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Jagged Little Pill

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A review of Holly Grigg-Spall’s Sweetening The Pill

In 1957, a pill called Enovid hit the American market. Though it had been developed as a contraceptive, it was sold as a treatment for menstrual disorders, with a label warning users it would prevent pregnancy. To the half million women who were to “mysteriously develop severe menstrual disorders” in the following three years, it was the beginning of a sexual, economic, and social revolution. To Holly Grigg-Spall, author of Sweetening the Pill, it was the beginning of an era of misogynistic pharmaceutical exploitation of and control over women’s bodies.Holly Grigg-Spall Sweetening The Pill Zer0 Books, 208 pages

With Sweetening the Pill, Grigg-Spall sets out to write a feminist critique of hormonal birth control—a warning to women about the power of oral contraceptives to harm our health and keep us under the heel of patriarchal capitalism. Unfortunately, any good points she makes are lost amid a jumble of confused and confusing misinformation about the pill’s effects on the body and society. The result is a dishonest anti-pill treatise which, though putatively anti-capitalist, furthers capitalism’s illusion of unlimited agency—and blames women for not exercising it.

Birth control has come a long way since that menstrual regulator with its winking warning label. Side effects are now much less pronounced—from the common and usually temporary (headaches, nausea, breast tenderness, moodiness, loss of libido) to the rare and dangerous (blood clots, pulmonary embolism, high blood pressure, stroke). Aside from the (not insignificant) exception of heightened breast cancer rates among users, the pill, with over 50 years of data from both laboratory experiments and regular usage, is generally considered safe.TNI Vol. 18: Family Planning is out now. Subscribe for $2 and get it today. 

But safe according to whom? The drug companies that make millions in profits off the pill? Grigg-Spall rejects them as sources of reliable information, and not without reason: A pharmaceutical corporation can’t be trusted to do much besides pursue profit. Instead, she relies on her own personal experiences, the negative testimonies (and only the negative ones) shared by women on message boards, and a handful of anti-pill writers and activists. Why the reader should accept these sources as credible is never fully explained. Some are simply women sharing experiences that have been under-discussed in the larger conversation about birth control, while others believe things like that “women with a similar sense of purpose and those that have a similar outlook and approach to life are more likely to synchronize” menstrual cycles. Grigg-Spall takes many quotations out of context or even outright alters them; a woman who originally wrote “If guys could feel what life can be like on the pill” is quoted as saying “If guys could feel what life was like on the pill.”

The message pieced together from this patchwork of sources is simple: Hormonal birth control is bad. Irredeemably so.

The reason the pill is bad, we’re told, is that it’s “unnatural.” Grigg-Spall takes the consumer trend toward “natural” products and—apparently without realizing it’s a consumer trend she’s following—overlays it uncritically onto the issue of birth control. The word “natural” is used over 50 times in the book: “the natural rhythms of the woman’s body,” “healthy bodies that are experiencing natural ovulation cycles,” and so on. Natural is, the book proclaims like a Whole Foods ad, self-evidently superior. “Natural” doesn’t have much inherent moral value one way or the other, but Grigg-Spall lades it with unearned meaning she expects the reader not to question.

Because the pill is “unnatural,” for example, we know it makes women “sick.” It’s certainly true that, for some, the pill can provoke depression and anxiety, occasionally the wild, howling, desperate kind—but so can PMS, which the pill often alleviates, and which is described in the book as a patriarchal lie. Some books require a box of tissues nearby; this one needs a browser window open to Google, or at least a pen to scribble “Citation needed!” in the margins. I spent hours I’ll never get back researching the book’s claims about bone loss, nutrient deficiencies, metabolic suppression. I’d need a full-length book of my own to explain in detail which were true, which were sort of true but misinterpreted, and which were utterly false, but all three categories are represented.

Here’s one example: “Hormonal contraceptives,” the book announces, “are ranked by the World Health Organization as a class one carcinogen alongside tobacco and asbestos.” This is true, but it’s presented deceptively. “Class 1” in this case means “known carcinogen,” not “especially harmful carcinogen.” “Alcoholic beverages” are on the list too, as are “salted fish (Chinese-style)” and “sunlight.” While the pill does raise users’ chances of getting breast cancer, the WHO—the very source being cited—says it does so “slightly,” whereas Grigg-Spall says “significantly.” The pill also decreases the risk of uterine and ovarian cancer, which she acknowledges but dismisses as comparatively unimportant. We’re supposed to accept these health claims — some of them much wilder — without skepticism. Who wouldn’t, after all, want to shake off all the unnatural slime of modern society and live in balance, free of inscrutable and unstoppable outside influences?

Like almost every product of modern science, hormonal birth control does not appear in nature. It can have ill health effects, though they’re far less common than Grigg-Spall makes them out to be, and usually milder. But a completely natural life free from ill health effects is not something you can build with a few simple consumption choices. Hormonal contraception is one cog in a complex system, and any honest assessment has to acknowledge the tradeoffs it entails. The most significant advantage is, of course, that the pill lets women have children if and when they want to, and that this dominion over our fertility has helped us achieve an unprecedented amount of social, sexual, and economic progress in only a few decades. Maybe that’s not natural either, but I’m pretty happy about it anyway.

Even as I watched Grigg-Spall tunnel deeper and deeper into her appeal to nature, I assumed that we would end up on the same page. Even if the health risks were as grave as she claimed, surely she’d still have to recognize that women were often willing to brave those risks for the benefits, both personal and societal, of reliable family planning.

I was wrong. When Sweetening the Pill isn’t eliding those benefits completely, it’s hinting without much subtlety that the alternative isn’t so bad. “We have been led to see a pregnant teenager as inherently wrong, no matter what the circumstances,” Grigg-Spall writes, “…yet how do we decide what is an unwanted pregnancy and what is a ‘happy accident’?” If the alternative to “unnatural” interference with fertility is unwanted children, well—so be it. She allows that that’s an event “unsupported culturally and financially,” but waves that complication aside: “If pregnancy outside of the prescribed timeline does indeed cause destitution that is not the fault of the woman with the unwanted pregnancy but the fault of…society.” True enough, but I imagine a lack of culpability is cold comfort to a woman stuck working two full-time minimum-wage jobs for the rest of her life to support a child she wasn’t looking for in the first place.

To be fair, the book does outline non-hormonal alternatives to the pill (and patch and ring and shot). Condoms, diaphragms, and spermicide count as more “natural” because they don’t interfere with a woman’s hormones. Abstinence is preferable to the pill as well, and Grigg-Spall accuses feminists of “perpetuat[ing] pill use” with the idea that “women have to be sexually available” and “can’t, won’t, or don’t say no to sex.”

Her ideal birth-control method, though, is a secular update to the rhythm method, and we get pages of detail about taking temperatures, checking cervical mucus, observing cervical position, and charting this information every day. Honestly, this all sounds like a wonderful way to avoid pregnancy for women who have the time and inclination and who don’t experience certain menstrual, uterine, and ovarian disorders. For most people, though, it’s impractical. If a woman can’t commit to a daily examination of her cervix, she’s fairly likely to end up with one of those “happy accidents.” Asking the average woman to perform not one but several actions at the same time every day, each of them more complicated and less discreet than taking a pill, would not actually lower the unintended pregnancy rate.

Once again, the book presents birth control as a simple issue. The only criterion a woman need involve in her decision is whether or not a given method is natural and therefore healthy. The demands a job and children make on her time are not factors. Rape, abuse, and coercion are not factors. There is only natural and unnatural.

Because the book values “naturalness” over pregnancy prevention, it views the pill primarily as an “insidious” “menstrual suppressant” foisted on women by a society that hates them and wants to control their bodies. This notion is what drew me to the book in the first place. To what extent is hormonal contraception a manifestation of a society that does, unquestionably, hate women and want to control their bodies? When the feminist establishment lauds the pill as revolutionary and life-changing, what are they ignoring?

Alas, the book’s case for pill-as-patriarchal-plot is a weak, self-contradictory, and dishonest. It condemns the very real cultural pressure to be on hormonal birth control—from TV commercials, doctor recommendations, feminist endorsements—but ignores the equally real pressure not to be on hormonal birth control, or any birth control at all. Grigg-Spall is from the UK, and I can’t speak to mainstream attitudes about birth control there, but she’s writing mainly about the US, and in the US, we have abstinence-only sex education, a severe dearth of family-planning clinics, and a major political party that routinely denounces birth control as abortion. “Society demands that women must be sexually available,” she writes. No objection here, but society, including thousands of people with actual political clout, also demands that women keep their legs crossed and stay unavailable until marriage. Far from being a bludgeon in the hands of a single-minded all-sex-all-the-time society, birth control is actually one of the most powerful tools women have to navigate the subtleties of the paradoxical requirements placed on them.

The ghostly absence of the right wing persists throughout the book. Grigg-Spall mentions once or twice how regrettable it is that the religious right has “ongoing cultural control,” but instead of exploring that control, she reservedly endorses it, citing extreme right-wing anti-sex propaganda semi-approvingly. Videos by an unspecified group of nuns and an unfortunately named abstinence-only group called 1Flesh apparently have “valid and…thought-provoking points” alongside their “senseless noise.” These “valid” points include the pill’s effect on “women’s attraction to men and vice versa” (a point so vague as to be meaningless) and “the effect of synthetic hormones on the environment” (women’s birth control makes up only the tiniest fraction of estrogens in the environment, the vast majority of which come from hormones given to farm animals).

Even Rush Limbaugh’s viciously misogynistic comments about Sandra Fluke, according to Grigg-Spall, “raise questions that the debate had otherwise let alone. Why do women take a pill every day to prevent pregnancy?” In order to present women as brainwashed victims of a unanimously pro-pill culture, the book has to bend over backward giving ironic credence to the men who most fear and want to control women’s bodies.

This fantasy world, in which women are only ever pressured to take hormonal contraception, is not even internally consistent. Several pages are devoted to the “exaggerated exterior signs of femininity” women are apparently pressured to achieve by taking birth control. Then several other pages are devoted to the directly contradictory idea that by regulating menstruation, women are succumbing to the pressure to “get beyond femaleness” and approach the non-menstruating male body our society considers biologically superior: “If we shut down the essential biological center of femaleness, the primary sexual characteristics, then can we say that women on the pill are still ‘female’?”

To Grigg-Spall, a purer, more natural femaleness free from internalized misogyny involves almost obsessive attention to the machinations of a woman’s own ovaries and uterus. Wouldn’t it be beautiful, the book asks, if we stopped making our bodies “compliant to society’s restrictions” and instead embraced our natural cycles? I’m not convinced that avoiding the gender-neutral discomfort of cramps, bloating, and heavy bleeding is solely a form of social compliance. What would getting attuned to our cycles entail? Among other things, telling your boss or coworker when necessary, “That task doesn’t resonate with where I am in my cycle, would you mind doing it instead?”TNI Vol. 18: Family Planning is out now. Subscribe for $2 and get it today. 

That that request would almost certainly be denied is, for Grigg-Spall, only more proof that capitalism privileges “compliant” male bodies over menstruating female ones—which it does, but not because most women are incapable of certain tasks at certain points in their menstrual cycle. And if you lose your job over such a request, the book doesn’t seem overly concerned. Jobs are only ever described as a mode of capitalist exploitation—which they are, but they are also an alternative to the unpaid and undervalued domestic work which many women battled and battle to escape. “Women are losing control of their sexual and reproductive lives,” Grigg-Spall writes, as if they were totally in control before the 1950s, as if not having a job meant not participating in capitalism, as if women who had to work in an era of housewives wouldn’t have benefited from having fewer children at more opportune times.

Like many women, I use hormonal birth control, but that doesn’t mean I don’t, like many women, have suspicions about the pill I take every day. I’m not “naturally” inclined to buying more feminine hygiene products than I absolutely need. I don’t use tampons or disposable pads; I don’t even use shampoo. I’m fed up with the sexist treatment I’ve received in the medical system and exhausted by the misogynistic taboos surrounding menstruation and women’s bodies in general. I went into this book hoping to see a thorough excavation of the intense complexity of menstruation and fertility in a patriarchal and capitalist society. And although this book raised certain important questions, it only rarely attempted to answer them with anything but simplistic hand-waving and deliberate ignorance. There is a coherent and challenging feminist critique of hormonal birth control to be written, but Sweetening the Pill is not it.

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