The Pill

The Pill


All my years of public school health education failed to teach me about the final stage of puberty: the one that comes in a tiny cardboard box. Suddenly, after the training bras and braces were retired, many of my friends started slipping tiny pink pills into their mouths during lunchtime. With hushed voices, they told me they were “on the Pill,” mostly due to cramps and irregular periods—nuisances that often come with the territory of having a uterus. I soon joined the club of licit pink-pill slipping girls myself, along with the 82 percent of teen birth-control users who rely on the drug for purposes, at least in part, other than pregnancy prevention.1

The first hormonal birth control pill was created in the 1950s. It was called Enovid. It was marketed exclusively for family planning purposes, and only prescribed to married women.2 The pill continued to serve this demographic for decades until it underwent a dramatic marketing face-lift that allowed it to end up in the medicine cabinets of cramp-ridden teenage girls like myself.

Until the FDA loosened advertising regulations in 1985, prescription drugs could be advertised only to physicians.3 Following the FDA’s decision, pharmaceutical companies began advertising the birth control pill directly to the consumer. Birth control pills took on all the ethos of a fun-loving Tampax commercial; according to advertisers, it was a virtual panacea to all the physical tribulations remotely related to the possession of fallopian tubes. Manufacturers promoted their new brands of oral contraceptives as so-called “lifestyle drugs,” a term coined in 1978 to describe medications that are designed to improve a person’s quality of life by treating less serious conditions.4 The “new pill” co-opted by advertisers is chemically very similar to the original pill, the main difference being the message it sells: It’s a life-enhancing drug that women will want to use, and therefore buy, from menarche to menopause.

Birth control advertisements often remind me of a SoulCycle class: they’re loud, feature many women sweating, and odds are someone will tell you that “you can do anything.” In fact, it’s very possible you’ve seen a birth control advertisement and didn’t even realize it was for birth control at all. An advertisement for Yaz features attractive women jogging on screen while pop music blasts in the background. The advertisement explicitly states that Yaz can treat acne and premenstrual syndrome, entirely foregoing mention of its contraceptive capabilities.5 Same goes for Seasonique’s commercial, in which modelesque females go camping and partying while they talk about how Seasonique “repunctuated their life” by reducing the frequency of their menstrual periods.6 Despite having nothing to do with running or camping or partying, Yaz is the best-selling oral contraception pill in the United States, and Seasonique isn’t far behind, with over one hundred million dollars in sales annually.7

Yaz and Seasonique, and basically all other birth control pills on the market, are very similar on a chemical level; every brand contains either estrogen, progestin, or a combination of both. The main differences are the color of the packaging, and the variation of names that often sound like Game of Thrones characters, like Alesse or Desogen. 

“The pill,” alongside other methods of birth control, is always accompanied by a densely packed leaflet filled with stressful advice and information: Always take the pill at the same time every day; take two if you miss one, but if you miss three still take two but pray; don’t freak out if you randomly bleed; always consult your doctor, but especially if you have abdominal pain, breast lumps, chest pain, or depression. When I started taking “the pill”  I was enticed by all the promises that Seasonique, Yaz, and even my doctor had made me. So, with each new box, I carelessly tossed the directional leaflet while I sat back and waited for my skin to clear and cramps to vanish. 

Youth oftentimes comes with the privilege to ignore medical symptoms. Your body is young and elastic, plumped up with collagen. I’ve never had more faith in anything than the faith I had in the disease-fighting abilities of my 14-year-old old blood cells. As a result, during my mid-teenage years I never thought twice about the pill I was putting in my body. Any cramp I incurred I chalked up to pulled muscles from dance class, any nausea was probably from eating too much chocolate, and any feelings of moodiness were probably from staying up way too late. In fact, I felt privileged to be able to take birth control so carelessly; I had recently learned about its more restricted past in my history class. 

Modern-day menstruators in the United States are incredibly privileged to have access to hormonal contraceptives. The birth control pill wasn’t available to unmarried women until 1965, and even then, hormonal birth control was only available in pill form. Now hormonal contraception can take the form of implants, intrauterine systems, injectables, and rings. All this scientific progress has had a remarkable impact on female advancement in the past five decades. Contraception enhanced women’s opportunities to control childbearing and their careers, allowed them to choose contraception and plan fertility independently of their partner or spouse, and increased female human capital accumulation, labour market options, and earnings. The birth control pill can even partially explain the dramatic increase in women’s education, college and professional degrees, and participation in the labour market since the 1960s.

When I was 19, I told my doctor that the pill had turned on me. “It makes me cry all the time,” I told her, waving my hands in an exaggerated motion. “I’m depressed and it’s Aviane’s fault!” My doctor said she couldn’t confirm or deny a relationship between my symptoms and the pill due to lack of research. This confused me—Seasonique told me birth control would help me break free from the chains of menstruation, and Yaz basically promised that the pill would make me a track star. I felt duped, the pill did neither of those things . . . and I still had pimples and cramps. 

I wasn’t alone. A report published by the Center for Disease Control in 2013 showed that almost half of women have discontinued a form of contraception because they disliked it or were concerned about side effects, and a third of the women had tried five or more types of birth control.8 Women are hoping for something better. Society has undergone rapid technological advancement since the advent of the pill. We have iPhones and Zoom University now; why hasn’t the pill followed suit?

There’s enough evidence to create a strong correlation between the FDA’s move in 1985 and the slow scientific progression of birth control options. A recent study noted that current annual contraceptive-technology development funding is thirty-nine million dollars less than the funding received in 1980 (adjusted for inflation). The pill has been hijacked by marketing decisions, rather than scientific innovations, which have guided the development and positioning of next-generation contraceptive products. 

Birth control pills have been used for decades with relative safety by millions of women, but there is no precedent for continuous use of such large doses of synthetic hormones from the teen years to menopause. The health risks and benefits of long-term use of hormonal contraceptives for menstrual suppression are still widely debated. While many researchers and clinicians endorse the practice, citing the pill’s fifty-year track record, others are skeptical, noting the clinical evidence of potential increased risk of osteoporosis, stroke, and certain cancers.910

It’s dystopic in its very nature that the numbers that guide contraceptive research are not data points from test trials, but rather the number of zeros on a revenue report. This creates an incredible blind spot where it is increasingly difficult for birth control consumers to access unbiased information on the drug they are prescribed and unable to access meaningful studies on their prescribed drug because the studies simply cease to exist.  

If I were to go back in time to my teenage years, I can’t say that I would stop me and birth control from meeting. I’ve been on and off of birth control too many times to count. Birth control advertisements continue to frustrate me, since the pill absolutely does not make me feel like the Yaz and Sesonique ladies. Though, I’m hesitant to be over-critical. The pill gives me a sense of control over my life, a sense of control women sixty years ago couldn’t revel in, and that’s why I keep coming back for more. 

  1. Guttmacher Institute, “Many American Women Use Birth Control Pills for Noncontraceptive Reasons,” news release,  November 15, 2011.
  2. Pamela Verma Liao and Janet Dollin, “Half a Century of the Oral Contraceptive Pill: Historical Review and View to The Future,” Canadian Family Physician (Medecin de Famille Canadien) 58, no. 12 (2012): e757-60.
  3. Elizabeth Seigel Watkins, “How The Pill Became a Lifestyle Drug: The Pharmaceutical Industry and Birth Control in the United States Since 1960,” American Journal of Public Health 102, no. 8 (2012): 1462-72.
  4. Watkins, “How The Pill Became a Lifestyle Drug.”
  5. Mitchell, Steve “TV ads for birth-control pill Yaz gloss over the risks,” Consumer Reports, November 07, 2008.
  6. Watkins, “How The Pill Became a Lifestyle Drug.”
  7. Doyle, Rodger. “BY THE NUMBERS: World Birth-Control Use,” Scientific American, vol. 275, no. 3, 1996, pp. 34–34.
  8. Madeleine Schwartz, “Where’s Better Birth Control?The New Yorker, November 21, 2014.
  9. Schwartz, “Where’s Better Birth Control?
  10. Eric W. Dolan, “Women Taking Hormonal Contraceptives Have Reduced Perseverance on Cognitive Tasks, Study Finds,” PsyPost, January 23, 2020.
Back to Top