In Our Control (37 page)

I first went on a pill—I have no idea which one—when I was a senior in college. I had some menstrual irregularities and a doctor (he attempted to describe the menstruation process to me by using a lawn-mowing analogy—why he thought I didn’t understand it at age twenty-two, I have no idea) prescribed something to get me back on track. Whatever it was, it was horrible. I became a complete emotional basket case. I was on it for only a month, and it made me clingy, weepy, and just plain strange. Anyway, the experience has made me a little wary of birth control pills ever since.

Before I got married (last August), my husband (then, fiancé) and I had to decide what we would use once we got married. Since he is generally prone to avoiding medications of any kind, and due to my previous experience, we decided to go with something more “natural.” A friend of mine recommended FAM. I started learning about it, and I loved this method—it’s fun, for those who enjoy understanding the biology—and since my husband’s a scientist, he likes to learn a little about it too.

Here’s a big caveat, however: I cannot exactly be a poster child for this method. I, admittedly, have been almost exclusively using the temperature shift as a guide for fertility. Also, the method basically says, if you want to be “safe,” abstain from sex whenever you might be fertile, and use a condom at all other times if you are trying not to get pregnant. We didn’t really do that—instead we would use condoms when I suspected I was fertile, and nothing when I thought I was “safe.” That said, we got pregnant.

The mother-to-be adds thoughtfully, “The moral of my story is that if you really want to avoid getting pregnant, or at least have more control of your fertility, you should follow whatever method you use to the T. If you’re on a pill, take it every day at the right time. If you’re using more natural methods—do everything suggested.”

It should go without saying (but I will say it!) that any method of natural birth control should involve watching and observing your cycles for
a significant amount of time before you begin to rely on it for contraceptive purposes. This time should be measured in months—plural, multiple, many—if not years.

With this method, practice makes perfect. The more you chart and come to understand your body, the less likely you will be to make a mistake. Given this fact, many women wonder why training in fertility awareness from a noncontraceptive perspective (that is, to fully understand menstrual cycles and maintain good gynecological health) isn’t offered to younger women.

One of those people is Toni Weschler, who received hundreds of letters from women over the years asking why they didn’t receive this useful information when they were just starting to bleed instead of the same old talk about how to conceal and silence periods. Her response was a book that adapted FAM for the younger set, leaving out specific information on how to use the technique for birth control.
Cycle Savvy
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details the basics of menstruation and ovulation (and how to observe and track them) for girls ages fourteen and older. This sort of knowledge can aid, among other things, in helping to diagnose period problems without resorting to potentially dangerous early drug interventions. It can also help catch really serious problems, such as ovarian and reproductive cancers, before they become fatal. On a more basic level, it can take the fear out of normal but frightening events like spotting, sharp abdominal pains around menstruation, and of course, mysterious discharge.
Cycle Savvy
is a truly revolutionary book in the way it reimagines menstrual education: it assumes that young women should be given the tools to understand what is happening in their bodies, not just told that it is normal and handed a tampon. Or told they are not normal and put on the Pill.

Even in its redacted form, Weschler’s book caused controversy. Some women had tried various methods of FAM and had unexpected pregnancies. They didn’t want their daughters to suffer the same fate. Other, more usual suspects, simply didn’t want young women having too much information about either their bodies or sex. Janice Crouse, a senior fellow at the conservative Concerned Women for America’s Beverly LaHaye Institute, explains, “I think it is inappropriate. Instead, I think that we need high ideals for our teenagers, to teach them the value of self-control because those
are the disciplines that you need for your whole life. Providing this type of information says that teenagers are hostages to their hormones.”
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While there are many problems with this sort of thinking, the most obvious is that it relies on older models of “feminine” virtues, in which women are instructed in silence and self-control: like it or not, this thinking insists, biology is destiny. The second problem that it misconstrues the basic message of fertility awareness. In fact, it’s precisely when we fail to understand how hormones work that we become hostage to them. Not knowing why something in the body happens the way it does and living in fear of it is an awful sort of mental captivity. As journalist Catherine Price notes, “I’ve never bought the argument that if you give teenagers more information they’re going to run out and have more sex. I’d instead suggest that any girl who’s going to devote time to taking her temperature and checking out the daily position of her cervix is not the girl we need to be worrying about. We need to be worrying about keeping the ‘mysteries’ of the female body so mysterious that young women end up accidentally pregnant.”
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Researcher Beth Roth backs up this opinion, noting, “An adolescent girl’s lack of understanding of her menstrual cycle and inability to identify the fertile and infertile phases of her cycle directly contributes to contraceptive risk-taking behavior.”
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Concerns about a woman’s ability to understand and use fertility awareness are not limited to young women. Many adult women struggle to convince their partners that they are capable of successfully implementing the method. When I asked Katie Singer about broaching this sometimes difficult topic, she pointed out that men are fertile every day, but women only a handful of days each month. And yet most methods require women to bear the day-to-day burden of birth control. All the experts I consulted feel that FAM is a cooperative method and that male partners should be involved; in fact, they argue, it is the only method that requires both men and women participate.

The same sorts of conversations about personal responsibility, autonomy, and capability that are being had over dinner tables and in bedrooms are also happening publicly in clinical and educational settings around the world. As I sat through a presentation of contraceptive options from a young representative of Planned Parenthood last year, I marked the absence of any mention or acknowledgment of natural methods. This
absence was especially pronounced as the conversation included discussion of methods not currently marketed in the United States (Norplant) and methods with very low efficacy rates (contraceptive film). Why, I wondered, are fertility awareness techniques, whether you believe they work or not, so controversial that we can’t even discuss them? When women are forced to seek out information about FAM through backward channels and pass it along like contraband, is it any wonder that those who choose to practice it often stumble?

Part of the problem, of course, is distrust between Catholic groups and secular (often feminist) women’s health educators. While these alliances have been improving, they still leave much to be desired. Some of this problem is ideological: feminist educators have grown out of a tradition accustomed to fighting for broader contraceptive access, while conservative and Catholic powers were trying to foreclose options. Feminists look to expand access to methods to larger and more diverse groups of women, while Catholic groups often seek to tightly control who can receive contraceptive information and how they can get it. Marcos Arévalo of Georgetown writes, “Even the option of developing a referral system between family planning programs and NFP [natural family planning] NGOs is not possible in many settings because the ideological differences between the two severely limit the success of such a system.”
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Other problems are practical: it takes significantly longer to correctly train staff in how to teach FAM and longer still to convey the method to patients and clients. This difficulty is further compounded by the lack of resources for women who want to learn FAM. It is much easier to write a prescription for oral contraceptives.

The result of this is that communities of women who would greatly benefit from knowledge about FAM—particularly low-income women who struggle to afford expensive hormonal methods—cannot receive training or instruction. Indeed, for secular women, only those with enough money to pay for classes starting at a hundred dollars and up can get education in the few progressive fertility awareness centers that exist.

For many communities of women internationally, fertility awareness methods provide an option that is acceptable and easily accommodated to more traditional lifestyles. Nevertheless, many nonreligious organizations have favored educating physicians internationally in pharmaceutical
alternatives, even though these methods are often not readily used or accessed by many communities of women.

Many women who don’t choose FAM as a method of birth control would still benefit from learning how to chart and becoming familiar with their personal menstrual patterns. For one, observing your cycles will help you notice gynecological problems that range from the annoying to the life threatening: a greatly abridged list of these includes vaginal infections, abnormal bleeding, cervical and ovarian cysts, polycystic ovarian syndrome (PCOS), endometriosis, breast lumps, PMS, and even gynecological cancers. It gives us the tools to start learning about our complex hormonal cycles and comforts us with the knowledge that our private patterns are normal. In light of these many benefits, it seems unjust that most women are never schooled in these basics. And there is so much to know: there are multiple lifestyle changes that can help to normalize erratic periods, cut down on PMS, and basically alleviate period pain without drugs, including improving nutrition, avoiding environmental pollutants, and simply getting a good night’s sleep in a completely darkened room. Singer explains some of these and notes that simple changes can help to integrate many aspects of our increasingly fractured modern lives: “I’ve come to see how consumption of organic butter, my thyroid, hazardous waste in our oceans, my menstrual cramps, and my relationship with my partner are all connected.”
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If, as Singer says, most women aren’t even in preschool when it comes to their periods, perhaps doing a little charting is a good place to begin addressing this dearth of education. But most women will never get the chance. They will go on the Pill or another hormonal contraceptive and not look back until (for some of them) they are ready to have children. They will never wonder what their menstrual cycles could have taught them or if in getting rid of monthly cycles they lose something important.

Fertility awareness is still young. The challenge now is to integrate it with other available methods in discussions of contraceptive options. It offers women so many benefits beyond birth control. While many important questions about ease and efficacy linger, to let this valuable tool languish in the shadows as it has for so many years does not benefit women. To hold the past against a still-developing method limits knowledge and choices. Giving women the best information possible and letting them make their own decisions is truly the only way to achieve gender equality in medical care.

Chapter Nine
One Less? Facts and Fictions about HPV Vaccinations

The debate surrounding the HPV vaccine might be characterized by two slogans: “Just do it” versus “What’s the hurry?”
—Alan K. Cassels
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The news exploded in the world media during the summer of 2006: the world’s first anticancer vaccine had arrived. Gardasil, a shot that fights four forms of human papilloma virus (HPV), had been cleared by the FDA for use by American girls. Other countries raced to follow suit. If you were a woman, a doctor, or a parent at that time, you probably had an opinion about it. Most new vaccines are controversial, but Gardasil started a firestorm.

For many who had eagerly anticipated its debut, Gardasil was a wonder shot. For the first time, public health officials started to imagine a world where cervical cancer was all but eradicated. Women clamored to get their daughters vaccinated and potentially protect them from the suffering, and even untimely death, that cervical cancer could bring.

Amid all the elation there were dissenting voices. Almost from the beginning, parent groups, grassroots health advocacy organizations, and cautious doctors warned that the HPV vaccine was new and might not be either as effective or as safe as its makers dreamed. The discomfort stemmed from two issues: the speed with which Gardasil was embraced by health establishments and the strategies employed to ensure public compliance. Within months, Merck, the drug firm that created the shot, began an aggressive lobbying campaign to convince congresspeople and lawmakers to create mandatory school vaccination programs that would require middle-school girls to have the three-course series of shots as a condition of public school entry. Politicians, eager to win points with female voters as well as powerful lobbyists, sprang into action.

And then the young girls started to faint. Some experienced pain after
the vaccine was administered. Some even endured paralysis within weeks of getting the shot. Doctors—including Gardasil’s architect, Dr. Ian Frazer—were quick to suggest that the problem was simply nerves, hysterical schoolgirls inventing illness where there was none. Parents, however, were more concerned. Were they putting their daughters at risk or saving them from a dreaded fate? Women began to wonder why the drug was being tested—and in some cases forced—upon only female bodies. Why weren’t nations rushing to push the shot on boys as well?