After 50 years, the birth-control pill battle goes on

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      When Tony Bailey has sex, he likes “to feel every human touch, rather than prophylactic plastic”. And he said his girlfriends also like to feel their own responses, their own hormones, without the synthetic progesterone and estrogen key to the oral contraceptive pill, which can also fatten them up, tenderize their boobs, and make them crazy.

      Bailey is a 39-year-old Vancouver nightclub doorman, a personal trainer, and an ex–CFL defensive end. He likes to have sex—athletic sex—with his girlfriends. He’s been doing this for 20 years, and in that time has slept with “many dozens of women”.

      In the living room of his Killarney-area home, which is stocked with Buddhas, mirrors, candles, and erotica books, he told the Georgia Straight that, in his experience, women are shockingly bad at protecting themselves against pregnancy.

      “I noticed a big change in the mid-1990s,” Bailey said as he sat on his carpet, building a power sled—a piece of fitness equipment designed to “develop the explosive leg drive required for an elite performance”, according to touchdownskills.com/. “In the early ’90s, all my girlfriends were on the pill. Then people started to be more conscious about what they were putting into their bodies, and they didn’t want all those hormones. Women want sex to feel natural too.”

      Bailey’s sexual history includes a few partners who took the morning-after pill and one who had his child, now aged four.

      In any other year, such a statement wouldn’t be as significant. But this spring, Canada celebrates 50 years since the first birth-control pill, Enovid, was legalized. Back in 1960, it was the first piece of contraceptive technology that offered reliable pregnancy prevention, ease of use, and relative safety. Though it was not legal as birth control until 1969, many Canadian women used the “menstrual regulator” off-label to prevent pregnancy.

      In June, Prime Minister Stephen Harper will become president of the G8, a position he plans to use to highlight maternal and child health in the developing world. He’s under pressure from the Liberals, the NDP, and international aid groups to include contraception and safe abortions as part of that package.

      But Canada is hardly a model for effective contraceptive use. According to statistics, we’re a defective public-health role model.

      Greg Smith, executive director of the Vancouver-based Options for Sexual Health, says it’s generally accepted that as many as half of the pregnancies in this country are unintended.

      Considering the pill’s effectiveness and ease of use, it’s surprising that just one in five childbearing-age Canadian women with a sexual partner is on the pill, according to statistics from the UN publication World Contraceptive Use 2009. The report states that all methods, including traditional methods such as withdrawal and rhythm, give this category of women a birth-control use rate of just 74 percent.

      Teen pregnancy isn’t rare. Statistics Canada reported that in 2002—the latest year for which figures were available—girls aged 15 to 19 had a pregnancy rate of about 34 out of 1,000. More tellingly, there were about 35 abortions per 100 live births in B.C.

      As outrageous as Bailey’s statements might seem to public-health officials, his candour is to be admired, because he’s clearly not alone.

      It wasn’t supposed to be like this. Back in the 1930s, when family-planning pioneers were lobbying for access to birth control, proponents believed it would lead to women having complete control over their fertility and an end to abortions, according to Angus McLaren and Arlene Tigar McLaren’s book The Bedroom and the State: The Changing Practices and Politics of Contraception and Abortion in Canada, 1880–1997 (Oxford University Press, 1997).

      But half a century after the legalization of the pill, Canada seems unable to stem unintended pregnancies. Neither has the rest of the world. Each year, 75 million people are added to the global population—a number the United Nations claims would be reduced by three-quarters if contraception and abortion were available worldwide.

      Yet the frontline conversations about population don’t happen at G8 summits. Ground zero is Bailey’s bedroom.

      “Why not use condoms and the pill? Because people want to be human,” Bailey said. “They don’t want pills. They want to feel natural. They want sex to feel natural.”¦I don’t think people trust the pill fully, and the side effects for women have been harsh.”

      Why haven’t young Canadians latched on to their opportunity to shut out unintended pregnancies?

      The first time Options for Sexual Health’s Smith had sex, he was a 19-year-old university student celebrating Canada’s centennial on July 1, 1967. That was two years before birth control was legally available in Canada, and 21 years before abortion became easily accessible.

      His girlfriend got pregnant immediately. They were married six weeks later. Now, as the executive director of Options (formerly the Planned Parenthood Association of B.C.), Smith helps young people access contraception, the morning-after pill, and abortions—services he couldn’t get at their age.

      “Today’s young women were born after the pill and abortion became legal,” Smith told the Straight in his Hastings Street office across from Kootenay Loop. He said there’s been a shift away from the pill recently and toward nonhormonal methods of birth control.

      “They have no idea how much effort went into the battle to make these [the pill] available. Maybe they think it was always there. There’s been a loss of a sense of ownership in the struggle.”

      Unintended-pregnancy rates remain high in Canada, Smith said, because of bad policy. Conservative school boards keep sex education abstinence-based. As for boys, he said, sex educators are, so far, unwilling to answer their most basic question: “How do I do it well?” Until that gets taken seriously as part of sex ed, Smith said, most boys won’t be interested in hearing about the risks.

      Jolanta Scott-Parker, executive director of the Canadian Federation for Sexual Health, also told the Straight in a phone interview that she blames “systemic barriers” to contraception. Among them, she said, are the cost of the birth-control pill, which can be up to $30 a month; poor sexual education; and power imbalances in relationships.

      “Until we reach a place where power and control dynamics do not play out in relationships,” Scott-Parker wrote in an earlier e-mail, “there will still be occasions where contraception and/or protection is not used due to a lack of ability to exercise that protection.”

      That’s not it, says Ana-Maria Orb, a public-health nurse who runs the Youth Pregnancy and Parenting Program for Vancouver Coastal Health. The women she sees, mostly teens, have access to free birth-control pills, morning-after pills, and condoms through a number of clinics, as well as good sexual-health education through their schools, and they still get pregnant.

      “I often ask new participants, ”˜Tell me more; what were you thinking?’ ” Orb told the Straight in a phone interview. “I don’t hear about a lot of contraceptive failure. They say they didn’t think it [pregnancy] was going to happen to them. I think it’s a choice [to knowingly engage in risky behaviour].”

      Smith is very familiar with this wishy-washy contraceptive uptake—what falls between the services offered and what people actually do. When asked, he said he “isn’t sure” what best contraceptive practices Canada has to offer the rest of the world. “We’re good at science, at epidemiology,” he said. “We can deliver care in remote settings. We have well-trained physicians, though they still don’t get enough sexual and reproductive-health education. We still have work to do here.”

      Orb, too, doesn’t think more services and education are necessarily the answer. But she does know her program sees only the “tip of the iceberg” of all teen pregnancies in this city. The rest, she said, are aborted.

      In Canada, Orb pointed out, her clients get to make choices about contraception. That freedom wasn’t available here two generations ago—as Smith experienced—and isn’t available to many of her clients’ peers in the developing world. But if Harper heeds the advice of his political foes, it may be.

      It was a losing battle on March 23 in the House of Commons. Liberal MP Bob Rae tabled a motion to push Stephen Harper to offer contraception to the developing world as part of the maternal-health plan he’s presenting to the G8. If the motion had passed, the plan might have extended many of the same contraceptive rights Canadians enjoy.

      “This is a challenge of our time,” Rae declared in the House, referring to what he called the global “circle of death” caused by poverty, ill health, and poor nutrition. Later on, he said: “What we all see and have all known in our own lives as a moment of extraordinary happiness, which is the arrival of a child, instead for some is a moment of tragedy, a cause of hardship, of children being abandoned [due to maternal death], and they, in turn, die in these circumstances.”

      Access to contraception, he argued, is a key difference between Canada’s overall healthy moms and the frequent tragedy experienced in the developing world linked to reproduction.

      After an all-day debate, the motion was defeated 144-138. Although Minister of International Cooperation Bev Oda said the government is open to including contraception in the package, its inclusion is not as yet guaranteed. On April 26, she explicitly stated that the program would not fund abortion.

      Contraception as a human-rights tool and a population controller really works. Each year, family planning in the developing world prevents 187 million unintended pregnancies, 105 million abortions, 2.7 million infant deaths, and 685,000 children from losing their mothers in pregnancy and childbirth, according to Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, a 2009 report by the United Nations Population Fund and the Guttmacher Institute.

      If funding for contraception (excluding abortion) were doubled, the report suggests, an additional 52 million unintended pregnancies would be prevented. Canada has not yet committed to this. Instead, Oda said the initiative will focus on clean water, nutrition, and general health care.

      The defeat in the House of Commons is incomprehensible to Katherine McDonald.

      As the executive director of Action Canada for Population and Development, she’s on the offensive this month, lobbying the Harper government to include contraception in the G8’s work on maternal health.

      It’s so obvious, she said, that maternal health is tied directly to contraceptive technologies, including the pill.

      “It’s cheap,” she told the Straight in a phone interview from Toronto. “But currently, we’re without the political will at the national level. The sad thing is, contraception in and of itself is not controversial. Even in the Catholic countries, you get to the ground level and you see the nuns handing out condoms.”

      To McDonald, this isn’t just a faraway tragedy. It’s personal.

      In 1972, at 18, McDonald met a draft-dodger named “Spaghetti” in her hometown of Halifax. She got pregnant. At the time, birth control was newly legal and abortion could be performed for “therapeutic” reasons only. Adoption was an option, but she qualified for both welfare and a student loan (something that’s no longer allowed)—enough to make it through a four-year undergrad degree and law school.

      Now she’s a human-rights lawyer. Dylan, her son, is 37.

      “I was a teenage welfare mother,” McDonald said. “But it worked out because of the supports we had in Canada. That’s why I do this work.”

      To McDonald, this is a human-rights issue. She wants women in the developing world to enjoy the same supports Canadians do.

      However, her organization doesn’t pressure countries to put a lid on population growth, she said, as this can lead to human-rights abuses such as forced sterilizations and abortions.

      But early Greenpeace activist Rex Weyler will. If we could prevent all unintended births internationally, he said, the global population would start to shrink.

      Weyler recently helped organize De-Growth Vancouver, a conference on the importance of shrinking the economy, consumer culture, and population.

      Each year, he explained in a phone interview, the world’s population grows by about 75 million (about 130 million births annually, minus about 55 million deaths), or 35 cities the size of Greater Vancouver. That’s an unsustainable burden on the Earth, he said, and it’s easily avoidable. He also said that out of the 130 million there are about 80 million unintended births each year.

      Eliminate those pregnancies through better access to contraception, and the planet might just make it because our population would start going down.

      “Environmental groups don’t like talking about reducing population because it points the finger at the developing world,” he said. “They like to blame the overconsumption of the rich. It’s true, but it’s not the whole story. Population growth is also a problem.” In terms of the environment, globally available contraception provides the biggest bang for the buck, according to Fewer Emitters, Lower Emissions, Less Cost, a 2009 study out of the London School of Economics. The authors calculated that preventing all unwanted births between 2010 and 2050 would save one billion tonnes of carbon emissions, for a cost of $7 per tonne. That’s cheaper than switching to wind power ($24 per tonne), hybrid vehicles ($92 per tonne), and electric vehicles ($131 per tonne).

      What does this have to do with Canada, where the fertility rate—the number of children per woman of childbearing age—is only about 1.5?

      According to Weyler, everything. The natural drive to have sex, he said, is responsible for population growth among humans. When the drive for sexual pleasure trumps the drive to use contraception, each baby represents new greenhouse-gas emissions. And he takes issue with Bailey’s nonchalant attitude toward birth control.

      “Here’s a person [Bailey] who’s not willing to sacrifice even a marginal piece of the fun for the larger picture.”¦We have to somehow find the solution to this natural drive to overreproduce,” Weyler argued.

      How do we stop mindless procreation? Weyler suggested making contraception cool, like the ecology movement did with recycling in the 1980s. But he also knows the drive to have sex is stronger than the drive to be cool.

      “It’s troubling,” he said. “I’m not sure how to solve that.”

      He’s not the only one scratching his head.

      What sets Canadians apart from those in the developing world is this: we can afford to miss a pill or ditch a condom and still have a fertility rate well below the replacement rate. In large part, that’s because of our splendid access to the morning-after pill and abortion, according to Marina Morrow, codirector of the Institute for Critical Studies in Gender and Health at SFU.

      “I’ve been thinking a lot about Harper’s recent statements,” she told the Straight in a phone interview. “His position is a blow against women’s reproductive choice, and it will result in more women dying from unsafe abortions.”

      Canada stands as a lone beacon in terms of one particular reproductive right: this is the only democratic country, Morrow said, with no legal constraints on abortion. It’s one of the safest medical procedures, she noted, and it’s even considered an essential service here.

      Refusing to offer abortions, she said, drives women to undergo unsafe surgeries at a rate of about 20 million a year, according to the UN. The Adding It Up report noted that offering safe abortion—for example, as part of the G8 package—could save the lives of 53,000 women a year.

      In other words, if a Canadian woman gets pregnant, she isn’t risking death. In many countries, those who have sex can’t take that for granted.

      In the House of Commons, the Conservatives have shut the door on the possibility that Harper’s G8 presidency will be used to extend abortion rights to the developing world. But for contraception, they’re opening it a crack. Will that be enough?

      When he hosts the upcoming G8 meeting in Muskoka, Ontario, Harper must decide whether or not to offer the rights to family planning that Canadians enjoy and sometimes ignore, in spite of our privilege—or because of it.

      “This is something we’ve been dealing with since the beginning of time: how to have sex and not make babies,” Bailey reflected.

      In the developing world, some political will could only help.

      Comments

      4 Comments

      Anonymous

      May 9, 2010 at 12:16pm

      Interesting article... I just wonder about three things: 1- How does Bailey manage not to get HIV or if he has it, not to pass it on? 2- How can his girlfriends, knowing that he has and had so many sex partners at the same time, not be concerned with getting HIV (or stds)? 3- Instead of getting an abortion, which is health and psychologically damaging, why aren't these Canadian women who don't want to use the pills getting an IUD? This birth control method is cheap (costs $100-200 for 10 years), efficient (except in some rare cases) and has no (or low) side effects - I had two IUDs in the last 15 years... awesome!!! But it must be inserted by a doctor and you have to use it cleverly and watch out for HIV, herpes and other stds. Like the pills, it is safer when combined with a condom... that we like it or not!
      More info at: http://www.emedicinehealth.com/birth_control_intrauterine_devices_iuds/a...

      0 0Rating: 0

      R. Coppin

      May 10, 2010 at 7:24pm

      You didn't mention that 'the pill' became the first drug in the U.S. to come with full labels and FDA-approved warnings and contraindications. It was a case that went before a congressional committee because doctors weren't adequately describing the risks of taking 'the pill' to women, and a group of activists managed to force the issue.

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      Karen C.

      May 10, 2010 at 9:14pm

      Yes why don't people get an IUD? I used to take the pill but it made me moody and depressed and affected my sex drive. I love my $80 copper hormone free IUD.

      0 0Rating: 0

      Sohalia

      Dec 13, 2010 at 12:42pm

      I don't know - the options are unfortunate. Have a device permanently inserted inside of you, or take pills that cause awful side effects, anything from weight gain to fatigue, mood swings and low sex-drive. But men complain because they have to wear a condom?? Please. I'm so torn because I was on the pill before and I want the safety and security of it, but I don't want to feel like I did - so different from my normal self, tired all the time, prone to yeast infections and worse. Ugh.