by Ann Regentin
(10/27/04)

This is all to the good. Condoms are inexpensive, readily available, and do their double-duty of preventing conception and disease transmission quite well. As a first line of defense, they're hard to beat. The problem is that there comes a time in most heterosexual relationships when a greater degree of intimacy is desired. Condoms are a good solution, but an imperfect one. Skin to skin feels much better, and not just to men. A lot of women can also tell the difference.

The easy reaction is for her to go on the Pill, which has gotten a lot safer in the last few decades, but the Pill is another imperfect solution. A lot of medical conditions or medications can contraindicate its use, and some women simply react badly to it. For example, women who smoke should not take it. The Pill is not a panacea, and there should be other options.

There are, but the list of them is awfully familiar. The diaphragm and cervical cap, spermicide, and the IUD -- this is pretty much the same stuff that was around back in the 70s. Is it really possible that there have been no advances in contraceptive technology in the last thirty years?

There have been, in fact, many advances in birth control, both in terms of what is available and how it can be obtained. Variations on the diaphragm and cervical cap, made of silicone instead of latex, are now available without prescription, and hormonal birth control has a much wider variety of delivery systems, some of which have small enough doses of hormones so that women who are unable to take the Pill can use them. Norplant didn't work out very well, but there are now variations, such as patches, a vaginal ring, and even a hormone-releasing IUD. IUDs in general are much safer and are, in fact, the most popular form of reversible contraception in the world. Spermicides, too, have come a long way, with new formulations and delivery methods. It might be pretty much the same old stuff, but like condoms, the newer generation of contraceptives offers a wider variety of options. So why worry?

Because most of these advances have been made outside of the United States, and many are not readily available here.

The Mirena IUD, which delivers low-dose, topical hormones directly to the uterine lining, was developed and used in Europe for several years before it was used in the United States. The silicone barriers, too, were developed in Europe and are often hard to find in America. While the Today contraceptive sponge was off the market, Canada and Europe stepped up to the plate with the Protectaid and Pharmatex sponges, arguably considerable improvements in more ways than one. They require no preparation (no wetting) before insertion and even may provide some protection against sexually transmitted disease. No plans are being made to introduce the Protectaid sponge, at least, into the American market; neither sponge is FDA approved. An IUD that, like the Mirena, releases a low-dose hormone into the uterus but takes up less space and is usually better tolerated, is not available in the United States at all.

The pharmaceutical companies blame the litigation that followed some of their more disastrous offerings, such as the Dalkon Shield, for their reluctance to put more effort into birth control. There were some hefty damages paid out, but behind some of that litigation was incomplete research, or a certain amount of fudging to get a product through FDA approval. However, nothing was done to find a middle ground that offered protection to both the corporations and consumers, and birth control research was dismissed as too risky to undertake.

Another popular culprit is market trends. Again, according to the pharmaceutical companies, there isn't enough market to support innovation. Now that the baby boomers, who fueled the research boom in the 1970s, no longer need contraception, the perception is that nobody else does, either, or at least there is no need for anything new. Why spend millions on research and development when what's on the market seems to be working? With no perceived demand, there's no reason to put effort into supply.

Although both arguments have merit, they are not enough to explain the near-halt of contraceptive research in America. Other countries have dealt with lawsuits over side-effects, and with changing demographics, and those countries are still coming up with, if not a lot of radical new products, at least significant improvements on the old ones. The idea that American women are somehow different in their contraceptive needs than women in Canada and Europe is absurd, especially in light of the fact that some European companies have seen enough of a demand in this country to go through the trouble and expense of getting their products approved for use here. So what's really going on?

The argument about reproductive choice in America tends to center on abortion, and "pro-choice" activists seem to see it as a sort of Holy Grail. As long as abortion remains legal, the reasoning goes, women's right to control their fertility remains intact.

On the "pro-life" side, however, there's an entirely different point of view. It's not just abortion of a developing fetus that must go, but any contraceptive that might interfere with the implantation of a fertilized egg, which is, to many of their minds, a form of abortion. This means that "pro-life" activists are often looking beyond overturning Roe v. Wade, and into eliminating all hormonal, and many mechanical, methods of birth control. They aren't just trying to outlaw abortion, they are also trying to outlaw the methods of contraception most likely to prevent unwanted pregnancy.

Others take it to even greater extremes. In 1996, Gracie Hsu of the Family Research Council was quoted in The Scientist as saying, "I believe our position would be that we oppose federal funding. When contraception is introduced into a relationship, it has a possibility of breaking down a marital bond, because it could be used outside marriage." In other words, the only good birth control is no birth control.

There are a number of people who share this vision, and thanks to conservative activists, federal funding for research on new forms of birth control has dropped precipitously since the 1980s. So has the number of major corporations working on research and development, from at least nine to only one. FDA approval for reproductive technology is often stalled or denied. The dearth of options isn't a matter of inertia; it's the result of a persistent, well-financed campaign to achieve that very end.

A classic example of how all of this plays out in practice is the Today contraceptive sponge. When it was first introduced to the market in 1983, it rapidly became one of the most popular over-the-counter birth control options. It was easy to see why. It was discreet, comfortable, and allowed for a great deal of spontaneity.

When a 1994 FDA inspection of a New Jersey plant revealed bacterial contamination in the manufacturing process, the company simply stopped production, rather than upgrade their facility. There wasn't enough market to make it worthwhile, they said. Women all over America behaved like Elaine on Seinfeld, buying and hoarding what few sponges they could find, effectively contradicting the claims about the market. Almost ten years later, the Today sponge, redeveloped and retested, is still waiting for FDA approval, even though its safety and effectiveness were never questioned.

Because of fairly liberal import laws, it's possible to get all three sponges via the Internet, but that's not the same as having them on the shelves in America, and the sponge problem is only one symptom of a wide-spread disease. Funding for family planning, as well as research and development, is being slashed. Teens are being denied access to information, as well as contraception, via "abstinence only" sex education programs. A so-called moral stance that is not supported by research has kept emergency contraception from being available without a prescription, rendering it useless in many cases, since women cannot always manage to see a doctor within five days. Even more chilling, an increasing number of doctors are refusing to prescribe the Pill, and an increasing number of pharmacists are refusing to fill prescriptions for it. Access to birth control in this country isn't merely stagnant, it's backsliding.

The question of reproductive choice isn't a personal issue; it's a societal one. The overall well-being of any culture is closely linked to the status of women, and the status of women depends on their freedom to plan when, how, and with whom to have children. That freedom does not hinge on Roe v. Wade alone. The right to abortion on demand is only one part the right of a woman to decide how to express herself sexually and when to reproduce. The ability to prevent unwanted pregnancy is at least as important as the ability to terminate it, and as with abortion, the fact that a thing is legal does not mean that it's obtainable. In America at least, contraception is getting increasingly difficult to obtain.

The fight is no longer about abortion, but about freedom of conscience and quality of life. Sexual freedom isn't just about gay rights or alternative lifestyles anymore. The rights of all of us to love on our own terms are being eaten away a lot faster than we seem to think. The Pill isn't enough. We need more and better methods of preventing pregnancy, but because of our complacency, we have already lost much of our hope of ever getting anything new. If we don't do something soon, we risk losing the options we now take for granted.

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