"Girls, it was understood, were so wildly and indiscriminately fertile that just looking at an erect penis from across the room might result in pregnancy." Credit: Roberta Bayley/Redferns

June 12, 2023   7 mins

Davina McCall’s new special, Pill Revolution, starts with an eye-catching visual: McCall, wearing a red dress and a megawatt gameshow host’s grin, spins a giant roulette wheel labelled with all the potential side effects of hormonal birth control. A dizzying array of horrors flies across the screen — HAIR LOSS! BLEEDING! WEIGHT GAIN! BLOOD CLOT! — before the camera pans to the “contestants”, a trio of stuffed animals sitting above nametags that read: GUINEA PIG.

It’s not exactly subtle. And it’s not exactly misguided, either: in the Fifties, when Dr Gregory Pincus began testing an early prototype for the pill, his test cases were incarcerated, institutionalised, and impoverished women. In other words, women whose incapacitation and economic despair made them easy to take advantage of. It was a deplorable measure, in a desperate time: funding for birth-control research was banned by the US government until 1959, so Pincus’s work was supported by private donors, whose advocacy was directly downstream from an unsavoury enthusiasm for eugenics. For those funding the research, the pill represented a way to keep the wrong people from procreating. For the doctors who created it, the pill was an exciting scientific challenge.

That it would eventually emerge as a vehicle of female sexual liberation, one of the most socially important breakthroughs in medical history, was something neither party anticipated. While women’s bodies and biology were central to the science of the birth control pill, women themselves — not only the ones who served as guinea pigs, but also the ones who would eventually choose to take the pill — were treated as something of an afterthought. Pincus rather infamously wrote off his patients’ self-reported side effects — that same litany of problems featured on McCall’s wild spinning wheel — as the “psychogenic” products of an overactive imagination.

In short, McCall is right to suggest that the ubiquity of the birth control pill has come at the expense of women’s ability to express their concerns about it. And with Pill Revolution, she seems poised to usher in a new age of pill-related controversy: one centred on health concerns.

In this, she is unlike early critics of the pill, who were, of course, far more concerned with sexual morality than women’s wellbeing. Hormonal contraception has long been a source of consternation amongst conservatives, particularly the religious variety, who see it as a facilitator of consequence-free sexual intercourse. That loathing has little to do with the pill specifically — and more to do with a categorically antagonistic relationship toward non-procreative sex of all kinds — but it proved markedly influential in the public conversation about birth control.

For me, that influence was most clearly visible in the form of abstinence-focused sex education programmes, which were ubiquitous in American public schools in the Nineties — including the one I attended. Among other things, these classes were an exercise in institutionalised slut-shaming. Often, a piece of lint-covered Scotch tape would be brought out as a visual representation of how premarital sex ruined a woman’s ability to bond with her eventual husband. And with the primary goal of discouraging teens from doing it, the instruction we received in reproductive science verged on intentional disinformation. Girls, it was understood, were so wildly and indiscriminately fertile that just looking at an erect penis from across the room might result in pregnancy.

Birth control, meanwhile, was described as unreliable at best. Often, these programmes would tout inflated failure rates for various contraceptive methods — without ever mentioning that these numbers included pregnancies which resulted when a couple had birth control available but hadn’t actually bothered to use it. The pill, we were warned, was less than 90% effective — and that was assuming you could get past the stigma of being the kind of trollop who needed to take it in the first place.

The point, of course, was not education, but intimidation: to scare you away from sex until you were married and ready to procreate, at which point you would not be bothering with birth control. The conservative hostility to the pill rumbled along in the form of abstinence programmes and purity culture for years before reaching its contemporary apotheosis in 2012. After the US government moved to provide birth control to all women free of charge, Rush Limbaugh infamously suggested that women who supported this measure were akin to prostitutes demanding other people’s money so they could have sex.

But Limbaugh’s outburst was a swansong for the Right-wing war on contraception. And the new backlash against the pill, as embodied by programmes such as McCall’s, is fuelled less by conservative pearl-clutching about hook-up culture, and more by renewed concerns over its side effects — a full-circle return to the issues that plagued the pill in its infancy.

Among women who believe that the birth control pill has had a deleterious effect on their physical or mental health, there’s a palpable sense that the medical establishment has behaved irresponsibly, foisting powerful pharmaceuticals on them while dismissing their doubts as nonsense. “As young women, we’re just chucked on the pill and expected to get on with it — but when we go back with concerns, you don’t feel like you’re being heard,” McCall says, echoing a sentiment that comes up repeatedly throughout Pill Revolution. A few years ago, Sarah E. Hill’s book about How the Pill Changes Everything made a splash with similar points.

Whether you agree with their broader points or not, the women making this case are responding to decades of gaslighting by the medical establishment. McCall explains during her program that the weeklong break many women have from their birth control cycle each month is not medically necessary, but rather a product of the Fifties-era desire of scientists to create a contraceptive product that would not raise the hackles of the Catholic church. What she doesn’t mention is that it was also meant to quell the doubts of women themselves: when Pincus realised that the progesterone in his prototype pill would cause the complete cessation of the body’s normal menstrual cycle, he suspected women would find this alarming. His prescribed regimen — three weeks of hormonal contraceptives followed by one week’s worth of placebos — was designed to cause a monthly drop in hormone levels, resulting in the shedding of the uterine lining. It’s not a real period, but it looks and feels like one, creating the illusion that the body’s natural processes remain unaltered. If this mollified the Catholic church, it also sold women a bill of goods about the true impact of the pill on their bodies.

Two things are true. First: hormonal contraception has been unequivocally a tool of female empowerment. It gives women an unprecedented and invaluable level of control over their fertility, and, by extension, their lives. Second: the utility of the pill for women in general does not mean that it is right for every woman individually. And in the mad rush to celebrate hormonal contraception for the world-changing invention it is, some women have been silenced, and side-lined.

If the pill has been absurdly demonised by its detractors as the purview of “sluts” and “prostitutes”, its most avid proponents seem to view it with a reverence bordering on the deific. Pill Revolution began to raise alarms within the medical community well in advance of its airing. In the Daily Mail last week, Dr Philippa Kaye wrote that while “I welcome any initiative to promote or improve women’s wellbeing”, she “was left with concerns that women may be alarmed” by the suggestion that the pill might have mood-related side effects. Where the trad movement sees the popularity of the pill as a symbol of society in decline, the progressives among us warn that its disuse would be nothing less than catastrophic.

In an interesting example of the phenomenon the French describe as “les extrĂŞmes se touchent“, people on both sides of this issue seem to take a rather dim view of women themselves — of our ability to manage our lives, our bodies, our reproductive health. The anti-pill contingent, represented by old-school conservatives and tradfluencers alike, suggest that women are so seduced by the illusory freedom of artificially-induced infertility that they become like hedonistic children, squandering their fertile years on meaningless hook-ups and breakneck career advancement at the expense of society at large. Even more progressive sceptics — including the growing TikTok movement of self-described hormone coaches who advocate for #naturalbirthcontrol — seem to believe that women are so hopelessly manipulated by Big Pharma, and addled by contraceptive hormones, that they’ve lost all connection with their bodies.

And yet, the pro-pill side isn’t much better when it wrings its hands over the notion that women might choose not to take the pill and, hence, get pregnant. As if pregnancy is something that happens to women out of nowhere, without their knowledge or consent. As if they couldn’t possibly be trusted to weigh the costs and benefits of hormonal birth control and decide accordingly if they wish to use it.

Much is made in these conversations of the fact that so many pregnancies are unplanned — 45% in America, up to 30% in the UK — in a way that reminds me, oddly, of the way my high school sex ed programme used statistics to persuade us that birth control was futile and untrustworthy. These numbers raise the terrifying spectre of a world in which millions of women are giving birth to children against their will, eliding the fact that unplanned and unwanted are not necessarily the same thing. It’s hard not to notice that the tone of these debates — especially when they dovetail with the bigger, hairier question of women’s reproductive rights in general — has a way of crossing the line between staunchly feminist and outright anti-natalist.

As a woman still of an age to be at least ostensibly concerned about birth control, I personally still find the anti-pill folks more off-putting, whether they’re purity-obsessed religious scolds who want to scare and shame women away from having non-procreative sex, or the contemporary “RETVRN TO TRADITION” ones with a fetishistic fixation on women’s fertility.

And yet, I’m not convinced that certain pro-pill types — the ones whose vision of liberated womanhood seems to begin and end with free birth control and company-subsidised egg freezing, the better to avoid the pesky workplace interruption of a ticking biological clock — are the heroes we need, either. The loudest voices in this conversation leave little room for a middle way, one that empowers women to avoid pregnancy if they want to, but also supports them if they wish to become mothers.

No doubt the people who want to keep women puttering away in cubicles during their peak childbearing years believe that they’re offering a better, more feminist vision than the ones who want to keep them barefoot and pregnant. But both groups are ultimately seeking the same end: to exert control over women’s fertility, and by extension, over their destinies. On this front, at least, Davina McCall’s Pill Revolution is a welcome entry into the debate: a call for more research, more education, and better options for women than the one-size-fits-all contraceptive regimen favoured by medicine and society alike.

The topic of birth control has never not been fraught, but it has also long been dominated by men, whether they’re scoffing at women who complain of side effects or screaming at them for being sluts. Perhaps this new controversy — one that originates with women themselves and prioritises their concerns — represents something more than another skirmish in the contraceptive wars; perhaps it’s a way forward.

Kat Rosenfield is an UnHerd columnist and co-host of the Feminine Chaos podcast. Her latest novel is You Must Remember This.