We need to talk about birth control

How the silence around contraceptive burdens is dangerous for the people affected by them

Preventing pregnancy is important, but can come at a cost.
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We all have a vague idea of what birth control is and what it does, but we don’t talk about it nearly enough.

When it comes to practicing safe sex, contraceptives are a must—particularly for encounters that run the risk of pregnancy. But aside from external condoms, the majority of pregnancy prevention methods place the burden on the person with a uterus. Birth control pills, IUDs, patches, and injection are all the onus of vagina-havers to seek out and use.

Understanding how birth control can affect a person’s health is vital, but we don’t often see a lot of open communication about sexual health, particularly when it comes to the sexual health of people with vaginas. There aren’t many television storylines about missing your pill or having to take Plan B—these are somewhat stigmatized topics that don’t come up much in everyday conversation.

But keeping silent about the impacts of birth control is dangerous.

While hormonal contraceptives are irritating and inconvenient at best—carrying your pills around with you everywhere can be a bit of a nuisance—at their worst, they present serious risks to users’ health.

Complications from the birth control pill are rare, but they can be serious, including risk of heart attack, stroke, blood clots, and liver tumors. Risks associated with IUDs include infection and ectopic pregnancy.

The potential dangers of birth control methods shouldn’t be blown out of proportion and used to scare away potential users—many people who use hormonal contraceptives aren’t affected by the most serious side effects. However, it’s important that users understand the risks of birth control before they commit to it and have a handle on the factors that may put them at greater risk.

While men with uteruses and non-binary folks with vaginas are impacted by the burdens of hormonal contraceptives, it’s also important to note the disproportionate effect these burdens have on women. Early IUD models killed women and made hundreds of thousands of others infertile. A paper published in 2019 found current risks associated with hormonal contraceptives would project at least 300 to 400 healthy young women dying yearly in the United States due to associated complications.

Because women have historically fought so hard for reproductive autonomy—and continue to fight for it today—there’s an underlying sense that we should be grateful for the opportunity to choose to use hormonal contraceptives, no matter the risk they present to our wellbeing.

However, the burden of even the less deadly side effects of birth control is a serious weight to place squarely on people with a uterus’s shoulders alone—and not something to expect us to be thankful for.

Nausea, headaches, and spotting between periods are all uncomfortable, commonly reported experiences with hormonal birth control. Users have also reported mood swings, and links have been found between the use of the birth control pill and depression. While IUDs may reduce the impact of some of the side effects associated with the pill, the insertion process can be quite painful.

No matter who’s using it, hormonal contraceptives are likely to negatively impact users in some way or another. And while it may not be fun, it’s often worth decreasing the risk of unplanned pregnancy. As it stands, however, people with a uterus often have little choice in whether or not they use contraceptives if they want peace of mind. There’s an unfair double-standard in safe sex practices that sees people with a penis exempt from having to actively participate in preventing pregnancy through hormonal methods. Slap on a condom and you’ve done your due diligence, while women and people with vaginas are often expected to have a foreign object inserted into their uterus or take a daily pill so penis-havers can skip out on the condom.

In 2016, a trial for injectable birth control for people with penises was halted after the men participating reported similar symptoms to those people with vaginas already experience on birth control. Part of the justification for this halt was that, for women, the risks associated with birth control are counterbalanced by the risks associated with pregnancy, while for healthy men, the contraceptive would introduce similar health risks for seemingly no good reason—cisgender men can’t get pregnant.

It’s hard not to see that viewpoint as devaluing the health of people with vaginas in comparison to people with penises. Yes, penis-havers can’t get pregnant, but what’s the harm in having male birth control as an option? The existence of the method doesn’t force anyone to use it—instead, it presents another option for sexually active people to prevent pregnancy. Hormonal contraceptive options exist for people who can get pregnant, and that makes sense. It doesn’t make any less sense to have options available for their partners as well.

If penis-havers, particularly cis men, aren’t going to be using hormonal birth control, the least they can do is understand the impact it has on their partners who do. Do some research, start a dialogue with your partner(s), and do your best to be considerate of what they are putting themselves through so that you don’t have to deal with the stress of an unplanned pregnancy.

Birth control is uncomfortable, awkward, and messy. But if we talk about it, we can make the experience of using it better and safer.

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