Ricki Lake is perhaps best known for hosting a syndicated daytime talk show in the 1990s — but now, she’s taking on a different role as a women’s health activist. Lake recently announced that she will be producing a documentary about the dangers of hormonal birth control methods. The film, called “Sweetening the Pill,” will be based on a controversial book by the same name.
“In the 50 years since its release, the birth control pill has become synonymous with women’s liberation and has been thought of as some sort of miracle drug. But now it’s making women sick,” Lake said in a statement along with the forthcoming film’s director, Abby Epstein. “Our goal with this film is to wake women up to the unexposed side effects of these powerful medications and the unforeseen consequences of repressing women’s natural cycles.”
This isn’t Lake’s first foray into documentary filmmaking. In 2008, she and Epstein collaborated to make “The Business of Being Born,” which advocates for the practice of home birth and criticizes the modern maternal health care system. And last year, the filmmaking duo also signed on as executive producers for a documentary about the benefits of breastfeeding.
It’s not difficult to trace a common thread through Lake’s recent areas of focus. The rise of home births is a fairly contentious area in reproductive health care, and advocates on each side of the debate disagree about how safe the practice is. Some of the same arguments that drive the natural birth movement — namely, the concern that women aren’t given enough information about their options, and often end up pressured into conforming to a medical practice that may not be the best fit for them — also animate the push to shift women away from hormonal contraception.
So far, Lake’s announcement has been met with mixed reactions. “Ricki Lake’s New Documentary Will Try to Scare You Off of Whore Pills,” the women’s site Jezebel mocked. “New Documentary Proves Birth Control Is More Than Just a Feminist Symbol,” the mommy blog Babble countered, in an article penned by an author who says she’ll never take any form of hormonal contraception.
So who’s right? Figuring out the answer to that question involves entering into a hotly-contested debate about birth control that’s been raging for decades.
Are women getting pressured into taking the pill?
If Lake’s new documentary sticks to the book, it will make the case that women haven’t been fully educated about all their contraceptive options, and are inadvertently flooding their body with potentially harmful hormones because their doctor never explained any other alternative.
Since 1982, the pill has been the most popular type of contraceptive in the U.S., particularly for women who are attempting to delay pregnancy temporarily. According to the latest data on the subject, nearly 28 percent of all women who use a birth control method opt for the pill. The next most common method, at about 27 percent, is female sterilization. Those numbers drop off dramatically for other types of contraceptives — just six percent of women trying to avoid pregnancy use the IUD, while less than one percent choose the patch or implant. Non-hormonal options, the methods that aren’t “repressing women’s natural cycles,” are at just about one percent.
Holly Grigg-Spall, the author of “Sweetening the Pill,” thinks that signals a serious problem.
“I’m not satisfied with how we present ‘choice’ at this time in regards to birth control — I want informed choice and expanded choice,” Grigg-Spall told ThinkProgress in an email. “Women should know that they have alternatives and should be able to learn to use these options successfully if they do not want to use hormonal birth control. At this time the tendency is to shuffle women from one hormonal option to another, and this is not what every woman wants or needs.”
Women’s health experts don’t disagree with the heart of that sentiment.
“Holly’s book raises really important questions. It is really critical that women do know all about the risks and all the benefits of all the contraceptive options available to them,” Chelsea Polis, an epidemiologist at the Johns Hopkins School of Public Health who focuses on reproductive health issues, told ThinkProgress in an interview. “Choice is so important, and different women and different couples need a range of options that will best suit their lifestyles.”
“The medical provider is really the expert on the method, from a clinical perspective. But they’re not the expert on the woman’s values. It’s a very personal decision,” Dr. Carolyn Westhoff, a professor at Columbia University and the senior medical advisor at Planned Parenthood, added. “We have a responsibility to make sure that patients have the information they need to make the right decision for them. I would never want to give the misperception that 100 percent of women should take the pill — certainly not.”
Family planning providers are moving toward a hierarchal approach for presenting birth control options to their patients. The World Health Organization (WHO) and the Centers for Disease Control (CDC) organize contraception methods into different tiers based on their effectiveness. To help present the information in the most helpful way, providers start with the most effective methods first — the patch, the IUD, sterilization, and the pill — then work their way down through other tiers if their patient is interested in additional options.
Some of the medical professionals who spoke to ThinkProgress flatly refuted the idea that women are getting pushed onto the pill in cases when there’s a better option available to them. “As doctors, we always say the best method is whatever women want and will use — we don’t twist arms. An unopened package of birth control pills isn’t helping anyone,” Dr. David Grimes, a clinical professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, noted.
On the other hand, some clinical settings could probably get better. If women are seeing their primary care doctor, rather than going to a family planning clinic that specializes in these issues, they may not feel comfortable initiating the right conversations about reproduction during an annual check-up. According to one recent study, most women don’t feel like they’re fully educated about all their birth control options, yet they’re not receiving counseling on the subject from their doctor. In response, some family planning experts are working to better integrate women’s reproductive health services into the rest of Americans’ basic health care.
Natural family planning
Holly Grigg-Spall and Ricki Lake favor what’s known as “fertility awareness methods,” which are based on women learning their menstrual cycles and avoiding sexual intercourse during the time of the month that they’re most likely to conceive. These methods are also sometimes referred to as “natural family planning.” There are several different ways women can track their cycles — through keeping a calendar, through monitoring their body temperature, or through tracking their levels of cervical mucus. And this method has an important flip side to it: the women who are trying to get pregnant can use it to help them conceive.
Polis, whose scientific work mainly focuses on contraceptive use in the developing world, acknowledged that fertility awareness methods are “great options” for the women who want to avoid artificial hormones, as well as for the women who want to better understand their bodies to help them conceive. But she cautioned that they don’t necessarily work for everyone.
“We need to think about the fact that unintended pregnancy is a big problem,” she noted. “I agree there should be better information about other non-hormonal options, like fertility awareness methods, that’s more widely available. But I think in Holly’s book, she glosses over some of what we don’t know about fertility awareness methods, and emphasizes far too strongly the efficacy of that method as opposed to the effectiveness.”
“Efficacy” is how scientists define how a contraceptive method works under perfect conditions — so, for instance, if a woman takes her birth control pill every day around the same time, as directed on the package. On the other hand, “effectiveness” is how well a contraceptive works under more typical conditions, when a woman may forget to take her pill for a few days out of the month.
Under perfect conditions, fertility awareness methods can prevent pregnancy just about as well as hormonal contraception does. But the current research in the field finds that most women aren’t using these methods perfectly, and their user error is leaving them at risk for unintended pregnancy. Each year, 24 out of every 100 couples who use these methods will get pregnant if they don’t always use the method correctly or consistently. That’s why many doctors don’t talk about fertility awareness methods with their female patients.
“Natural family planning doesn’t work very well for most women, and generally isn’t recommended. It has a high failure rate that’s not acceptable to most couples,” Grimes bluntly told ThinkProgress.
And Polis pointed out that effective natural family planning ultimately depends on women having a willing partner who will agree to abstain from sex during certain times of the month. It’s not a good option for women in abusive relationships, or women in relationships with a strong gender dynamic deferring to the man’s sexual needs.
The most studied medication in history
Grigg-Spall argues that since the feminist movement is primarily concerned with ensuring women’s access to contraception — which involves defending birth control from an ever increasing number of political attacks and court challenges — most women’s health advocates are unwilling to engage in an honest conversation about the side effects of hormonal methods. “Sweetening the Pill” makes the case that the pill is linked to hair loss, osteoporosis, muscle weakness, anxiety, and depression. Grigg-Spall cites the number of women who choose to stop taking the pill as evidence that too many people are experiencing negative side effects and are eager for an alternative.
“Right now, the dominance of hormonal birth control is restricting education, choice, and freedom — pillars of the reproductive rights movement. We can acknowledge the issues around access in the U.S., but also argue for the need for discussion of safety and side effects,” she said. “We just need to move the conversation to a more sophisticated and complex place.”
But when Grigg-Spall’s book first came out last year, it was critiqued for failing to elevate the conversation to that higher level. Several reviews of “Sweetening the Pill” argued that it glosses over much of the scientific research about hormonal birth control. “Unfortunately, any good points she makes are lost amid a jumble of confused and confusing misinformation about the pill’s effects on the body and society. The result is a dishonest anti-pill treatise,” Lauren O’Neal wrote at the New Inquiry.
“I think it’s important to ask questions about the safety of methods, but it’s equally important to say what we know about the risks and benefits of those methods based on scientific data,” Polis told ThinkProgress. “There are decades and decades of research into the pill. WHO notes that almost all women can safely use almost all methods of hormonal birth control.”
“The birth control pill is the most studied medication in human history. We know more about birth control pills than any other kind of prescription medication that anyone would ever take,” Westhoff told ThinkProgress. “We know a lot about its effectiveness. We also know that for most women, there are some risks. Everybody knows about blood clots. My entire life, I’ve watched blood clots pop up in the news over and over again. This is a risk we’ve known about since the 1960s. It’s entirely fair to say that both drug companies and doctors are desperate for methods that can get rid of these risks — I don’t think anyone’s hiding them.”
Birth control vs. Big Pharma
Nonetheless, opponents to hormonal birth control insist that someone is hiding something. After all, Ricki Lake says her documentary will “wake women up” to the reality about the pill.
That attitude is reinforced whenever birth control risks grab headlines. Over the past several months, the media has covered lawsuits against NuvaRing by referring to it as a “potentially lethal contraceptive,” warned that the pill will “double” women’s chances of getting glaucoma, and covered several cases of unexpected deaths attributed to the birth control patch and pill. “Side Effects May Include Death,” the Huffington Post cautioned in a recent feature story about the development of NuvaRing.
A lot of the suspicion around hormonal contraception appears to be driven by skepticism about Big Pharma. Particularly when it comes to stories of women dying from blood clots — as in the NuvaRing civil suit — there’s an underlying assumption that Americans aren’t getting the whole story because the information is controlled by pharmaceutical giants.
“It’s very easy for people to conflate hormonal contraceptive methods with big, evil pharmaceutical companies,” Polis noted. “We should always be looking at companies and at pharmaceutical research with a very critical eye. But with contraceptive research as a whole, it’s important to acknowledge that Big Pharma isn’t pulling the puppet strings. You have a lot of independent scientists whose scientific reputation and credibility is at stake here. If someone were trying to interpret the data in a way that would be useful to a pharmaceutical company, that’s going to be rooted out in the peer review process, or in future studies, or in literature reviews. The science sorts itself out.”
“I have worked with many of the people who have been involved in conducting this research, and my overwhelming impression is that people are doing this very difficult job to protect women’s health and public health,” she added.
Westhoff worries about the persistent negative press surrounding birth control. “It gets headlines, it gets magazine stories, and it scares women and they quit their method. That’s a real problem,” she said.
“Reporters weren’t so good at balancing the risks with the benefits in the 1960s and 1970s, and a lot of harm was done to public health,” Grimes added. “But it’s very heartening to see women’s magazines doing more work in this area — they call me up all the time. Reporters are providing much better context.”
In addition to the risks, the birth control pill also has positive side effects for many women. The women who have the ability to plan and space their pregnancies end up having healthier babies. The pill helps women have lighter and more regular periods, and decreases the incidence of painful cramps. It can be a medical treatment for endometriosis or ovarian cysts. Birth control may help lower women’s risk of ovarian and uterine cancers.
What counts as natural, anyway?
While the media is quick to report on the risks of hormonal birth control, risky pregnancies don’t always inspire the same type of coverage. For instance, consider the tragic case of Marlise Machado Muñoz, the pregnant Texas woman who was kept on life support for months even though she was brain dead. That sparked weeks of stories on the issues of bodily autonomy, end-of-life wishes, and the medical definition of death. But, even though Muñoz died after suffering a blood clot that was the direct result of being pregnant, her case wasn’t necessarily covered as a cautionary tale about the risks of pregnancy. “I don’t know that people reacted to that terrible story by saying, ‘oh my god, pregnancy is so dangerous,’ ” Westhoff noted.
In fact, she explained, the hormones that flood women’s bodies during pregnancy have “dramatic effects” on their health risks, and taking hormonal birth control is actually safer than being pregnant. That comes as a surprise to many Americans. Westhoff said the first time she told that fact to a journalist, they laughed — they thought she was joking.
Although methods like the pill, the patch, and the ring do carry an increased risk of blood clots, pregnancy puts women at triple that risk. In many areas of the world, pregnancy and childbirth remain the single greatest danger to women’s lives. And here in the United States, we lag far behind other wealthy nations on several indicators of maternal health, and one in four pregnancies in this country includes at least one incident of hospitalization outside of delivery.
Grimes doesn’t mince words about the medical community’s imperative to prevent unplanned pregnancies. “In fact, I’d say it’s unethical to suggest that women should be hearing more information about a less reliable contraceptive method at the expense of other methods, since that will put them more at risk for unintended pregnancy, which is dangerous. It’s irresponsible to say we should emphasize ineffective methods, from a public health point of view,” he said.
That line of argument isn’t persuasive to hormonal birth control skeptics like Grigg-Spall. “Comparing the risks of hormonal birth control to pregnancy is a false dichotomy when there are non-hormonal alternatives that many women use very successfully,” she told ThinkProgress via email.
Within that worldview, there’s a sharp divide between a woman’s “natural” state of being and the artificial additives that didn’t originate in her body.
“But what’s natural? To die of a condition, or to take a medication to prevent it?” Westhoff pointed out. “There’s nothing necessarily special about our body’s hormones — in fact, they can get us into trouble. Some women are on anti-hormone medication for the treatment of breast cancer because one’s own hormones can be part of the problem. In a sense, it’s natural to get sick and die. People take vitamins to supplement their diets, they take antibiotics to avoid infections, they take medications to lower their blood pressure and help prevent stroke. I don’t see why the birth control hormones are subject to some qualitatively different criticism.”
Celebrities’ lasting impact on public health
There’s somewhat of a comparison to be made between Ricki Lake and Jenny McCarthy, the model and actress who has become synonymous with anti-vaccine conspiracies.
McCarthy, now a co-host on the daytime talk show The View, believes that vaccinating her son contributed to his autism. That particular theory is based on a widely discredited study conducted by a doctor who’s had his medical license revoked. Although federal health officials have repeatedly reassured Americans that there’s no link between vaccines and autism, the myth continues to contribute to declining rates of vaccination for measles, mumps, and rubella. Now, measles is beginning to reemerge.
Just like the controversy over hormonal birth control, the push to reject vaccines follows similar themes: sticking to what’s considered “natural,” avoiding what’s seen as an unnecessary medical intervention, and skepticism about what pharmaceutical companies could be hiding from the public.
Although McCarthy can’t take all the credit for stubborn vaccine deniers, she did help give the autism myth a prominent platform. According to a USA TODAY/Gallup poll taken in 2008, about one in four adults said they were familiar with McCarthy’s views about vaccines, and 40 percent of that group said her claims made them more likely to question vaccine safety.
Here in the United States, the risks of fearmongering about the pill may not necessarily be as problematic as anti-vaccine conspiracy theories. Women here do have access to options other than hormonal birth control, and they’re perfectly free to explore them. And opting for a different contraceptive method certainly won’t expose thousands of other people to an infectious disease.
But Polis — whose work mainly focuses on access to contraception in African nations — believes that when prominent people like Ricki Lake stoke controversy about birth control, there’s actually the potential for very serious consequences outside our country’s borders.
“Sometimes people don’t recognize how much influence the debate in the U.S. has on international family planning, and on issues of access for women in developing countries. When there’s a lot of hubbub raised here, and people start getting scared off of methods, that feeds into how ministers of public health may react,” Polis explained. “Even if the science isn’t supportive of those conclusions, these things can end up trickling down through unscientific channels in ways that can bias people against certain methods, or actually restrict access to certain methods.”
“There’s such a different calculus for a woman in the U.S., who has access to resources and safe health care and equal gender dynamics, than for the women who don’t have access to those things,” she pointed out. “We should at least acknowledge that there can be global impacts, and we need to acknowledge our own forms of privilege.”