The pill is still a girl's best friend

Risks from oral contraception never match the drama of the scare stories, argues Polly Toynbee
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The Independent Online
The pill panic is on, again. Yesterday the Committee on Safety of Medicines warned that seven brands of low-dose oral contraceptive carry a greater risk of thrombosis than other types. We have been here before, and no doubt we will be here again. In the darker corners of our cultural undergrowth there lurks a powerful puritanical instinct, eager to believe that the pill is bad for you, it will kill you - in effect, you will die of the promiscuity that the pill precipitated in the Sixties. The Pope said the same about syphilis when it first swept across Europe. Homophobes said it about Aids in the Eighties: death and disease are the wages of sex.

But there is far more to fear from fear itself. The previous major pill scare in 1983 was followed a few months later by a high peak of unwanted pregnancies and abortions, mainly in the 16 to 29 age group. Pregnant women are still more than twice as likely to get a thrombosis as women who have been taking any of the seven contraceptive pills implicated yesterday.

It was a big panic about thrombosis that led women in 1977 to move from high-dose to such low-dose pills, in the correct belief that they offered a lower risk. Yesterday's report shows that one group of the low-dose pills carries less risk than another. However, the fact is that more women may be put at greater risk of thrombosis as a result of another anti-pill panic. A million and a half women take these seven low-dose pills. Thirty out of every 100,000 of them will get a venous thrombosis - some 450 women in all. But the risk of death from that is exceedingly low: 1 per cent, or four to five women a year.

While this does represent nearly double the risk of other forms of contraceptive pill, and six times that for women not on any oral contraceptive, the pill has other health benefits, less often stressed than its risks. Taking it for even a relatively short period of time gives an increased long- term protection against endometrial and ovarian cancers. The benefits of this protection far outweigh the risks of thrombosis, even of those more dangerous pills listed yesterday. Ovarian cancer is the most common gynaecological cancer: 6,000 women are diagnosed with it every year and about 4,300 die of it. The pill halves the risk of getting ovarian cancer and this protective effect lasts for 15 years after ceasing to take it.

A quarter of all women of child-bearing age rely on the pill, and the great majority of them are in the younger age groups, who suffer least risk of thrombosis - though it increases if they smoke. Sterilisation is a slightly more popular method of contraception: 12 per cent of women and 12 per cent of men, mainly in their mid-thirties and upwards, choose this more drastic method. Seventeen per cent rely on the condom, 5 per cent on the IUD.

Over the years since the pill was first made widely available, there has been a host of scare stories. Some have been well-founded, based on serious research, as with yesterday's report. The problem is often not with the research but with the way it is presented, giving women very little chance to assess this minor risk in their lives against other far greater hazards.

But other reports, such as the two studies published in the Lancet that set off the 1983 scare, have not been substantiated by later research. Those two linked pill use with breast and cervical cancer. The cervical study has since been more or less dismissed. Conflicting research failed to prove an association with breast cancer, but to be on the safe side the Family Planning Association advises doctors to mention a "possible but unproven connection".

Some pill panics have been trivial, ill-researched frighteners gleaned by headline-hungry newspapers from obscure reports. The trouble with medical scares in the press is that they tend to linger, a vague, unanswered worry rattling about in the back of the mind, never quite refuted or confirmed, except perhaps in the small print of specialist medical publications that don't reach the public eye.

How many false alarms can you think of over the years about the causes of cancer, cot-death, schizophrenia or spina bifida which made a splash on the day, but then faded away, unresolved? The mythology of the pill is littered with these shadowy fears and factoids, half-remembered headlines, rumour, gossip, supposition and superstition.

It used to be said knowingly, for instance, that it is not a good idea to stay on the pill for many years without a break. Especially where women started taking it in their teens, the word was that they might risk infertility, the natural rythm of their bodies would be destroyed for ever. Nature is not mocked, goes the notion, and if you mess with it too violently for too long, it will retaliate.

Not so. That is a theory long since discredited. The Family Planning Association asserts confidently that for healthy non-smoking women there is no clear reason not to take the pill right up to the menopause.

Every time there is a panic, the use of the pill drops. It reached an all-time high of 29 per cent before the first thrombosis scare and dipped to 22 per cent in the mid-Eighties. It remains, however, the most popular contraceptive method by far among the young, who favour it because it is so easy, and so unproblematical - sex without the awkwardness of revealing premeditated intent. No strings, nothing need be said or done, sex without embarrassment.

But it is precisely this simplicity that worries people. As the Sunday Telegraph pronounced during the 1983 scare: "There is no such thing as a free lunch ... Mother Nature wants to cool our hot little heels over the pill, ticking us off with a warning that it is not a green light for licence." That underlying feeling permeates the glee with which the media fall upon anti-pill stories, while conspicuously failing to give front- page headlines to the studies that have shown its beneficial effects.

Women themselves these days tend to fear the pill because it feels unnatural. Gross hormonal interference with the rythms of the body goes against the grain in an age when people flock to natural remedies, homeopathic medicines, herbal teas and anything labelled "whole" and "organic".

Men have always feared the pill because it gave women their freedom. Nervously, men joked about it and pretended it gave them freedom for unbridled rapacious sex, but in truth it was women's sexuality that was liberated by it. Fear of pregnancy and all the social constructs that entailed kept women in their submissive social place. The Pill is women's best friend, and it is time they learned to overcome their mistrust and love it as they should.

Each new scare deserves to be taken seriously, but it needs to be put into proper perspective. It is quite wrong to think Mother Nature knows best. In matters of women's fertility, she is the enemy.

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