September 2010

Bonnie B. Lee

nonfiction

In Our Control: The Complete Guide to Contraceptive Choices for Women by Laura Eldridge

Young women discover very quickly that navigating their sexuality is a perilous journey through treacherous and unforgiving waters. With whom, when, how soon, how often, even just how, not to mention the adjacent Scylla and Charybdis whirlpools of pregnancy/reproduction and femininity (and the proper expressions thereof) -- the rocky shoals are narrower and stretch on for longer than any of them have been prepared for. They are fifteenth-century Portuguese sailors in search of the Spice Islands who have ended up, bafflingly, in Argentina.

In Our Control: The Complete Guide to Contraceptive Choices for Women seeks not only to put women at the helm -- quite literally, in control of their sexual bodies -- but to provide a more accurately rendered map of the contraceptive and reproductive landscape. Laura Eldridge, a disciple of pioneering women’s health activist Barbara Seaman, expands upon her mentor’s lifelong work to better inform women of the risks and dangers of contraceptives in addition to championing their benefits.

Any discussion of contraception nowadays begins, and very often ends, with The Pill. Having just celebrated its fiftieth birthday, younger women may take for granted the easy accessibility of hormonal oral contraceptives, but pharmaceutically speaking, it is a recent invention whose longterm effects are still unknown. Only now is the first generation of women on The Pill reaching postmenopausal age. Although fifty years may be short in medical technology terms, it is a very long time for such a popular and widely prescribed drug to have been hardly improved upon or rigorously researched since its introduction. (Eldridge finds that newer is not always better; two recently released oral contraceptives, Yaz and Yasmin, have been tainted with lawsuits, false advertising claims, negligent trial methods, and even deaths, and the patch contraceptive’s fall from grace in the past five years was rightly precipitous.)

Many would argue that any drug, whether exclusively for women or not, comes with risks and side effects. Unfortunately, the emphasis on contraceptive development has been on what is suspiciously most profitable for drug makers, not on what meets the needs and lifestyles of female consumers. Thus women are subject to the marketing ploys of drug makers and vulnerable to their underlying messages packaged in girly, pastel-toned advertisements that shrewdly co-opt the very language of feminism and empowerment.

Some of these messages are more alarming than others. One such claim that underpins Seasonale and Lybrel is that menstruation is such a debilitating and inconvenient nuisance that it should be eliminated entirely. Early in the reproductive rights movement, the medicalization of the female body was a boon that granted greater access to contraceptive options in the privacy of a doctor’s office and shed the issue of moral implications and shielded reproductive choice from social scrutiny. Now, the medicalization of the female body has produced science that seems to negate a woman’s body altogether. As difficult as a monthly cycle may be for some, studies show that the majority of women would be more uncomfortable having absolutely no periods at all. Such drugs treat what is central to mature womanhood as essentially a disease that can be cured.

Though Eldridge is careful not to advocate for one option over another, she stresses the advantages of largely unexplored nonhormonal barrier methods. It is a testament to the success of oral contraceptive advertisers that women feel the only longterm option available to them is a hormonal one, The Pill, and that it is unquestionably safe. Whither the diaphragm, or the sponge? These options are not as profitable for makers but are more affordable for consumers and can be extremely effective in pregnancy prevention when used properly.

Eldridge isn’t just out to suckerpunch and dropkick the big, bad, Big Pharma Monster, though. So much of current medical knowledge of fertility and menstruation are tangled with social assumptions about women (PMS is one such example) that it becomes impossible to separate them out, further complicating our understanding of contraception but highlighting the need for more discussion and more pressure regarding safety, research, and product development.

What Eldridge rightly points out is that discussions of contraceptive methods (versus those of other prescription drugs as say, Lipitor or Zyrtec) are particularly hazardous to women for all the surrounding issues they activate, underscore, or even explode -- those issues, that is, that starkly highlight gender difference and inequality. Such discussions have frustratingly inevitable moral overtones in an American context. No, more birth control options do not promote promiscuity, and limiting options clearly does not reduce teen pregnancy rates. Birth control is not just for "loose" young single women in college or the city but for those in committed relationships or for those who are family planning, or perimenopausal, among other reasons. I wonder that these things need to be explained and stated aloud over and over again; I also wonder if those same polemicists even care to listen.

But perhaps pregnancy prevention is not what is most centrally at stake for those who talk about contraceptives (as opposed to those who use them). Concurrent with the increased presence of women in universities, workplaces, and authority positions, The Pill underscored a deep mid-century anxiety about the extent of woman’s power -- and man’s place beside her. Such heightened social tensions found their expressions (still do) in reproductive rights, making a woman’s body the battleground for social concerns that are abstracted and distanced from any individual’s health.

This is just one thesis of many explored in Eldridge’s cogent and tightly presented book. In Our Control feels particularly germane here and now, in America, where sex education varies wildly and is based largely on the accident of where you happened to attend public school. Eldridge’s book combines serious digging through medical journal articles with first-person interviews of anonymous everywomen. A woman’s knowledge of contraception, and sexuality in general, can be mostly sourced to the anecdotal experiences shared in a private setting amongst friends, and the rest back to a state-mandated junior high health class. Eldridge expands that circle of intimates, broadening our knowledge and indirectly, our experiences by filling in where medical research so far has been silent or absent or inconclusively contradictory. According to Eldridge, more choice is irrefutably better, but what constitutes the best or most desirable contraceptive is not always clear, especially when those very choices have so many attendant and unpublicized hazards. The needs of different populations across America, not just of the young and unmarried, and of populations in various parts of the world, are all relevant in this highly important discussion that Eldridge capably presents. This is an issue that touches everyone, everywhere, including men.  

Eldridge’s book is extensively researched and footnoted, not shying away (thankfully) from scientific terminology and precise chemical structures. Eldridge isn’t a scientist, but a woman doesn’t have to be a biochemist or a medical doctor to be better informed of what she puts into her body, and ultimately, how it affects her. Though it may appear to be a handbook or reference guide, In Our Control delves into history, science, politics, popular culture, current affairs, and notions of modernity and femininity in densely informational but highly accessible prose. Many intelligent young women shrink from the “feminist” label, but Eldridge is a young, bright exemplar of modern femininity who continues the important journey of her map-charting forebears.

In Our Control: The Complete Guide to Contraceptive Choices for Women by Laura Eldridge
Seven Stories Press
ISBN: 1583229078
512 Pages