Sheffield DocFest: The Business of Birth Control

Hormonal contraception is credited as one of the most important inventions of the twentieth century. It liberated women from compulsory parenting and gave people the ability to choose whether they wanted to have children and, if they did, to plan the timing. Since then, the pill in particular has also been adopted as a way for people to manage painful or heavy periods and to delay periods during exams, holidays or weddings.

It's true that the contraceptive pill comes with an alarmingly long list of side effects. But most people who take it get off pretty lightly, with the benefits of avoiding pregnancy or easing agonising cramps outweighing spotting or breast tenderness.

But there are people who take hormonal contraception (usually the pill) and experience devastating side effects. Some even die, and this is the subject of The Business of Birth Control, which had its UK premiere at DocFest. The film, directed by Abby Epstein, spoke to the family and friends of women who had taken the pill or used other hormonal contraception and lost their lives to the side effects (not everybody who takes hormonal contraception is a woman, but the stories featured in the film were all women).

This is an important message, as many of us take the pill for granted. It's been around for so long, and so many people take it, and the pills are so tiny, that it’s hard to imagine it can do anything so serious. Seeing those left behind after vibrant young women had lost their lives in a bid to avoid pregnancy or ease their endometriosis or PCOS is a stark reminder that no medication is consequence free. There's always a balance between benefit and risk, and there are no guarantees that any individual person will not react badly to any medicine.

The Business of Birth Control looks beyond the personal stories into failures within the industry and the medical profession to take concerns seriously, as well as questionable ethics from pharmaceutical companies. It is powerful and will make many people question whether or not they want to continue taking hormones that were initially tested for short-term rather than long-term use.

The most valuable aspect of the film, from my point of view, was the information about how Black and other racialised communities were exploited in the testing and use of hormonal contraception in the past. These stories should be more widely known, and must be factored in when treating members of communities who may be understandably mistrustful of medical practitioners.

But what the film does not do is provide balance. The combined pill is taken by 100 million people around the world and around 3 to 10 per million die of clots as a result. While we need to be aware of the very serious risks, we also need perspective. If someone stops taking the pill and becomes pregnant, their risks of a clot rises to 29 per million. In the weeks post-birth, that becomes a shocking 300 to 400 in 10,000.

I was taking the pill in 1995 when there was a thrombosis scare around certain brands. Many people, in a panic, stopped taking it. The following year, there were 12,400 additional births and 13,600 additional abortions. At a time when the right to access abortions is being undermined, especially in America, scaring people into stopping using the contraception that may work best for them feels dangerous.

Depression is another risk covered in the film, and this is certainly more prevalent than deaths from blood clots where the pill is concerned. It's an example of a point where doctors prescribing the drug must take particular care when assessing whether a patient is suited to it or not. And warning us to monitor our mood while we’re taking it could also be a valuable step forward.

Tapping into a feminist vibe, The Business of Birth Control makes viewers feel like they're undermining women’s rights and autonomy if they use (or need) hormonal contraception. It instead extols the virtues of tracking your cycle and monitoring vaginal discharge as a way to prevent unwanted pregnancy (the company behind some of the tech promoted in the film was also a financial backer of The Business of Birth Control, which is not made very clear). It was not fully explained that these “natural” forms of contraception tend to be less effective at preventing pregnancy.

There are certainly risks associated with synthetic hormones and it's important to be aware of them when we're deciding which we may want to take. But relying on anecdata to produce a damning documentary that does not even touch on the hundreds of millions who have benefited from this medication undermines its overall message.

Being informed about what we put in our bodies is vital, but fear-mongering is not the way to motivate people to make the best decisions. When this film neglects to present any kind of balance, it does lean more towards sensationalism than responsible reporting.

We need to hear the stories of those who lost their lives, and we need to see the evidence of damage. But The Business of Birth Control does us all a disservice by implying that, if you take your Microgynon, you’re a bad feminist and you’re going to die.