The Pill: reducing women's autonomy
Debates about the ethical dimension of the Pill are like smoke-filled 19th-century battlefields “where ignorant armies clash by night”. Inquiry is enveloped by dense clouds of competing studies, ideology-fuelled rage, commercial interests, and social indoctrination.
It’s rare to find an overview of the issues which frames it as an anthropological problem, rather than as solely a medical, social or ideological issue. Fortunately, a recent article in the journal Frontiers in Medicine by three Spanish authors, a pharmacist, a doctor and a bioethicist, tackles this controversial issue head-on.
Their starting point is that hormone-based contraceptives are artificial. This is fundamental to appreciating its effects on women – and all of society. They conclude that an evaluation of the impact of the Pill upon women has to be holistic. It needs to take into account all dimensions of a woman’s life – not just whether or not the Pill leads to cancer or heart failure.
Dr Micaela Menarguez, one of the authors of this stunning article, answered some questions from Mercator about their findings. She is a pharmacist at the Catholic University of Murcia (UCAM).
The Pill protects women’s autonomy by giving them control of their fertility. What could possibly be wrong with that?
When considering women’s autonomy and their fertility, some questions have often been ignored. On the one hand, the Pill affects physical and women's mental health; there are many studies already published which show this question.
On the other hand, the Pill decreases libido, sexual desire in women, and affects their sexual life. If we consider all these questions, we need to find other solutions for fertility control and regulation.
At this moment, Natural Family Planning, which involves women in the knowledge of their own cycle, seems to be the best solution. It also provides women with the opportunity to know when they are fertile and when they are infertile and helps them to make considered decisions about their sexual life, without associated health problems.
It is also important to note that fertility control is not the only element in women's autonomy. Most women want complete and honest information about the effects of the Pill on their health. This would give them full autonomy in their relationships and their lifestyle.
How does the Pill affect women’s mental health?
In many ways, starting with mood swings. Recent studies have shown that there is a correlation between women using the Pill and mental illnesses like depression, anxiety, suicidality and even attempted suicide.
This happens because there are neuronal receptors in the brain for the kind of hormones that the Pill contains in its formulation. They may involve areas involved in regulating emotions, affecting the synthesis of neurotransmitters, and potentially leading to their deregulation.
How does it affect women’s romantic life?
The Pill affects both women’s emotions and sexual desire. In both cases, women lose, because they become more unstable, become moodier, and enjoy sex less.
And, of course, it also affects relationships between men and women. The exogenous estradiol in the Pill seems to make women evaluate their partners less positively. On the other hand, increased levels of progesterone after ovulation in women who are not under the Pill make them perceive their partner in a more positive way.
The link between the Pill and various forms of cancer is highly controversial. What’s your opinion?
On one hand, studies have proved that cancers related to hormones probably become worse with the Pill, because it is hormone-based. Studies that argue that the Pill protects women from some cancers have a lot of methodological problems (e.g. selection of population). What we do know is that pregnancy and delivery protect women from breast, ovarian and endometrium cancer.
Your paper highlights the fact that there are many gaps in what doctors know about the effects of the Pill. Where are the biggest gaps, do you think?
Doctors simply don't know how dangerous the Pill is. Most of them really don’t. For example, its effects on mental health, its effects upon libido, its effects on the cardiovascular system, the risks of certain cancers and so on.
It is crucial for them to keep up to date on recent research, with a critical analysis of their findings and the methodology to provide optimal advice to their patients.
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Do you think that most women understand the risks of the Pill? Are they acting autonomously if they don’t?
Absolutely not. Few doctors inform women about these risks because most of them are simply unaware. But how can women make a fully informed, autonomous decision about using the Pill without knowing what the risks are? Normally, doctors just tell their patients that the pill is the only solution for fertility control and fail to inform them about other methods.
There is no transparency in that information. Many times, they give no information about the risks of hormonal contraception. This is wrong. Women have a right to physical and mental health, don’t they?
What’s the effect on adolescent girls who use the Pill and have multiple sexual encounters?
During the teen years, the human brain develops rapidly: the years between 12 to 18 are of great brain plasticity due to the actions of sexual hormones on brain receptors. At that time, neuronal connections take place as what is called neuronal pruning. Both events allow the brain to become mature.
However, if a girl is using the Pill, or falls prey to an addiction like alcohol, pornography, or drugs, this neuronal work cannot be done properly. The damage may be permanent in her adult life. Also, adolescence is a very fragile moment from the affective point of view, and the pill can have a higher impact on teenagers' mental health than in adult women.
Having relationships involving sex with different partners can affect mental health more than if those relationships occurred without sex. There is more risk of anxiety and depression. Plus, the risk of sexually transmitted diseases is higher in teenagers because they lack G mucus in their cervix, which is responsible for the immune system at the cervix.
The key assertion of your paper is that the Pill is not part of a holistic approach to health. Could you explain that?
A satisfactory sexual relationship is just not one that offers physical satisfaction. Physical satisfaction is important, but it is not the only thing.
Human beings, according to the findings of modern anthropology, also have feelings, affections, emotions, desires, and a spiritual dimension. These cannot be ignored.
On the emotional side, a sexual relationship should make us feel how much we are loved rather than that we are being used. In the spiritual and transcendent dimension, a sexual relationship should make us feel that the other person is ours; he gives himself to us, and he shares his intimacy with us to express that he wants to share his life with us.
Full sex is much more than physical pleasure; it is tenderness, affection, feeling loved and feeling that someone gives themselves to us. Shallow sex often does not even provide physical pleasure for women, due to their loss of libido due to the Pill. Thus, the Pill cannot offer a fulfilling sexual lifestyle; it fails to integrate all the dimensions of the dimensions of a woman’s life. Not to mention, of course, problems like STIs.
Academic activists have successfully forced editors to issue retractions for articles promoting unpopular ideas in recent years. Do you fear that your paper might suffer this fate?
I hope not; I really hope not.
All drugs have adverse effects which limit their use. Thus, to consider that the hormones present in the Pill don’t have adverse effects is very, very naïve. Our paper’s conclusions are based on extensive research in the scientific literature — it has 244 references to leading scientific journals.
Thus, it is not just our opinion; it is a holistic perspective on previous findings of clinicians, scientists and researchers worldwide. Our conclusions can help couples, and particularly women, to have better and more fulfilling sexual relationships.
Micaela Menarguez is the Director of Bioethics at the Catholic University of Murcia and teaches classes on Fertility and Family Planning at CEU San Pablo University.
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