In Our Control (25 page)

The past decades have changed this argument, nuancing it and sometimes rejecting it outright. Understanding these changes and the way that we see periods today provides a gateway for asking larger questions about the choices we make about sexuality, social roles, and ultimately, birth control.

Most women are familiar with the idea that menstruation is a “taboo” subject. For us this word means forbidden or proscribed, but it actually has a more specific meaning in anthropology, having to do with super-naturally sanctioned laws. Before the language of science and medicine claimed ultimate authority to speak about how people and bodies should and shouldn’t be, that kind of last word belonged to religion. With regard to periods, the term “taboo” is generally used to talk about various cultural practices that restrict or dictate female behavior during bleeding. Areas of study on this subject are too numerous to mention, running the gamut from African tribal restrictions on women entering the forest to cultures where women spend their menses in a communal hut to Jewish purity laws.

Historically, these taboos were seen as pure impositions of male power on female bodies. Men were afraid of women and their blood, so they controlled female behavior during menses. Thomas Buckley and Alma Gottlieb challenge more traditional notions of power dynamics in menstrual practice, arguing that women may have had more agency in the creation and maintenance of these rituals than previously imagined: “The possibility should not be ruled out that women themselves may have been responsible for originating the custom in many societies … There is also the possibility that such seclusion, when practiced, may sometimes in effect be voluntary, a cultural option to be exercised by women in their own interests rather than those of men.”
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Seen this way, women aren’t victims of cultural strictures, but rather pragmatic participants in them.

If a woman lives, for example, in a culture that believes that bleeding women endanger crops, she can use this misconception to rest from work for a few days. This is a complicated sort of power: it relies on negative beliefs about female bodies, but it nonetheless confers a certain amount of agency on exactly the community it is seeking to control. An example in our society would be a teenage girl who wants to obtain birth control pills. She may be reluctant to reveal her intention to have sex to either her parents or medical practitioner, but she has other strategies at her disposal. If she chooses to access language that medicalizes her period—saying, for example, that her cramps are intolerable—she may receive the pills she desires. This is a very limited means of gaining agency; it relies on manipulating existing ideas and structures rather than trying to forge new ones.

Another very useful distinction that Buckley and Gottlieb make is to break menstrual beliefs into categories, observing that some assume that bleeding women are a danger to their communities, while others hold that they are a danger to themselves. In the first case, menstruation puts women in a position of power and in the other, a place of vulnerability. While American cultural conversations about menstruation are usually framed in terms of the former, medical approaches to periods tend to make use of the latter.

Premenstrual Syndrome is an interesting area of overlap between these two ways of understanding female power. Women experiencing PMS are problematic, according to stereotypes, because they pose dangers (or more likely inconveniences) to others: they readily express anger at partners and coworkers, feel empowered to reject work, and engage in “unfeminine” behavior. In general, they destabilize gender expectations and traditional social roles. Medical responses, while acknowledging these concerns, also play on patient fears that they may “harm” themselves if they don’t pharmaceutically address their hormonal flux. Among other problems, medical accounts of PMS list depression as a major manifestation of the ailment, which can be managed with drugs ranging from antidepressants to birth control pills.

One example of this that held bigger lessons for all pharmaceutical consumers was the transformation of the antidepressant Prozac into the menstrual drug Sarafem. This story involves not only the smart rebranding of an aging and familiar pill, but the whole-cloth creation of an illness limited to the female population.

By the late 1990s, drug giant Eli Lilly was about to lose its patent on the blockbuster antidepressant Prozac. That means that the drug could be sold under its chemical name—fluoxetine—by other companies for less money. This represented a significant financial loss for the company, and to prevent this, they did some quick thinking. In 1998, Lilly hosted a roundtable of experts to discuss whether or not some women with particular symptoms during PMS actually had a disease.
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The panel included sixteen key experts, representatives from the FDA, and people from Lilly. The panel concluded that a disease dubbed “Premenstrual Disphoric Disorder” (PMDD) did exist and that Prozac could be used to treat it. By December of 1999, Lilly had FDA approval to market their drug for this purpose.

Lilly surprised everyone when they decided to completely rebrand the drug. Turning the pill pink and purple, they gave it a pretty, feminine new name—“Sarafem”—and embarked on a campaign to educate women not only about the pill, but about the disease itself. Because they had essentially created PMDD, women didn’t know they should be taking medication to treat it. Sarafem was chemically identical to Prozac, but after the latter became available generically and dropped in price, Sarafem was a lot more expensive.

What happened here makes important points about drug marketing, but also about cultural perceptions of PMS. Saying that Lilly and experts receiving money from that company “invented” PMDD does not mean that many women don’t suffer from debilitating PMS. Indeed some—although not most—women do struggle with more severe and disruptive monthly symptoms. The problem is that the “disease” was designed to fit a drug that already existed. By organizing the right symptoms and giving them a name, pharmaceutical makers also designed the cultural response to their new health problem. The pains, mood swings, and other symptoms that women experience are physical realities; the ways that Lilly and their experts train women to identify, understand, and respond to the problems are subjective and cultural.

This situation is particularly dangerous because the line between normal premenstrual symptoms and those severe enough to warrant pharmaceutical treatment are blurry. It isn’t like performing a test for strep throat. This lack of clarity has made it easy to suggest that healthy women would benefit from chemical management of normal monthly hormonal fluctuations.

This suggestion is not inconsistent with a culture that locates female difference (always already only a step away from disease) in PMS and menstruation. Instead of working to identify and address sexual and gender injustices, cultural conventional wisdom points the finger at women’s bodies. The problem isn’t a social system that privileges men over women; it is a pathological physical difference that can be treated with drugs.

Author Sophie Laws feels that the concept of taboo inaccurately describes modern Western ways of dealing with periods, preferring the idea that periods are ruled by etiquette. She points out that the rules we make—and break—today surrounding menstruation don’t have to do
with religion or the supernatural, but rather with social considerations. She defines etiquette as “rules of behavior governing social relations among people of distinct social statuses or classes,”
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and explains that etiquette works to maintain established roles by wielding the threat of social punishment. In other words, it is a way of behaving that both defines and maintains power relationships.

So what are the “rules” we follow when it comes to bleedings? For one thing, we are secretive about the process. Women go to great lengths to conceal menstrual products, especially after use. As discussed earlier, this is in part an effort to appear to the world as nonmenstruators. This silence extends to menstrual advertising, which never shows images of blood, opting instead for white, clean motifs and mysterious blue liquids. It also extends to everyday conversation. Laws notes that one of the most important pieces of etiquette involves who can and can’t initiate conversations about menstruation. Men are allowed to do so publicly, making jokes or other references to the process, but female speech on the subject is considered inappropriate except in the context of intimate relationships and same-sex environments. The fact that the most acceptable way to talk about periods in a co-ed setting is in the context of jokes and statements rife with gender kitsch is because these forms of speech reinforce traditional ideas about men and women; they don’t, in other words, threaten established power relationships between the sexes. The fact that men are the ones with the authority to initiate that speech further drives home the message that even when it comes to this indisputably female subject, they are still in charge.

The entire relational dynamic of menstruation functions, in Laws’s opinion, to “emphasize an image of women’s lives as circumscribed by men’s gaze.”
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In other words, the way that men and women relate to each other on this subject functions to remind women that male priorities and desires dictate many aspects of their lives. When bleeding, women are constantly aware of themselves and of the men around them, and by extension, of the terms of their relationships to these men: “Orientation to others, to one’s appearance rather than one’s own feelings, are of the essence.”
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How we make others feel becomes more important than how we feel. Laws is more explicit: “My view is that menstruation is used in our culture as the basis, the excuse, for a flexible and changing set of ideas and practices which reinforce men’s power over women.”
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Our cultural silence about menstruation is not only psychologically stifling, it can be dangerous, too. Karen Houppert, a former staff writer for the
Village Voice
, became publicly interested in menstruation for the first time when she went out to buy tampons. She discovered that Tambrands—one of the largest manufacturers of tampons at the time—had both raised the price of their product and reduced the number of tampons in a box by nearly a fourth.

Houppert’s frustration with the menstrual hygiene industry’s profits—an approximately two-billion-dollar-a-year
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behemoth that holds women worldwide hostage to its whims—grew into greater concerns about product safety and social perspectives. In 1995, she penned a
Village Voice
article called “Embarrassed to Death: The Hidden Dangers of the Tampon Industry” in which she argued that culturally enforced silence about all things bloody was putting women at risk by allowing the menstrual product industry to operate relatively unscrutinized. Women were so eager not to engage publicly with the subject of periods that crucial safety concerns were going unaddressed.

While the content of Houppert’s article was certainly controversial, the part of the piece that really got tempers flaring was the cover. “The picture,” she says, “looked like any of a dozen provocative ads for skin creams, perfumes or health clubs: a woman’s sexy lower torso in profile, smooth thighs and pert butt alluringly displayed. But here, peeking out from between the woman’s thighs, was a tampon string.” Not surprisingly, Houppert notes, “people freaked … They couldn’t get past the cover to the article inside.”
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The reaction to Houppert’s article functioned as literal proof of its content: important issues that affect the lives of most women could not be considered because the cultural imperative that menstruation remain invisible and private was too strong.

Breaking the Silence

I believe that both the enforced silence surrounding menstruation and the twentieth-century pressure women feel to pass as nonmenstruators have huge ramifications for choices about birth control. Just as menstrual concealment
produces a fantasy of bloodless womanhood, so hormonal birth control creates a cultural fiction of contraception without cost. Given the wide array of health problems and side effects associated with the treatments, these methods are in actuality free of repercussions only for men. Just as pads and tampons conceal blood, so the female body contains the real tolls exacted by hormonal contraceptives.

It is important to note that young women learn about birth control even as they are being inducted into proper menstrual behavior. Although sex and menstruation aren’t necessarily related, cultural messages regarding the two are often concordant. One of the many ways that culture, menstruation, and birth control come together is over the issue of teen sexuality. It has been well documented that average age at menarche—that is, the age at which a woman gets her first period—has been dropping over the past century. This may be for a number of reasons, including improved nutrition and greater exposure to environmental hormones and toxins. In 1976, physical development expert J. M. Tanner published an influential report in which he argued that the age at menarche was dropping by four months per decade. This otherwise unsensational report collided with growing cultural concern about adolescent sexuality and contributed to a rash of near hysterical newspaper headlines in various national publications.

Of course while menarche signals the ability to conceive children, it does not imply sexual activity. All of these breathless 1970s accounts of nubile preteens assumed a metaphorical alignment between menstruation and sex. The fact that the presence of a period indicates the absence of a pregnancy didn’t seem to make a dent in the argument: earlier periods meant earlier intercourse and more unwanted teen pregnancies.

Research on early adolescence again reared its head in the popular media in 1991 in a
Newsweek
article called “The End of Innocence.” While much had changed in American life, the article was remarkably similar to the ones published a decade and a half before. Both single and working mothers, those popular media villains, were implicated in pubescent precocity, along with some new culprits, such as the rise of HIV/AIDS. The language of the article is telling, noting that early periods and absent parents have combined to cause a “breakdown of authority.”
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If we dig into this, we see that several connections and analogies are being drawn: the
“breakdown” of the womb lining and the “breakdown” of the traditional family, premature bleeding and premature sex, and ultimately, the presence of menstrual bleeding and a threatened social order.