On a recent girls' weekend away, by Sunday brunch we had discussed everything from the perfect martini and the politics of the bikini wax to favoured forms of contraception. Of our group, aged between 31 and 40, two of us are single and two are in long-term relationships. But no one is on the pill, which I found rather surprising. I thought everybody was on the pill.
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My friends aren't lazy or negligent. It's more that after a lengthy process of trial and error, they've come to the conclusion that the pill is not for them. Instead it's condoms, the withdrawal method or, in the case of one friend, her partner having a vasectomy.
Among this cohort of educated, health-conscious women, the pill is viewed as something you take in your 20s because that's what you do in your 20s: you go out and be responsible and get a prescription - and you take it every day, then double up with condoms if you're with someone new.
The contraceptive pill was approved for widespread use in Australia in 1961 and has now been available to three generations of women. It is still the most popular form of birth control in Australia, but it is now facing resistance on a number of fronts.
This includes women who don't like introducing a synthetic hormone into their bodies, women in their 30s who want to give their systems a "break" from the pill or who've had bad side effects, and a generation of women coming of age in the era of apps, where downloading Period Tracker or Clue gives them a means of calculating the "wrong" and "right" times to have unprotected sex.
A recent British Pregnancy Advisory Service survey of 150,000 women found that a third of women reported not using any contraception at all. Of these women, the largest proportion were in their 30s and 40s. "It was the women aged 15 to 24 who were the most sensible," according to a report in June in Britain's The Telegraph.
In Australia, there is no routinely collected data that gives a complete picture of contraception use. However, data collected as part of the HILDA report (Household, Income and Labour Dynamics in Australia) and released earlier this year revealed that about a third of fertile women who do not want to get pregnant are not using any contraception.
Of women using a contraceptive method, almost one third relied on the pill, with Australian studies showing that oral contraceptive use was highest for women in their 20s. "In Australia, we have relatively high rates of pill usage and sterilisation and relatively low usage of IUDs," says Dr Suzanne Pearson, senior medical education officer at Family Planning Victoria. "Although the pill is a common method, it's not the only method.
"The data points to five reasons women are not on the pill: side effects, leaving it to chance, being forgetful and/or not interested, breastfeeding, and because 'it feels unnatural and unhealthy,' " she says.
On my girls' weekend, conversation about the pill went something like this:
Agatha, 31: "It gave me really painful periods so I only took it for a few years in my 20s. Now I use condoms."
Jane, 36: "I was unable to think clearly when I was on the pill."
Steph, 37: "It gave me inflated boobs, which I didn't like."
Jane: "A friend of mine got pregnant on the mini-pill. I use condoms – my boyfriend said, 'No women I've ever been with wants to go on the pill.' He doesn't care at all that he's the one responsible for contraception."
Steph: "Many women in their 20s seem to be on it and then you realise in your 30s that it doesn't feel healthy to stay on it for more than 10 years."
Jane: "I've been on it twice and it killed my sex drive. I was 26 when I first went on it and in about a week my sex drive disappeared. And a few years later I went on it again, but it was a different pill and it was like going into a cloud. I felt very foggy."
Steph: "I got quite a distinct moustache. It was not attractive. I was as horny as all hell, but no one would have sex with me because I had a moustache!"
What's alarming is that all three of my friends have had to resort to taking the "morning after" pill at least once, when the primary method of contraception either failed (the condom coming off) or there was no contraception being used at all (usually because the sex was spontaneous). None has had an unplanned pregnancy as a result of contraception choices, but not everyone is so lucky.
According to research from the Guttmacher Institute, more than half of all unintended pregnancies in the US occur among the 10.7 per cent of women who use no contraceptive method at all.
Sunday Life spoke to women of all ages who use non-medicinal or more natural methods of contraception to avoid pregnancy. These methods include using apps to track cycles, and the "withdrawal method" - popular with generations of Catholics who were forbidden to use birth control by their Church. All have been on the pill at least once, but have stopped taking it because of side effects.
Fiona, 42, from Sydney, accidentally fell pregnant in her 20s when she relied on a device "where you measured your urine every day. You put a stick in your stream and it tells you whether you are ovulating or not."
Fiona miscarried. She has since married and gone on to have three children (all planned) using an app called Period Tracker. "I use a thermometer to measure my skin temperature, as just before you ovulate your temperature will drop. You graph it and you get to know your system. Now we know there are certain days of the month to be careful."
Fiona counted lumps on her hands, spot bleeding and eight kilograms in weight gain among the pill's side effects. "Now I don't believe in putting a synthetic hormone in my body," she says. "Nobody warned me about the side effects. Obviously there's a risk [of pregnancy] not being on the pill, but the main thing is for a woman to do due diligence and get to know her body. I'm a big believer in that. My body is my best adviser."
Hilary, 25, from Melbourne, is still trying to work out what form of contraception is best for her. She was put on the pill when she was 15 because of terrible period pain. After a couple of years on and off it, and changing brands, she noticed emotional side effects that began to freak her out.
"One day I cried for two-and-half hours and was feeling scared and thinking, 'That's not normal,' " she says. "I had just gone on a new brand of pill, so thought that might have been the cause. I went to a doctor and told them that I was going crazy and they brushed over it – I don't think it's taken seriously. They wanted to prescribe antidepressants. I felt like the pill exacerbated sensitive days to heightened levels."
Hilary is no longer taking hormonal birth control. "I've started doing research," she says. "I'm not super hippie – I'm just wondering what my body feels like." In a long-term relationship but not wanting children yet, Hilary charts her periods using an app called Clue and practises the withdrawal method.
"Long term, I'm at the cross-roads as to whether I could sustain going [back] on the pill," she says. "I'm with a long-term partner. He understands that the pill was not going well for me. I'm trying to do research but it's so confusing."
It might be all well and good to get to know your body. But on the flip side, many doctors are concerned that women are relying on an app to prevent pregnancy. "I know that women are using apps to track their cycles," says Dr Pearson. "We would discourage them from using apps as a form of contraception. We are really interested in talking to women about long-acting reversible contraception - known as LARC - such as implants and IUDs, as these are highly effective methods."
From her perspective, Hilary wants doctors to ask patients more questions before they prescribe the pill. "In my experience, doctors don't ask you about your family history of strokes or hormone issues," she says. "You're never taught to tell if and how you are ovulating. You are never taught about discharge. And yet all that stuff down there tells you what's going on in your body."
Hilary's anxiety levels have settled down markedly since she went off the pill. But the issue of effective long-term contraception remains. "Getting pregnant is a concern," she says. "I do take care, but there's no 100 per cent safe method."
CONTRACEPTIVE CHOICES: A SNAPSHOT
Of Australian women of child-bearing age who use contraceptives:
31% use oral contraceptives.
21% use condoms.
12% use a combination of oral contraceptives and condoms.
14% have a partner who has had a vasectomy.
10% have had tubal ligation.
12% use IUDs, injectables, implants, and other methods including "traditional" (non-medical) methods such as withdrawal.