pill.

The National Women’s Health Network, which advocates for the FDA to take drospirenone pills off the market, has likewise has been a longtime advocate for cautious approaches to contraceptives. (Its co-founder, Barbara Seaman, literally wrote the book on safety concerns about early — 1960s — higher dose versions of the pill.) OBOS and NWHN share a common value as organizations in favor of evidence-based approaches to the risks of any drugs targeted to women.

Fortunately, numerous reviewers are calling out the problems with “Sweetening the Pill.” Lauren O’Neal writes that Grigg-Spall overlooks real benefits of the pill, while Jill Filipovic raises concerns about “scaring women away from highly effective forms of birth control with inaccurate claims.”

Grigg-Spall’s essentialist argument is also under fire. Over at Slate, Lyndsay Beyerstein asserts that “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.

It’s easy to write off Grigg-Spall’s inaccurate and reductionist account, but it’s worth noting that this perspective threatens to distract from the discussion that needs to be happening: Instead of promoting fear, women should be offered more evidence-based information on the benefits and side effects of all contraceptive methods, along with more comprehensive sex education and improved access to their method of choice.

To learn more about the pill, check out:

To learn more about safety issues related to pills containing drospirenone, see these previous posts:

5 responses to “New Book on Birth Control Overlooks Evidence”

  1. Considering the reliance on reviews it seems as though the writer of this post has not read the book for herself. I would be more than happy to email a PDF review copy. Please drop me a line at hollygriggspall at gmail dot com.

  2. I find it really irresponsible that in the above exerpt from Our Bodies Ourselves the patch and ring are presented as being just as safe as the pill, when in fact the amount of estrogen absorbed into the bloodstream is significantly higher with these methods.

    There is also no mention of the fact that an otherwise healthy woman like myself, may have one or more clotting disorders she is unaware of, which, when combined with the pill can be fatal.

    Unfortunately, we don’t test women for these conditions before we prescribe hormonal birth control, so there’s no way to know until you experience adverse side-effects, the most serious being death.

  3. I’d also like to draw your attention to how little coverage the work of OBOS and NWHN in regards to drospirenone-containing OCPs has received from the media. Very few mainstream feminist publications (if any) seem to have discussed the interaction the groups have had with the FDA.

    I point you to this post by Elizabeth Kissling for the Ms. blog for further discussion of the lack of coverage:

    I, however, detail this work in my book. The groups’ assertion, in a letter to the FDA, that “lives will be saved” if the drugs are removed from the market has not been highlighted by the vast majority of feminist blogs and publications. I, however, have covered this work through my own blog, the SMCR re:Cycling blog, and as part of my book.

    Considering I am one of the few writers to make note of the efforts of OBOS and NWHN I am surprised by the conclusions drawn in this post.

  4. Regarding apparent overall risk of blood clots being low, I recommend the book “How to Lie with Statistics” by Darrell Huff. A lot of ‘science’ is bought and paid for and its not hard to skew numbers to make them tell whatever story you want. I have a hard time believing anything after working in research and understanding how easy it is to skew your outcomes.

    Even if the risk of blood clots is low, what about the other side effects that arent rare at all? Depression, no sex drive, inability to lubricate, weight gain. Does the drug have to kill you to be argued to be outdated and kind of severe? What about quality of life? What about the side effects you dont see and that they arent studying?

    Should we still be promoting that healthy women take serious drugs for a decent proportion of their lives when there are alternatives available?

    The Fertility Awareness Method needs some serious promoting. I cannot believe I wasnt taught about it in High School. I guess there isnt enough profit in it. Thermometers are pretty cheap and last a long time….

  5. The lack of research on women’s sexuality is criminal yet not surprising when we look at who funds the research and makes money off the results.

    I am disappointed that OBOS is not encouraging further examination of the issues raised by Ms. Grigg-Spall. An outright condemnation of her work is not a path towards liberating women and freeing them from a near lifetime of hormonally adjusting medication. The obsession with penetrative sex (& the absolute need for full time female birth control) harms women by reinforcing the belief that penetrative sex is the only way to be sexually satisfied.

    I commend her for starting a dialogue on this issue. I speak as a middle aged hetero female that has used the Fertility Awareness Method since my early 20s with 100% success (including two planned pregnancies). Plotting ones’ basal body temperature works!

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