What you need to know:
- Widely viewed as one of the most significant medical advances of the 20th Century, the contraceptive pill was revolutionary when it first became available.
- Five decades on, the same problems facing earlier generations taking the contraceptive pill - weight gain, loss of libido and poor mental health – remain issues today.
Like other teenagers, 14-year-old Hailie Dall had painful periods. She sought help from her doctor, who gave her little information before prescribing the combined contraceptive pill (which contains a dose of synthetic oestrogen and progestin).
While the cramping disappeared, Dall says she experienced new ailments, this time from what she believed were side effects of the contraceptive; joint pain and tooth sensitivity. For six years, she took the pill, until one day last July. “What if I just stop taking my birth control pill?” Dall, now 20 years old, thought to herself.
Since then, Dall, who works part-time as a pharmacist technician and nanny in Philadelphia, says her periods have remained pain-free and she is more energised. Her tooth and joint pain issues have resolved themselves, too. In February, she filmed a TikTok video about her experience, where she has been documenting her day-to-day life for over a year.
Almost instantly, users flooded her video with comments, sharing their experiences on various birth control pills. Some said they experienced zero side effects, others talked about “hating” the way they feel. Many, like Dall, had quit entirely. Nearly one million people have viewed her TikTok video.
"I didn't think there were that many women who (also) just stopped...it felt so freeing,” Dall told The Fuller Project. “Why do all these women have to be forced on a pill when they're young teenagers and vulnerable?”
Widely viewed as one of the most significant medical advances of the 20th Century, the contraceptive pill was revolutionary when it first became available. In 1960, the Food and Drug Administration approved the pill as a contraceptive method in the US. A year later, it became available in the UK, Australia and New Zealand, ushering in an era of sexual, social and medical liberation. People now had a choice over how and when they got pregnant.
Yet five decades on, the same problems facing earlier generations taking the contraceptive pill - weight gain, loss of libido and poor mental health – remain issues today. As the pill’s 60th anniversary approaches outside of the US, young women and people with wombs are increasingly interrogating the lack of information doctors provide about side effects when prescribing the pill and calling for additional options, particularly non-hormonal alternatives.
"Women aren’t as willing anymore to put something in their body without questioning it,” says Sarah E. Hill, author of How the Pill Changes Everything: Your Brain on Birth Control.
"There’s now organic, unbleached tampons... I think it’s part of the same movement. Women have been given hormonal contraceptive pills that don't make us feel very good, we talk to our doctors and a lot of times we're dismissed. Women are fed up.”
Globally, the pill is still an extremely popular and effective contraceptive choice. An estimated 151 million people are currently on the pill (it offers 99 per cent efficacy against pregnancy when taken correctly). For women around the world, it’s the fourth most common choice of contraception after female sterilisation, condoms and the intrauterine device (IUD), commonly called a copper coil, according to estimates from the United Nations (UN).
In the UK and across the US, the pill remains the top form of contraception. But there has also been a decline in usage in those countries – seven per cent over five years, and nine per cent in the last 15 years, respectively, according to the NHS and the Kaiser Family Foundation – as more switch from the pill to long-acting reversible contraceptives (Larcs), such as the coil.
Across sub Saharan Africa, the contraceptive injection is the leading method of choice, followed in joint second place by the implant and male condoms then the pill, according to the UN. A similar picture emerges in Kenya, although Kenyan women who use birth control pills are most likely to switch to another method due to side effects or health concerns, according to the government demographic data from 2014, the latest available.
Yet for many, said side effects aren’t necessarily dramatic or all-consuming. At the age of 16, Jasmin Caviezel started taking the contraceptive pill. “I didn’t feel 100 per cent myself,” the 24-year-old said on phone. “But it wasn’t a big issue because maybe it was just me changing during puberty, right?”
It was only after she attended pharmacy school in Switzerland and studied the artificial hormones contained inside the pill that she felt more informed. “I felt so much better (after quitting), not like a robot just kind of moving through life. Women need better options,” said Caviezel.
In the UK, a 2016 research from the Family Planning Association found a worrying gap in contraception services, with a fifth of primary care doctors surveyed saying they didn’t offer the IUD or the intrauterine system (the hormonal version of the IUD) and almost a quarter saying they didn’t provide the implant. Over half said there was not enough time to walk patients through what methods were available.
"Women don’t have to take a pill every day – (there are) lots of different choices,” says Dr Mary Jane Minkin, a clinical professor in the Department of Obstetrics, Gynaecology, and Reproductive Sciences at Yale University’s School of Medicine. “I'd like to see people in the (medical) profession say, “Well, what about trying this instead? But young practitioners often haven't gotten as much training, and may not be as knowledgeable of the side effects.”
Society should think of the pill like any new technology, says Alice Pelton, co-founder of The Lowdown, an online reviewing platform similar to TripAdvisor, but for contraceptives, where women can read up on and rate their chosen method.
“Everyone got really excited about social media, then they started hating it and calling for regulation. I think it’s very similar,” she says in a phone interview from London. “We’ve seen the beginnings of a new wave, with things like (smartphone app) Natural Cycles, but we're still not seeing enough new technology coming out and frustration is building.”
Data is another issue. Scientists barely scratch the surface of studying the issues women and people with wombs face when taking the pill, let alone once they come off it, says Hill.
“It’s something we know almost nothing about,” she says. “The more information we have, the more we can give people a roadmap for what's going to happen, and predict how they're going to feel.”
In recent years, the explosion of fertility-tracking technology has highlighted the fact that growing numbers are looking to ditch hormonal contraception altogether. This is true for both Caviezel, who chose the copper IUD because it’s hormone-free (“It works for me,” she says) four and a half years ago, and Dall, who currently relies on male condoms with no plans to switch back.
Still, for many, the pill is the best and most effective option, they say. That some have the time and resources to think about quitting is a privilege, but not one we should avoid discussing, says Hill.
“The ability to regulate our fertility safely and effectively is by far the biggest women's rights issue out there,” she adds, “but we also need to recognise that talking and thinking critically about our hormonal birth control is the first step in designing something better.”
This story was published in partnership with The Fuller Project.