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Birth Control Crash Course

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November 16, 2021

By: Soumya Jaiswal

The uterus is the least understood and most politicized organ in the human body. 

The explanation is quite predictable. Centuries of sexism and racism in medicine have manifested as little to no research being done on issues that have primarily affected women, especially women of color. In truth, the pill is prescribed for a slew of issues from acne to migraines to endometriosis to, of course, pregnancy prevention. According to Dr. Julia Lee, board-certified OB/GYN, the majority of doctors do not attempt diagnosing some uterine diseases because there is no treatment or plan of care in place that would differ from how the patient manages symptoms anyways — hormonal birth control. 

Healthcare in this country is not cheap. The average cost of a doctor’s appointment without healthcare is $160 according to a study done by the Johns Hopkins Bloomberg School of Public Health. That is over ten percent of the monthly income of someone living on the poverty line. The incredible science that has gone into modern medicine means nothing to the populations that are not able to access it. And if someone wants to try a few different types of birth control pills to find which works the best for them, that’s another doctor appointment each time. 

This is why the most equitable and convenient solution would be to make hormonal birth control pills available over the counter (OTC). People could easily save hundreds of dollars spent on doctor’s visits and purchase their birth control pills OTC anyways. Even with the little research done, more is known about birth control pills than a good chunk of what people can find available to them at drugstores (suspicious weight loss pills, anyone?). The cost of almost every hormonal birth control with insurance is zero dollars, but even without insurance can be as low as $7. It is also free for those who qualify for certain government programs such as Medicaid. 

Plan B emergency contraceptives and barrier contraceptives are already available OTC, so there is no good reason for hormonal contraceptives to be omitted from this list.  

Having open and honest discussions about birth control outside the doctor’s office is still stigmatized in most of the country. The deep-rooted hatred for abortion that exists in many conservative and religious communities often spills over into birth control use. However, the issue is not often about morality. Like abortion, there is a major knowledge gap in most of the general populace about how exactly birth control works and what it does to the body. Unless someone has experience with a certain type of birth control, it is safe to say they don’t know the ins and outs of how these pills work. 

Crash course: There are two types of birth control pills, combination pills, and mini pills. Combo pills contain estrogen and progestin in the active pills, which are the first three or so weeks in a monthly pack, while mini pills only contain progestin. These hormones keep the ovaries from releasing an egg into the uterus (thus- pregnancy prevention). They also thicken cervical mucus and limit the formation of the uterus lining, AKA endothelial tissue (which greatly decreases the symptoms of some uterine diseases). The last week of the pill pack will either not have anything, and you simply don’t take pills for a certain number of days, or it will have sugar pills that are a clearly different color and simply dissolve in your stomach like a tic-tac. During this time, the person will have a “period”. In reality, this is called withdrawal bleeding. It is the uterus’ response to the drop in hormone levels. An authentic period is a result of the built-up endothelial lining being shed, but someone on hormonal birth control never grew that lining in the first place. Thus, birth control periods are much lighter and last for fewer days (another major plus for many people). In fact, the first birth control pills developed did not even have a withdrawal week because it is not medically necessary, but feedback from many women at the time indicated that they liked the routine of having a period, so the sugar pill was added. The jury’s still out on that one. Once the current pill pack is finished, the next one can be started right away. 

As I said, unless someone has experience with a type of pill, is a medical professional, or is passionate about reproductive health (which is awesome!) odds are they don’t know how it works. But being able to see different types of hormonal birth control available, reading through their ingredients and instructions of use, seeing other people pick them up off the shelf to purchase- all of these can help further educate and destigmatize the use and existence of the pill. We could start seeing them in first aid kits with typical painkillers, school nurses might have some in their office — all of these small cultural practices can slowly build into transforming the way that we view birth control. 

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