by Jane Bennett, published in Byron Child, April 2006

The Oral Contraceptive Pill is currently taken by hundreds of millions of women worldwide. In fact, the Pill is so closely associated with contraception these days that 'the Pill' is often assumed as a synonym for contraception. It's heralded as the great liberator - but at what cost?

Since 1960 when the first oral contraceptive pill, Enovid, was approved for sale by the US Food and Drug Administration the hopes, the power and the controversies of the Pill has often reached mythic proportions. Lets have a look at some of these.

Myth #1: The advent of the Pill in the 1960s heralded real liberation for women from the shackles of unwanted pregnancy and childrearing.

By the time the first oral contraceptive pill was made available, middle class, educated, married women of the Western world were already managing their fertility reasonably well with the improved mechanical methods already available. We were no longer having large families of twelve or thirteen children - unless we wanted to. Due to the social mores of the time information about, and access to, contraception was largely only available to married women.

Following the back-home-to-have-babies fifties after the end of the Second World War, the sixties (and seventies) saw the powerful push of women's liberation on all fronts: in work, in education, in law, in relationships, in control over, and information about, our own bodies, and in availability of contraception. That the Pill has become the symbol of all this has vastly simplified and diminished this complex and revolutionary social movement.

Although the development of oral contraception was driven and funded by grave concern about overpopulation, especially of the burgeoning populations of the Third World (the Nobel Laureate Frederick Robbins, speaking about oral contraception, told an audience at a meeting of the American Association of Medical Colleges, 'The dangers of overpopulation are so great that we may have to use certain techniques of conception control that may entail considerable risk to the individual woman.'), the vast commercial potential of the Pill was noted, and heavily promoted to doctors and women alike.

The promise of a 'magic pill' and greater 'convenience' was irresistible for millions of Western women who remain the population most likely to be on the Pill. It was promoted in the 1960s as the way a progressive 'modern' woman would manage her fertility.

Exposing modern misrepresentations of the Pill, a recent study for the Inspector General's Office of the US Department of Health and Human Services, disclosed that more than 70% of oral contraceptive advertising to doctors is 'misleading or unbalanced' - making contraceptives the most 'deceptively advertised' category of prescription drug, with antibiotics in second place.

Myth #2: The Pill remains the most effective form of contraception available, and the only real choice for women wanting to manage their fertility responsibly. (For brevity's sake we can include here other forms of synthetic hormonal contraception like injectables, implants, hormone releasing IUDs, vaginal rings and transdermal patches.)

Although many women take the Pill so as to be free of concern about pregnancy, no form of contraception is, of course, 100% effective. Generally the statistics for the Pill quote 99% effectiveness (96% for the mini-pill). This means that of one hundred women on the Pill for twelve months one is expected to get pregnant. These are the theoretical rates and many factors reduce this effectiveness in the real world.

For instance:

The effectiveness rate for typical use of the Pill (i.e. how its used in real life) is around 94%. A number of other forms of contraception (non-chemical) are equally effective.

Perhaps more important than relative effectiveness rates is understanding the characteristics of different methods of contraception, being well-informed as to how to use them properly, practicing open communication and mutual responsibility for contraception in a relationship, and making informed choices according to lifestyle, age and stage of life and health.

The convenience of simply taking a little pill every day to manage fertility is for many women the Pill's most attractive feature. However chemical methods of contraception profoundly disturb our biochemistry, our physiology and brain chemistry, as well as our menstrual cycle, so that this apparent convenience comes with considerable cost that must be paid for in compromised health, sexuality and, often, fertility later on.

The interplay of sex hormones naturally occurring throughout the menstrual cycle has a complex and intimate relationship with all organs and bodily functions. Peer-reviewed literature of health professionals and researchers continues to reveal complex associations of oestrogen, progesterone, testosterone, androstenedione, and DHEA(S) that play significant roles in maintaining the cascade of physiological events that promote healthy bone metabolism, nutritional uptake, sexual interest and response, and cardiovascular function, as well as adequate sleep and energy cycles, and so on.

It is interesting to note how powerful sex hormones are and how little is needed for healthy human functioning. Hormones are generally measured in parts per trillion , and in order to collect a teaspoon of oestradiol, the most prolific oestrogen in womens' bodies, we would need to distil the blood of 250,000 women of childbearing age (not on the Pill).

Simply put, the Pill interferes with, and flattens, the natural cyclic rise and fall of sex hormones and works, ironically, by suspending our bodies in a perpetual state of false early pregnancy.

Amongst other effects of the Pill on health and sexuality some common impacts are:

• depression (For instance: a study by The Royal Alfred Hospital, Melbourne, published in February 2005, found that women taking oral contraceptive pills are almost twice as likely to be depressed than those not on the Pill. A British study found that of female suicides a significantly higher proportion were on the Pill than the general population, of comparable age.)

• weight gain

• nausea

• loss of libido (For instance: a recent American study by Dr Claudia Panzer, an endocrinologist in Denver, Colorado and published in the Journal of Sexual Medicine found that a chemical produced by the Pill to stop ovulation continues to suppress testosterone levels - central to desire in men and women - for up to a year after women stop taking it. In this seven-year study women on the Pill were found to have four times the level of sex-hormone binding globulin (SHBG), which stops testosterone from circulating in the body, as those who had never taken the pill. Twelve months after ceasing use of the Pill women had twice as much of the chemical in their bodies as those who had never used oral contraception.)

• headaches and migraine.

Undoubtedly, effective contraception is of fundamental concern for heterosexual women, and their partners, and impacts profoundly on their capacity to enjoy and explore sexuality. The Pill has attracted, by accident or design, certain mythic qualities, which vastly overrate its real capacities, and highlights our tendency to pursue 'convenience' without understanding at what expense this is bought.

It behoves us to seek accurate information about all available contraception (admittedly sometimes hard to come by) and decide which method(s) to use after carefully considering our current needs, our health, our relationship and our lifestyle. When impacting something as important as our fertility, our sexuality and our relationships some deep and soulful consideration honours more realistically this complex and unfolding area of our life. Through conscious and ongoing choice we allay unbidden complications bursting through the veil of convenience later on. Within this framework of truly informed choice the Pill can more realistically take its place amongst other chemical, mechanical, and natural methods of contraception available.

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