The Business of Birth Control Explores the Deeply Complicated Past, Present & Future of the Pill

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When the first birth control pill hit the market in 1960 it was considered revolutionary. A liberation for women. They were emancipated from the bondage of their child bearing bodies and able to assert autonomy over their wombs to take back control of their lives. Now, more than 60 years since the first iteration of the pill was approved, there has been little to no innovation in the area of contraception to meet the needs of today’s modern users.

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These are the stakes laid out in a new documentary film from director Abby Epstein and executive producer Ricki Lake. The team behind 2008s The Business of Being Born is back with The Business of Birth Control. The new film, streaming in the U.S. and Canada, explores the history of of birth control from its eugenicist beginnings, the well documented side effects of anxiety, depression, and death, as well as how holistic feminism and reproductive justice movements demand more than just access to abortion and contraception.

SheKnows spoke with Epstein days before the streaming release of the film. She said the spark to pursue the second The Business Of . . . documentary came when she received an advanced copy of Holly Grigg-Spall’s 2013 book Sweetening The Pill: Or How We Got Hooked on Hormonal Birth Control.

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“I read her book on a plane, flying out to Ricki’s house in LA and it was just light bulbs going off the whole book and I was like, “Holy sh—, like this story hasn’t been told,” Epstein said.

The 90 minute film begins by explaining that in the before times only married women could get a diaphragm and only with the consent of their husbands. With the release of the pill women were able to take back that control. CDC records show nearly 65 percent of women in the United States use some form of birth control.

Since 1960 the birth control market has become a multi-billion dollar business. It is no longer solely advertised for preventing pregnancy. The film notes that birth control is pushed as a lifestyle drug with 35 percent of women being prescribed the pill for non-contraceptive reasons. A supposed cure all for everything from heavy menstrual cycles to PMS, acne to anxiety.

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In reality, the side effects of hormonal birth control include anxiety and depression, clitoral shrinkage, painful sex, blood clots and more.

It is this point where the film’s stakes are highest because the blood clots linked to hormonal birth control can be and have been deadly.

“If you look at how many women die every year, it’s like about two airplanes, like two 737s going down,” Epstein said. “If you’ve talked to most women and talk about a blood clot, it doesn’t even sound that serious. What’s a blood clot? You don’t understand that this little something that starts in your calf muscle can shoot up to your heart and kill you in five seconds. Five seconds!”

Between three and four hundred women die every year from hormonal birth control. Interviewed in the film are the surviving parents and family members of women who died from blood clots linked specifically to Yaz, Yazmin, and Nuva Ring. Included in the film is footage from the congressional hearings where it was determined that these products were safe. Such hearings have been happening since the 70s when the first generation of birth control pill users complained about the side effects.

Suicidal ideation and suicide, stroke, diabetes, and heart attacks are all side effects of hormonal birth control. Other side effects include conditions such as endometriosis, PCOS (polycystic ovary syndrome) and fibroids; an issue that affects Black women at a rate two to three times more than white women.

Gessie Thompson, a nutritionist featured in the film said one of the underlying causes for all three of these conditions is the birth control pill.

Thompson is one of several Black women featured in the documentary speaking to the intersectionality of how modern gynecology and the science behind birth control are rooted in the suffering of, the experimentation on, and the humiliation of Black and brown women. It is also noted in the film that the current reproductive justice movement was initiated and is being led by Black women with credit going to the work of Loretta Ross in the 1990s.

Epstein noted the history of segregation within the feminist movement. It is the reason some Black women consider themselves womanists (a term coined by literary icon Alice Walker, author of The Color Purple) than feminists. However Epstein does believe the two causes are coming together to work collaboratively toward the same end goal.

“I can’t say that white women and women of color are impacted by the system in the same way. We know that’s not true. But I think that there’s a common ground that we’re finding and I think what we need to realize is that nothing is going to change from within this system, ever.”

In finding common ground and working for collective change Epstein said the goal of the documentary is education, information, access, and options.

People need to be educated about how hormonal birth control works and what it does to their bodies including the adverse side effects which include death.
That information needs to be readily available and not written in medical jargon in a pamphlet folded and tucked inside the birth control packaging.

Epstein and others in the film advocate for black box warnings similar to what’s on a cigarette box to prominently warn women of the risks of hormonal birth control, but they know that is a long shot.

People need to have easy access to birth control.
People need to understand that they have more options than hormonal birth control including copper IUDs or using the Fertility Awareness Method — which requires a woman to track her menstrual and ovulation cycles to understand which days they are truly fertile.

By advocating in this way, Epstein argues that women and people with vulvas could finally force a systems change in the way they are treated. At the moment there is no incentive to do so.

“If millions and millions and millions are taking this pill and using the products that are on the market, and NuvaRing is making $600 million a year, then why fix it?”

Without the education and information many women aren’t fully aware of their options and think they may only have access to one kind of contraception. That’s not true. What is true is that women have been sold a product they may not like, but take anyway because they believe they have no other options. This has created a multi-billion dollar industry reticent to change because the prevailing argument is, What else are they gonna do?

The answer: advocate.

Epstein said, “You’ve got to figure out what’s a fit for you and not give in to fear or pressure that you’ve got to be on something.”

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