Ep 60 Giving birth to "The Pill"

least every month just in horrible pain, couldn't leave. And also because I didn't want to get pregnant. And as soon as I started taking the oral contraceptive I it was like night and day, like the pains were so much less, my periods almost disappeared. It was like I was so so grateful to be able to just like function normally, is what it felt like. And I've been really fortunate and that I haven't had very many problems, and all these various forms have continued to do the

trick for me. So you know, I don't want to get pregnant. And the birth control that I've taken has been very effective in that way, and so I'm I'm really grateful for, you know, for having access to birth control and continued access to birth control, and I hope that it stays that way.

any real issues with it. I tried. I think I had to increase my dose like one and then I did have one very stressful year where my insurance got wonky and I wasn't able to get access to birth control, and that was very stressful because I very much didn't want to become pregnant. But I was able to get back on until I decided a few years ago to start trying to get pregnant. So I'm really grateful that I was able to make that decision when it was

right for me and my partner and our family. And then after I had my baby, I got the copper IUD, which is a non hormonal option of contraception and that's been really great for me too. I one year in and I'm still not pregnant, so that's nice. Yeah. I also am just really grateful I had, you know, only one year when I wanted and needed access to birth control and I didn't have it, and that was a

really really stressful year. So I can't imagine, like never having access to it, how different my life could have been.

And you know, in the episode, I had asked about stigma against genital herpes in other countries and whether it existed, and multiple people reached out to us from a bunch of different countries and said no, no one even thinks about it here, like it's not a second thought, and that if there is any stigma, it seems to be lifted from American TV shows or movies that like either joke about it or make fun of it or call

it out or something like that. So wow, there you go. Cool, And then I mean, it is it is great that there's like no stigma in other countries, so just let's be more like that. And then the other thing is that our last episode was Thelidamide, and apparently there's a major storyline or plotline on Call the Midwife about thelidamide, and Aaron, you and I watched like so much of that, but I guess we still.

it's internal. So in general, in people with a uterus, we have two ovaries and then Filippian tubes, which are what kind of collect the eggs that is connected to the uterus itself. The inside lining of that uterus is called the endometrium, and then the bottom of the uterus is called the cervix. I feel like that's an important one. And then you have the vaginal canal, and then the outside world. Okay, the outside world does that work? All right?

So then let's talk about the menstrual cycle, because this is the thing that happens about every month or so in most people who have a uterus. We're going to go over the specific phases and hormones that are involved in a second, but the cycle essentially begins weirdly with the start of menstruation. So the start of like vaginal bleeding. Isn't that weird that that's where we start it? I mean, is it's just arbitrary, right, It's totally arbitrary. That's just

that's where we start it. And then it ends with the kind of resumption of menstration like the next cycle, or with implantation of a blastocyst, which would then be

called pregnancy. So at the beginning day one of your menstrual cycle, you're bleeding, probably, and at this point in time, almost all of the hormone levels in your body are pretty low, and there are a complex series of feedback loops between three organs or parts of organs, the hypothalamus in your brain, the pituitary which is also in your brain, and then your ovaries themselves, and all three of these release hormones that result in the endometrial lining, so the

lining of your uterus proliferating and expanding, and then follicles in your ovaries maturing, and then eventually egg release right ovulation. So if day one is the start of menstruation, that will usually last anywhere from two to seven days, and then the process of follicle maturation, so basically eggs getting ready to be released in your ovary is happening at this time. So your brain is releasing two hormones FSH and LH that are causing that follicle too mature. This

phase is called the follicular phase. Get it okay, pollicle okay. And through this time period, your estrogen levels are slowly rising, So they start off kind of low and then they slowly start to rise. Around day fourteen, but this can vary from like twelve to twenty days. Estrogen levels will surge and that causes another hormone LH to surge, and those two hormones surging is what triggers ovulation, okay, and then after ovulation, the egg is released from those ovaries,

it has to travel down the Filippian tube. And now you're in the next phase, or the luteal phase of your menstrual cycle. And what's happening during this phase is that where the egg was released from in your ovary develops into what's called the corpus ludium, and this secretes yet another hormone, progesterone, and so now it's also going to be secreting estrogen, but progesterone is going to rise much more than it has up to this point in

the cycle. So now you have steadily high progesterone and estrogen. This is going to prevent any further eggs from maturing. It's going to stabilize the lining of your uterus, that endometrium, so that if that egg is fertilized, it can implant in the endometrial lining and a pregnancy can take place. If that egg is not fertilized, then after fourteen days, that corpus lutium degenerates, essentially drone drops and the menstrual cycle starts over aka, you bleed from your vagina.

implantation of an embryo. In humans and a couple of other primate species four species of bats, one species of spiny mouse, and the elephant shrew. This process happens spontaneously. So the question is not why do we menstruate? We men stright because spontaneously every month, our uterus is like, hey, gotta build up this real thick lining, gotta get things ready before there's an egg that's been released, before there's an embryo that's been created, Like we do that for

no reason, just ready to get it ready. And we don't know exactly why that happens, but that is what then leads to menstruation. Yeah, isn't that fascinating?

We don't have solid answers to that question, okay, but it is all triggered by those specific hormones, right, So it's all hormonally driven, and that whole cycle of menstruation can last anywhere from like twenty five to thirty five days. And one thing that I think is important about that is that that variation in length occurs in follicular phase, so that first phase when the follicle is developing, not

during the luteal phase. So the period from ovulation to menstruation is almost always right about fourteen days, maybe twelve to fifteen. It's a much narrower window.

of synthetic progesterone. Ignore them all for now. Both of these in combination are then going to be present when you take this pill at higher levels than they would be during a normal follicular phase of your cycle. So what they do is, by the constant presence of a higher level of especially progesterone, you inhibit ovulation from ever occurring, right, because ovulation depends on a surge of estrogen, So a rapid increase in estrogen, which triggers a rapid increase in LH.

By having relatively higher levels of progesterone and estrogen, your body never sees that surge and therefore never ovulates.

so like breakthrough bleeding. And so it helps to regulate menstrual cycles because you can have like this constant level of estrogen and then you take it away for a certain number of days and then boom, you're going to shed that lining mm hm. And so that's kind of the most In the United States, that's the most commonly used form of contraception is the combined OCP. Now, these pills also do a few other things that become more

important in other forms of contraception. The presence of progesterone helps to thicken the cervical mucus. So remember the cervix is the bottom portion of the uterus. It's the top of the vaginal canal. So that's the entry way for sperm to get in to the uterus. So by thickening the mucus that's present there. It makes it really really difficult for sperm to actually get into the uterine cavity, and if sperm can't get in, then fertilization can't take place. Now, Aarin,

you said you've used the neuvera ring before. Have you ever used the patch?

blood clots. Now, a caveat is that the increased risk of blood clot by taking oral combined conscious reception is far less than the increase in risk of blood clot that you get by becoming pregnant, like right, way, way less, Okay.

just progestin. It usually is lower doses than the amount of progestin in combination pills, which I think is interesting. So, although they do help to inhibit ovulation, they do so a little less consistently than combination pills do, but they do a wonderful job of drastically changing the cervical mucus.

things that the progestin only pills do. It's better at inhibiting ovulation than progestin only pills, So deepot shots are really good at blocking ovulation so you're not going to ovulate. They're really great at changing the cervical mucus so that sperm can't get in, and deepo privera also remember that estrogen in the combined pill helps to stabilize the lining of the uterus so that you, you know, don't have breakthrough bleeding and you have like that kind of a thing.

With deepo privera and a lot of the progestin only contraceptives, it diminishes the proliferation of that uterus so that you're just not building up a lining to begin with. Yeah. The only downside with the deepot privera is that, unlike pretty much which every other form of contraception, fertility takes longer to increase back to baseline after you stop using it. And that's because it's so long acting, so it inhibits ovulation for a lot longer than the twelve to thirteen

weeks in which you should get your shots regularly. Okay, gotcha, Okay, And then we have my favorite. But these are all great options, and those are the long acting reversible contraceptions, Larks. There's two kinds. There's the IUD and there's the implant. Okay, gotcha, you know this already, erin.

it does all the same things to your cervix. And then finally there's the copper IUD, which is the only non hormonal form of birth control that I've talked about thus far, and that is a plastic T shaped little thing,

but it's covered in coils of copper white. I don't know who thought of this, it's incredible, But copper ions happen to cause inflammatory changes in the lining of your uterus, the endometrium that have spermicidal activity, so it kills the sperm if they make it into the uterus, and if that's not enough, if not all sperm die. These ions also block the activation of enzymes in the heads of sperm that are necessary for fertilization to take place.

with your hormones whatsoever. So the biggest side for a lot of people with copper IUDs is that they because you have this kind of constant inflammation in your uterus. It can lead to more bleeding. So if you already have really heavy periods, some people don't like the copper id because then they have heavier periods potentially. Okay, I want to sum it up a little bit and then

we'll talk about the effectiveness of all these different ones. Okay, Yeah, And actually I want to post this really great graphic that's from Reproductive access dot org that has all these different forms of contraception and their effectiveness with typical use. So in summary, we have the pills as well as the maneuvera ring and the patch. With perfect use, those options are actually like ninety eight ninety nine percent effective. They're super effective.

is about ninety six percent effective with typical use. Again, we're reaching over ninety eight ninety nine with perfect use, So that's if you got it exactly on time every time. The larks so iud's explan on these are over ninety nine percent effective. Wow, they are equivalent to a tubal ligation, so having your tubes tied in forms of effectiveness. And they are reversible and don't require surgery, and in the case of the implant it doesn't even require a pelvic exam.

not true. No, So an abortifatient is something that we can use to induce an abortion, So terminate a pregnancy after the point of implantation, right. Implantation in the wall of the uterus is the scientific and the legal definition of the start of pregnancy.

the United States without a prescription, male or female. By the way, they are most effective if they're taken as soon after an unprotected sexual encounter as possible, right.

My goal for this section is to try to understand how we got to where we are today by examining some of the past struggles for reproductive rights, particularly in terms of birth control, and then focusing more narrowly on the development of the hormonal birth control pill. Awesome, and a quick caveat before I begin. There are a million different ways to tell this story, but no one wants to sit here for a million years, and so I'm going to focus primarily on the US for birth control history.

And I would love to talk about the global history of each and every contraceptive, but nobody wants an episode that long. Nobody, Okay, So I think there's this common misconception that birth control methods emerged out of the twentieth century as a result of an increase in scientific technology and a loosening of the puritanical morals that had shaped many of our earlier policies and laws.

the scientists and doctors of the twentieth century. It was tested and practiced by women who passed their knowledge of folk medicine from generation to generation. Early in human history, when humans lived primarily in small nomadic groups, family size was really important because it was much easier to feed and pack up and move a small family compared to a large one, and so it's not surprising that these

groups regularly practiced various forms of contraception and abortion. And then, with the agricultural Revolution one of our favorite themes to discuss on the podcast, larger family sizes were not only more possible to support, but they were even economically advantageous because more people then could work the land.

not correspond to a loosening of those ideological standards. If anything, things became even stricter during the Victorian era, which sharply defined how proper women should behave, and there were moralistic policies such as the Comstock Law enacted in eighteen seventy three, which forbade sending obscene matter through US mail, including but not limited to birth control devices or even information about

birth control. What side note, And I know that like, this episode is long and I should probably just cut this, but I really wanted to tell you that the namesake of the law, Anthony Comstock, as a teenager, masturbated so obsessively that he thought he might be driven to suicide by it. And he blamed it on the magazines and postcards, the sexy magazines and postcards, and so he made it his life's mission to prevent their distribution.

at its outset, it opposed all methods of birth control. Devices, behavior and restraint were the only approved proper methods. But this movement also dared to suggest that women could be sexual subjects rather than objects, that women were capable of sexual desire for pleasure itself, not just to become pregnant. At the heart of it, the voluntary motherhood movement was about a woman's right to say no, to refuse her husband,

her wifely duty. And this movement, I know. And this movement was preceded by and already existing drop in birth rates in the US. So in the late seventeen hundreds, American women had on average eight live births one hundred. Yeah.

rather a suppression of that technology. Nevertheless, people found a way around that, for instance, euphemistic advertisements that warned Portuguese female pills not to be used during pregnancy, for they will cause miscarriage or stimulates menstruation when late or irregular. Those were hidden messages to those in the know. Yep, okay. So, rolling into the nineteen hundreds, morality ruled over medicine, at least in the US, physicians saw themselves as guardians over

the sexual purity of their patients. Gross, absolutely disgusting.

He advocated for a campaign for industrial health access to birth control, and requiring STI testing before marriage, which is problematic very There had been growing support for birth control throughout the US, including from the medical community, but the fact that the president of this moral respected institution was calling for the separation of sex and reproduction. Was both sort of this culmination of decades of debate as well as a revitalization of the birth control movement or what

would become the birth control movement. Okay, people were also simply talking about sex. More Ford's concept that sex was good and repression was bad had reached the US and had led people to question their assumptions about sex, and a new set of beliefs, unfortunately housed in the objective terminology of biology, began to take hold. Eugenics. Yeah, yeah, yeah, real quick, just in case people haven't heard of eugenics or have heard of it but don't know what it is.

It has really old roots, but the modern eugenics movement began around the late eighteen hundreds and was a set of beliefs or policies which stated that people can be classified as having either superior or inferior genetics like just incredibly subjectively, and that those deemed inferior should not be allowed to reproduce. If it sounds like Nazi talk, it's because it is. Nazis got many of their ideas from US eugenics policies.

in others. Essentially, who should be able to use birth control was a concern of the whole society and not for an individual to decide.

people of color, to have fewer. This is eugenics. Falling birth rates, particularly among the wealthier and more educated, was attributable to birth control because the most effective methods were the most expensive and required seeing a doctor, and so women using birth control were specifically condemned as selfish or displaying unladylike ambition, denying their true purpose in life, which

was motherhood. I know, rage noises, but this didn't result in the proponents of the birth control movement championing it as an inherent right of women to have agecies over their own bodies, nor were they shamed into giving it up. Rather, this resulted in an unfortunate alliance between the birth control movement and the eugenics movement.

you see. And it's important to note that the eugenics movement in the early nineteen hundreds in the US was not some fringe group. Was also global, like a lot of countries had eugenics you know movements. It was huge and it greatly acted policy. For instance, by nineteen fifteen, thirteen states had compulsory sterilization laws. By nineteen thirty two, twenty seven states had them.

Growing up, Sanger had been taught to speak her mind, and when she moved to New York City after finishing nursing school, she met people whose radical ideas at least radical during the time, would completely change her life, in particular the socialist leader Eugene Debs and the famous feminist Emma Goldman, who became her mentor and from whom she would learn so much more about the voluntary motherhood movement.

As a nurse in New York City, Sanger spent much of her time serving poverty stricken regions where there was a lot of overcrowding, there were high rates of infectious disease, and like no one was getting adequate nutrition, and one

experience in particular made a huge impact on Saanger. There was a woman named Sadie who had been told by her doctor that she shouldn't get pregnant again because she would likely die, and so as a solution, her doctor recommended that she sleep on the roof so her husband wouldn't bother her Sadie got pregnant because who's going to sleep on a roof for your whole life, and then died after an abortion attempt.

Of course, the Comstock Act prevented the distribution of many of these articles, and Sanger was arrested for her involvement, but instead of showing up to court, she skipped town went to Europe for a couple of years, where her radical education continued, and her time there also led to her narrowing her focus on contraceptives rather than women's liberation overall, which is sort of At the beginning, she was much more about equality in the workplace and equal rights, and

then she was persuaded to just focus on contraception. In the books I read for this, Sanger is described as being kind of in the right place at the right time time. She was a huge fighter. She was very outspoken, but this fight. The fight for access to contraceptive seemed to be simply waiting for a leader to head the charge. Sanger coined the term birth control in nineteen fifteen, and in nineteen sixteen she opened the first birth control clinic

in Brooklyn Wow. There, she and her sister and a team of nurses handed out condoms and what were essentially early diaphragms, and the clinic was under constant threat of closure because it was illegal, and it did get closed a few times. But Sanger wasn't discouraged easily, and for a few years she continued the operation of her birth control clinics and the grassroots movement to increase awareness of

birth control. But beginning in the nineteen twenties, she began to form some powerful allies with physicians, politicians, and eugenicists.

into big cities, becoming financially independent. The idea of hey, maybe I don't want kids right now and that's okay was becoming more and more common, and during this time eugenics fell out of favor in the US as it

rose to prominence in Nazi German. It was replaced or maybe just repackaged as population control, with both international and national programs offering incentives for those willing to have an IUD put in or to be sterilized, and finder's fees for those who could find someone willing to have either procedure done. But generally speaking, at least privately, people were finding that they didn't need as much of a justification

for birth control for themselves. World War Two and then the threat of nuclear holocaust during the Cold war lent a sort of you know, get it while getting's good vibe to the times, and Alfred Kinsey's titillating research began making headlines and got people talking even more about sex, even though his findings were super flawed and biased, but they were a crucial step forward in chipping away some of the shame associated with sex in the US, and

during these decades, Sanger was still hard at work on her goal of making birth control accessible to women. The first clinic from nineteen sixteen had grown into many more across the country, organized first as the American Birth Control League, which later became the Birth Control Federation of America, which then changed its name to the Planned Parenthood Federation of America in nineteen forty two.

She had also listed the help of a philanthropist and feminist named Catherine McCormick, who graduated from MIT in nineteen oh four with a biology degree, the second woman ever, I think, to graduate from MIT, and McCormick would essentially fund the entire creation of the pill, like it was basically all from her Wow. Sanger had approached researchers to try to realize her dream, but she was repeatedly turned down because it was disreputable work.

Worcester Foundation for Experimental Biology. After his meeting with Sanger, he realized that creating a birth control pill could not only get him the scientific respect he felt he deserved, but it would also earn him fame for tackling what he felt was a pressing global issue overpopulation. Agreed to look into the possibility of a birth control pill, and

he even knew where to start. Back in nineteen thirty seven, a few researchers from the University of Pennsylvania had published a paper titled The Effect of Progesterine and Progesterone on Ovulation in the rabbit, which described how progesterone injections could prevent ovulation. Pinkus and another researcher at the lab named M. C. Chang set out by first repeating the experiment described in the paper. Things went as expected, so then they started

to play around a bit. What if a progesterone pellet was lodged under the skin of the rabbit, And does this also work in rats who ovulate spontaneously like humans, as opposed to rabbits who ovulate after copulation? Yes, it does. Indeed, all told, things were looking very promising for Pinkus and Chang. The next step was simply to test out the procedure on humans, so Pinkus teamed up with a doctor who specialized in infertility named John Rock. Together, they sought out

dozens of women seeking help for difficulty in conceiving. They didn't tell them about the study that they were to be a part of, which was not required by US law at the time, nor did they ask for any kind of consent, nor did they pay the women.

The rest experienced things ranging from breast soreness, change in pigment or size of nipples, nausea, vomiting, vaginal discharge, increased or decrease libidos lactation, et cetera.

taken orally. But despite the initial promising results of the pill, Pinkus was still facing difficulties in retaining people in the study, so he decided to change things up a bit maybe instead of just like keeping people in the dark and not telling them anything about what they are involved with. What if we actually recruit women who want to try out a contraceptive pill. What a concept?

So he started to play around with combinations. So first he added an antacid or changed the dose, but it didn't really make a difference. And then he and Chang made a discovery the progestin that the company, the pharmacocal company Cyril had provided was actually contaminated by a small amount of estrogen and it had just slipped under the cracks, So that must be causing the side effects, right, So then when he gave women the pure progest in, nausea

and breakthrough bleeding became even worse. Okay, let's add a little bit of that estrogen back in. Too much and there'd be breast tenderness and nausea, too little on your back to breakthrough bleeding. Eventually he found a sweet spot. They were back on track to getting this pill to market. Cyril, the company that had produced the synthetic progestin, applied for FDA approval to market this birth control pill that they were calling Navid, but not for contraception, for infertility and

menstrual irregularities. Interesting mm hmm, And in July nineteen fifty seven, the first packs of Navid or a Novid I'm not really sure, were prescribed to women for those purposes, but also for whatever the doctor wanted to give them for. Yeah, that's how flabile use. Yeah, that's how it works, and so that included contraception. In nineteen fifty eight, there were still seventeen states in the US that had laws banning the sale, distribution, or advertisement of any kind of contraception.

In Massachusetts, where the pill was developed, it was a felony to sell or prescribe, or hand out or provide information about contraceptives. What uh huh oh, my gracious, but things were changing, and part of that change was not just the early signs of the sexual revolution, which I talked a little bit about in the Herpes episode. It was politicians realizing that their voters wanted access to birth control. It was also corporations like Cyril realizing how much profit

they could make through the legal sale of contraceptives. It was an untapped market, and socially, what had in previous decades been a moral majority had decreased to a small but vocal minority, largely made up of the Catholic Church. When articles published in popular magazines such as Time or Life highlighted the drug, there wasn't the roaring backlash that they had expected to accompany this news. They merely presented

this drug as almost a welcome innovation. Of course, these articles barely mention the side effects or long term safety, but following their publication, there was a rush for the pill. So by nineteen fifty nine, which is when anovid or novid is on the market only as a treatment for infertility or irregular periods, and estimated five hundred thousand women were taking the drug. Wow, so word it had gotten out.

Though there may not have been a lot of outcry directly on the pill's release, there was still plenty of debate about contraception in politics. Some advocated for funds to be used in international aid programs to supply contraception, which of course smacks of eugenics, particularly because in one proposal, for instance, the reasoning was that otherwise we face quote

communist political and economic domination. Oh my god, what gross. Meanwhile, the pill was up for approval at the FDA, not for its sale, which it already had, but to be able to advertise for it as a contraceptive pill as a birth control pill. This was a totally different process, and a very new one, because rather than the pill being used to treat a condition, it was being taken by healthy people, and so its safety standards were totally different.

The FDA agent handling their application took his time with it, a Lla Francis Kelsey. He wanted to know whether there was an elevated risk of cancer or blood clots associated with long term use, and so he decided to send out a questionnaire to sixty one doctors that had experienced prescribing the drug. Ultimately, even though some doctors said, I don't think it's ready. I think they are to many

side effects. The decision that most doctors came to was that the pill had far fewer side effects and was much safer than an unwanted pregnancy.

on May ninth, nineteen sixty Wow. Its use grew steadily, and within a few years it was not known as enevid but just the pill, which, with that simple name highlighting just how incredibly important it had become like the pill, the pill. I mean, everyone knows.

The pill simply gave them the choice. In nineteen seventy, women made up ten percent of first year law students and four percent of first year business students. In nineteen eighty, those numbers jumped up to thirty six percent and twenty eight percent.

how apparently in the Soviet Union this time. They tried to recreate the birth control pill there, but they didn't put enough resources into its development, and so there were some horrible side effects associated with it, and a lot of women confused that birth control pill with polidamide, and so they assumed that they were the same, and so the use of hormonal birth control pill like really dropped

and emotion became the main form of birth control. Oh wow, So she's still writing the thesis, but she said she's going to send it to us when she's done.

were to white women. Later analysis showed that there was disproportionate prescription of those forms of birth control pill between black people and white people, or people of color and white people. You know, like, that's and that's not even to mention the force sterilization of thousands upon thousands of

black and Native American women. Yes, and then there's some more bad news, so like the Dalkon Shield IUD scandal, in which many women were hospitalized or died due to infections related to that IUD, and it was pulled from

the market. That Dalkon Shield was pulled from the market much much like, way too long after it should have been, And this led to an enormous decline in other IUDs as well, out of fear of lawsuits and out of fear of the women who were like, well if I put this in here, am I gonna like is this going to hurt me? But throughout the nineteen seventies, there were some positive developments. In nineteen seventy two, the Supreme Court legalizes birth control for unmarried people Loretta lynbs I

know Loretta Lyn's song. The pill is released in nineteen seventy five, and sterilization procedures become stricter, requiring informed consent and a waiting period.

access contraceptives. The birth control movement became more about the individual rights of a woman to have agency over her body, rather than a tool for eugenics or population control. That's not to say that those perspectives are gone, nor should the origin story of the birth control movement be forgotten, but even more important to remember or pay attention to is the justifications that people use to restrict access to

birth control. Only when birth control became a representation of women's liberation and a woman's right to decide for herself what to do with her life and was no longer a justification for racist population control programs, did the outcry against it begin to grow. Think there's a very unusual timing there. Birth control doesn't go against nature. We have been practicing it four thousands upon thousands of years. Hormonal birth control pills mimic what our bodies do during pregnancy.

Why not a similar outcry against condoms? If there was a male birth control pill, would there be as much debate over whether it was natural or moral? I highly doubt it. Restriction of reproductive rights isn't about what's natural or healthy. It's about control. It's about putting people in boxes narrowly defined by those in charge. This pushback against reproductive rights has picked up a terrifying amount of momentum

in these past few years. Aaron, why don't you bring us up to speed on birth control today?

are okaying. There aren't a lot of non hormonal male contraceptive options that have really been under that advanced level of clinical investigation, so not large scale studies of those yet they're mostly in animal models.

date article. But in two thousand and eight to twenty twelve, there was a really long term phase two clinical trial of an injectible combination of testosterone and progestine, so a four year study that was to be very effective, and seventy four percent of male participants and eighty percent of their female partners said that they were satisfied or very satisfied with their birth control method, so this injectable, and eighty five and eighty eight percent, respectively said that they

would use this method of contraception if it was available. Now, the side effect profile included weight gain, changes in libido either increased or decreased, an increase in acne, an increased risk of hypertension so high blood pressure, and increases in abnormal liver function tests, as well as a slight increase in moderate to severe depression. Now, one thing to point out is that those are essentially exactly the same side

effects as female targeted combination oral contraceptive pills. Okay, Another thing to point out is that in this study only six percent of participants discontinued the study due to these side effects.

by hemorrhage. There are so many ways that you can die, blood clots, everything, Right, So in preventing pregnancy, you have a bit more risk that you might be willing to take before you exceed the benefit, if that makes sense. So your risk benefit profile is different when you are targeting females preventing pregnancy versus preventing males from getting somebody pregnant because they are not directly affected by pregnancy.

that's not the case. Combination oral contraception is the most common by far, and for a really long time, like you mentioned, especially after those lawsuits in the eighties, iud's got a really bad rap in the United States. But in the last few years, the rates of long acting

reversible contraception use has been steadily increasing. So in two thousand and eight, the overall LARK use was about six percent, and in twenty fourteen that had increased to fourteen percent, which is really incredible because again these are much more

effective forms of contraception. Okay, and over roughly that same time period, So from two thousand and eight to twenty eleven, when we saw this increase in long acting reversible contraception use, that is the first time in recent decades that the unintended pregnancy rate actually declined. Really, in twenty eleven, it had declined to forty five percent from fifty one percent in two thousand and eight. Huh, and twenty eleven is

the most recent data I could find on this. So that also means that forty five percent of pregnancies in this country are unintended, which either means unwanted or wanted later, like not wanted right now.

spent on contraceptive coverage. And if you take into account additional family planning services like STI screenings, HIV screenings, cervical cancer screenings, it's like thirteen billion dollars of saving by investing in family planning services.

probably remember everyone the Hobby Lobby case. Oh God, okay. In that case, the Supreme Court ruled in favor of Hobby Lobby in a five to four decision, saying that in a family owned company with particular religious beliefs, they

could deny coverage of their employees' contraception. Then in twenty eighteen, Trump issued an even broader ruling saying that almost any organization, including nonprofits, private companies, non governmental institutions, anyone who claims a religious or moral objection to birth control is not required to provide it to their employees. And here's what

I think is really important two things. First of all, under the original ACA, the original Affordable Care Act, religious entities like churches or mosques were already exempt from having to provide contraceptive coverage. So religiously affiliated nonprofit institutions like universities, hospitals,

and charities were not exacts empt. But under the original ACA, they could issue a formal request for exemption to the government or their insurance provider, so that it would be the insurance company itself that would have to front the cost and cover the contraceptives for employees. Okay, so like a religious university or hospital wouldn't have to pay for its employees to have birth control, but those employees could

still be covered directly from the insurance provider. But somehow that was considered unacceptable, and so this new Trump ruling insisted that these organizations had the right, based on religious or moral grounds, to completely deny access to contraceptive coverage for their employees. And in July of this year, the Supreme Court ruled essentially in favor and punted it back

to lower courts. Of this extremely broad base restriction. There were only two voices in dissent, and guess what they were, both women, shocking the late Justice, the late Justice Ruth

Bader Ginsburg and Justice Sonya Sodamayor. And what's very frustrating is not, I think just that this happened, but also that these companies were allowed to cite blatantly untrue statements as their reasoning for objecting to birth control, not only claiming that birth control itself is against their particular religious beliefs, but claiming that the forms of birth control they were objecting to are capable of destroying embryos and causing abortions, which is simply not true.

of the start of pregnancy. So yeah, not only are contraceptives not acting as abortive fashions, but access to contraceptive coverage reduces the rates of abortions.

neonatal outcomes, and again it reduces abortion rates. So there truly is no reason to hinder or block access to safe and effective, comprehensive Comprehensive that means all the options

that are available contraceptive coverage. So one of the things that we hoped to do in this episode was to provide you all with information about how these birth control options work because I think that that it's hard to know that information sometimes you know so because I know you care about the people in your life that can benefit from access to contraceptives and comprehensive reproductive healthcare. I think the most important thing that we all need to do is please vote.

And then finally, Our Bodies Ourselves dot org website has a brief history, a brief timeline of birth control, and so I extracted especially some of the later points from there.

link to a couple of their articles as well. You can find all of our sources from this episode and every single one of our episodes from all three seasons, that's sixty episodes on our website this podcast will kill You dot com.