How the Pill Changes Everything: Your Brain on Birth Control by Dr Sarah E. Hill packs a punch. This is the kind of modern medicine I live for.
Every woman with a period should read this. Or anyone living with someone with a period. And anyone who gives medical advice and treatment to those with periods.
Because this book is a deep-dive into how a very specific, localised problem is treated with a very broad solution that affects everything.
Using the pill to fix limited and specific issues (like preventing pregnancy or clearing up skin) isn’t a very targeted approach, since the pill fundamentally changes how your brain works.
And sometimes those effects are irrevocable. These effects are discussed a lot less than they should be, because the onus on preventing pregnancy falls largely on women.
Within the patriarchy, getting pregnant is, after all, a woman’s problem. It’s not like women not having control over their own reproductive rights has any detrimental effects on society, right? Right?! (Hint: that was sarcasm and it absolutely has a cascading effect on society, but that’s a topic for another day.)
Yes, this book is in the context of birth control and all the many ways in which being on the pill affects the whole system (your body) and not just your periods, but through this lens Dr Hill gives us a thorough rundown of how the system that is the female body works in the first place.
One of my favourite things was “you are your gametes”.
A gamete is a reproductive cell of an animal or plant. In animals, female gametes are called ova or egg cells, and male gametes are called sperm.
As Dr Hill explains in the book, you either have large, expensive gametes (women) or small, inexpensive gametes (men). And though we aren’t defined solely by our gametes, they do play a large part in shaping human behaviour.
Because that’s how we’ve gotten this far.
Women are born with all of their gametes and don’t make new ones. They are a finite resource.
And because a woman has already invested a lot of energy and resources into her eggs upfront, she is more selective about what she does with them. This includes being selective about who she agrees to have sex with.
For a woman, allowing a pregnancy to take place is a risky and costly process even before it has begun. Then during the pregnancy, many things can go wrong, and she’s not only risking the life of the unborn child, but also her own.
The time, energy and effort required doesn’t end with the birth, because when the pregnancy is successfully concluded, there is the offspring to take care of. A helpless human child that is utterly dependant on caretakers to survive (I’ve written about this before).
Putting people in the world is a fucking hard job, and is not without side-effects (stress, anxiety, post-partum depression, complications etc.).
Men, on the other hand, continually produce new gametes. This means, that on a biological and evolutionary level, they don’t have to be as worried about spending them as women do.
Yes, having an infinite supply of gametes comes with other challenges, such as knowing if a child is biologically yours or not, but with very little upfront cost to producing new gametes (and putting people into the world not costing as much as it does women) means men have ingrained behaviours that have the goal of spreading their gametes far and wide.
Like dandelions gone to seed, the goal is to spread as many of them as possible and hope that one of them sprouts into new life.
And this is all speaking on a basic, biological level. These are the innate human drives at the root of our behaviours.
A side note on partible paternity.
Partible paternity or shared paternity is a practise that has been observed in several indigenous cultures and documented in anthropological studies.
It’s a cultural belief that suggest a child may have multiple fathers and that the responsibility for raising the child is shared among all the men involved.
When there’s an ideology that sees pregnancy as the cumulative result of multiple acts of sexual intercourse, the women can be encouraged to have sexual relations with multiple men during the pregnancy.
In societies with the concept of partible paternity this often results in the nurture of a child being shared by multiple fathers in a form of polyandric (the state or practice of having more than one husband or male mate at one time) relation to the mother, though not always.
This practice is not universal and varies greatly among different cultures.
It’s important to recognise that cultural practices like these are complex and are deeply embedded within the social and historical contexts of the societies in which they occur. (Just as heteronormative practices are deeply embedded in most modern cultures.)
The point I’m making is that this kind of shared paternity, where each child has several fathers — and fathers being the ones who are more likely bring back resources that ensure the survival of the tribe, e.g. by hunting (especially when the women is unable to do so) — the women who are pregnant, post-partum and caring for small children, have a larger, more intertwined social support structure where the risk of going hungry is reduced.
It’s a way to mitigate the coexistence of costly and inexpensive gametes. This, of course, doesn’t reduce the risk of pregnancy, birth and infancy, which are still critical issues even today.
So, when we speak of women’s liberation, we speak of the freedom to choose.
Of being able to have sex and enjoy sex, a fundamental human drive, without the worry of pregnancy.
Enter: the pill.
The invention and widespread availability of the birth control pill (which wasn’t instant and is still not a given, even today) marked a significant turning point in women’s liberation.
The pill offered women unprecedented control over our reproductive choices.
Prior to its availability, women’s options for contraception were limited, often unreliable, and frequently controlled by men.
The pill allowed women to prevent unwanted pregnancies, giving us the ability to plan our families and pursue educational and career opportunities without the constant concern of becoming pregnant.
It played a crucial role in the sexual revolution of the 1960s and 1970s by separating sex from procreation, allowing women to engage in sexual activity without the fear of pregnancy, empowering us to explore our sexuality and desires on our own terms.
This newfound sexual freedom contributed to changing societal attitudes towards premarital sex and paved the way for more open discussions about sexuality and sexual health.
The availability of effective contraception like the pill was a factor in the push for the legalisation of abortion.
Advocates argued that preventing unintended pregnancies through contraception could help reduce the demand for abortions and make them safer when they did occur.
This argument was influential in the legalisation of abortion in many countries, including the United States with the Roe v. Wade decision in 1973.
The legalisation of abortion meant that women had access to safe medical procedures performed by trained professionals, reducing the need for unsafe methods like self-induced abortions or seeking out illegal providers.
This contributed to a decline in the number of deaths and complications associated with abortion.
With the ability to control fertility, women could delay or space out childbearing to pursue higher education and career aspirations.
The pill helped to break down barriers that previously limited women’s participation in the workforce and higher education.
By enabling women to plan when and if we wanted to have children, it facilitated our entry into traditionally male-dominated fields and positions.
Beyond the contraceptive effects, the pill has offered additional health benefits for many women, such as regulating menstrual cycles, reducing menstrual cramps, and decreasing the risk of certain reproductive cancers.
These health benefits have contributed to women’s overall well-being and quality of life.
So, there is a time and place for using the pill. But it’s the negative side-effects that we so rarely discuss in earnest.
And that’s what Dr Hill does in this book.
The truth about how the pill can affect women is hidden, but crucial. And it’s only starting to be known.
No researcher wants to be on record as the person who took down hormonal birth control, but every woman who is using, has used it or is planning to use is, it needs to know these things.
No doctor or gynaecologist ever mentioned most of the things discussed in this book to me, despite having been treated with hormonal birth control for excessively heavy periods since I was 18 years old.
The consequences of being on the pill can range from casual (mild mood swings) to devastating (suicide).
For me, it really hit home when Dr Hill covered how the pill can send you into a sexual nuclear winter. I’m no longer on any hormonal birth control because they kill my creativity and cause huge personality changes in me.
I hate the person I am on the pill. But I would have never, ever thought to question it had I not read this book.
And I cannot recommend it enough.
It’s a big book, I know. But read it in small chunks if you have to. Just read it.
This book should be in every counselling centre as it’s full of factual affirmations and opening your eyes with paradigm-shattering data.
This book is an even-handed, science-based understanding of who women are, both on and off the pill.
It will change the way you think about your period, your cycle, your hormones and how you view yourself.
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