Last month, the Associated Press distributed an article titled:  Birth control: Lots of choices, but confusion is widespread.  Good news: Even if you feel hazy or muddled right now, you likely have access to technologies your parents could only have dreamed of. Bad news: The confusion is no accident. When a serious presidential candidate can approve outlawing contraception, you know there are powerful forces aligned against you having control over your fertility. Getting the facts takes some digging, because powerful people are intent on burying them. If you know who is obscuring information and why, you’re more likely to figure out your real options.

For decades, sexual health information has been controlled by three networks of “Old Boys:” the Church, medical gatekeepers, and the pharmaceutical industry. All of them like their authoritative standing; none of them are particularly invested in your having the knowledge to manage your body and your fertility. All three use their political weight to stay in control of information and technology. Their highest objectives are, respectively:  protecting ideology, minimizing risk, and maximizing profits. None of these three has, as its top tier goal, empowering women (or men) to make fully informed decisions about our bodies and our families.  Rather, each of them has grounds to mistrust us, and to want the decisions in their own hands.  

The Church. Most people know that the Catholic bishops oppose both abortion and contraception. But given that Catholics comprise just a quarter of the U.S. population, many might be surprised to know that the bishops routinely meet with U.S. presidents (including Obama) and have been using their D.C. access to block American contraceptive access since the advent of modern birth control. Another FYI:  Bishop opposition to abortion is so extreme that they excommunicated a Phoenix nun because she authorized a first trimester abortion to save a 27-year-old mother of four!  In parts of Africa, which the Pope has called  a“reservoir of life” for the Church, pronatalist bishops boldly exhort Catholic women to produce more little believers, creating a Third World competitor to the Protestant “Quiverfull” movement. When it comes to women’s lives, Protestant fundamentalists, who believe that women were made for baby-making and that fertilized eggs are persons, are quite content to have the Conference of Bishops or conservative Catholics politicians like Santorum negotiating for them.

Here’s what the Bishops and their allies don’t want you to know:

• The rhythm method is a crap shoot. Some studies show that as many as one in four women get pregnant each year using the rhythm method. Natural family planning websites, which tout breastfeeding as contraception and fertility monitoring methods, may show numbers indicating that such methods are as effective as the Pill or even the IUD.  They do so by grossly distorting the data. Dig a little deeper and it becomes clear that accurate information is not their primary objective. For example, poke around at the Natural Family Planning Information site and you find these words:  “Every sexual act is intended by God to be a renewing of the marital covenant, the pledge of total self giving that was made by bride and groom in their vows. However, contraceptive intercourse is a restraining of that self-giving; in effect, it says “I take you for the ‘better’ of sexual pleasure but not for the (imagined) ‘worse’ of an additional child”. So it defrauds the covenantal renewal of its meaning and is therefore outside of God’s will.”
• Religious dogma already is built into our contraceptive options. The Pope almost approved the Pill a generation ago; in fact, in part, the Pill was designed to elicit papal approval. That is one reason that most women on the pill bleed every month, despite no health benefit from the week of bleeding. In 1958, Pope Pius XII approved the pill to treat menstrual disorders. John Rock, Catholic developer of the Pill expected that contraceptive approval would follow. Rock saw it as a natural extension of the rhythm method.  Like our bodies, the Pill used hormones to create an ovulation-free windows of time. In fact, it used the same hormones. Monthly bleeding was built in via a week of placebos to affirm just how natural it all was.
• IUDs work by preventing eggs and sperm from hooking up. Opponents of abortion and contraception would have us believe that virtually all modern contraceptives are abortifacients. They especially have targeted the most effective contraceptives available, IUDs, with this accusation. In reality copper IUDs like the Paragard work primarily by inhibiting sperm motility, thus preventing fertilization. Hormonal IUDs like the Mirena work primarily by thickening a plug at the opening to the cervix —another means of preventing fertilization–and secondarily by decreasing ovulation. In the case that a sperm actually fertilizes an egg, they may inhibit implantation. But since fertilization is so rare, a uterus with an IUD probably sheds fewer fertilized eggs overall than it would with less effective birth control or with none.  
• God (or nature) aborts half of all fertilized eggs. Our bodies treat fertilized eggs as if they were expendable; precious few ever approach personhood. In women who know they are pregnant, spontaneous abortion occurs 15-20% of the time, usually in the first trimester. However, research and expert opinion suggest that the actual rate of spontaneous abortion is much higher and that most of the time it occurs before a woman realizes she is pregnant. Some estimate that 50% of pregnancies abort spontaneously. If we count fertilized eggs that are shed before implanting, research on in vitro fertilization suggests that the failure rate may be much higher. Only a third of embryos become blastocysts (complex hollow balls of cells) and only half of blastocysts actually implant.
• Contraception works better than prayer for reducing abortion and saving lives. Chile is a devoutly Catholic country, and consequently abortion is illegal there without exception. For women of reproductive age, the Chilean abortion rate is 45 abortions per 1000 women each year. The U.S., most devout of all developed countries, has less restrictive laws, and better access to contraception and an abortion rate of 21/1000. The secular Netherlands, with universal healthcare and some of the least restrictive abortion laws in the world have a rate of 7/1000. Chilean women pay for the Church’s anti-contraception stance with their lives. Between 2000 and 2004, back-alley abortion was Chile’s third leading cause of maternal death.   

Pharma. Pharmaceutical companies don’t share the priorities of religious fundamentalists; on the contrary, they’d be happy to have us all using modern contraception – or almost modern. The problem is, profits and women’s health don’t always line up. In fact, they line up rather badly. The case of Norplant is a painful example. Although Norplant was one of the most effective contraceptives available at the time it was introduced, and Norplant II (Jadelle) is used widely around the world today, U.S. legal disputes over side effects put Wyeth pharmaceuticals in  bankruptcy court. The contraceptive was accused of causing, “Months to years of non-stop menstruation. No periods ever. Ovarian cysts. Massive weight gain. Massive weight loss. Mood swings. Panic attacks. Anxiety. Rage. Acne. Numbness in the arm. Numbness in the shoulder. Numbness in the hand. Blindness. Heart attacks. Cancer. . . . .”—none of which could be verified in scientific research, and none of which stood up in court. In the aftermath, other major companies essentially divested their research on new contraceptive technologies, leaving charities to pick up the slack. Most now content themselves with tweaking and re-tweaking Pill formulations, counting on ever more sophisticated marketing to compete for market share.

Here’s what Pharma doesn’t want you to know.

• Pills are old tech. 1960’s old, to be exact. Granted, the Pill transformed women’s lives—creating a level of contraceptive safety that empowered women to become lawyers, doctors and CEOs. It transformed family life, allowing parents to focus their love and financial resources on the children of their choosing rather than an undesired brood. But to do so reliably required abortion as a back-up plan. In real world use, one in twelve women gets pregnant each year on the pill, which is part of the reason that one in three American women have had an abortion. By contrast, the latest generation of long acting reversible contraceptives (LARCs), including implants and IUD’s, have failure rates as low as one in seven hundred.
• The best contraception is also the cheapest. The most effective contraceptives on the market have the potential to kill some of Pharma’s big profit streams. The Paragard copper IUD, which is top tier from an efficacy standpoint (over 99%) offers the cheapest month over month contraception. The problem for Pharma:  you put it in once and then don’t spend any money on contraception for the next 10 years. The Mirena hormonal IUD (99.8% effective once established), is more expensive, but has the side benefit of reducing menstrual bleeding and cramps over time by an average of 90%. Family planning practitioners who promote LARCs joke about putting themselves out of business.  
• IUD’s work way longer than they are approved for. I said the problem with a Paragard is that after the initial expense you don’t pay anything for contraception for the next ten years. That’s how long the FDA has approved it for. In reality, research shows that it’s good for twelve (and counting!), but there’s no profit to be made in getting the approval extended. The Mirena, which is approved for five years is actually good for seven. The extra years are all bonus for a woman who has an IUD that fits her body; all downside for people who rely on planned obsolescence to stay in business.
• Prices don’t correspond to costs. They correspond to what the market will bear.  In contrast to Europe and Canada where competition and single-payer systems keep prices affordable, women in the U.S. have to pay monopoly prices for LARCs. Only one copper IUD, one hormonal IUD, and one implant currently are approved for the U.S. market. The Mirena, which retails in the U.S. for over $800 (that’s without insertion) and is slated for an increase, costs around $350 in Canada, prompting some women to cross the border for their contraceptive care.
• One-size-fits-all contraceptives aren’t. Over the forty-odd years that women need contraception, there are lots of opportunities for medical problems of all sorts to develop, and if symptoms develop while a woman is using a contraceptive, the contraceptive is suspect.  Pissed off wingnuts dominate web forums and conversation threads about contraception (and about a lot of other medicines and medical devices for that matter), while unethical trial lawyers make a living off of hype, fear, and no-fault settlements. But the reality is, pharmaceutical science is pretty crude at this point. Every contraceptive has a profile of risks and benefits that varies from woman to woman (as does pregnancy).  What works for your sister may or may not work for you. We don’t know why people’s bodies respond so differently to the same chemicals or hormones, but they do. That’s why we all need an array of choices and ongoing access to knowledgeable, respectful advisors.

Medical Gatekeepers. When a young friend of mine recently asked her family practice doctor about an IUD, the doctor responded with 1970’s horror stories. (Imagine:  You go into Best Buy to shop for computers and, instead of getting shown the latest technology you get an animated lecture on the glitches in Windows 2.0.) Many women don’t get up-to-date information about their options simply because busy doctors are unfamiliar with the latest information about reproductive health. Medical practitioners, like the rest of us, are shaped by early experiences and tend to fall back on things that are familiar. Regulators too, have the deck stacked in favor of risk avoidance. Harm caused by simply leaving an old, familiar, status quo as is, (for example, leaving women without effective contraception) doesn’t get weighted equally with harm caused by doing something. In 2011, for example, much ado was made about the possibility that Depo-Provera may increase risk for women who are exposed to HIV. Gatekeepers began questioning programs that provide injectable contraceptives to African women. Little was said about an even greater risk:  If Depo were withdrawn and the same women switched to the other contraceptives available in their communities, which are less effective, many would die from complications of unwanted pregnancy. Inasmuch as medical providers and regulatory agencies believe themselves responsible for our decisions (a big responsibility), they will err on the side of doing nothing.

Here’s what old guard medical gatekeepers don’t want you to know:

• You don’t need to bleed. Most women and some doctors assume that heavy, even painful periods are natural.  Not so. It turns out that Western women have four times as many periods as our hunter gatherer ancestors, with lots of negative consequences including anemia and increased risk of some cancers. Spending a week per month bleeding has no known health benefit other than increased reproduction and lots of downside. American women miss 100 million hours of work annually because of menstrual symptoms. The choice of how many periods to have should be yours.
• General practice doctors don’t routinely stay up to date on contraception. They would be embarrassed if you knew how out-of-date their information actually is. Research both in Canada and in the U.S. shows that family practice doctors frequently endorse misinformation about contraceptive options. For example, many think hormonal IUDs increase your risk of pelvic infection, when the opposite looks to be true. Most are unaware that today’s easily reversed LARCs are as effective as sterilization, and can be used safely by teens and young women who haven’t yet had babies.
• Experience matters. If you’re going for the best reversible contraception available (an IUD or implant), comfort and long term satisfaction are highly correlated with practitioner experience. Even if you like your primary care provider, if he or she doesn’t routinely manage the kind of contraceptive you want, you’re better off finding someone who does—a gynecologist, a Planned Parenthood, or another family planning specialist.
• The FDA lags behind. European women have an array of contraceptive options that either never make it to market in the U.S. or are delayed by anywhere from 5-20 years. American regulators are influenced by a litigious environment and by religious fundamentalists, which skew the equation toward inaction. For example, Nexplanon, the latest iteration of the implant, only just became available in the U.S.  Similarly, the Mirena IUD has a long track record with women of all ages in Europe but is not yet approved for childless women here.  By the time it was officially sanctioned in the US to regulate heavy menstrual bleeding (2009), it was already in use for contraception or bleeding by 15 million women worldwide.  A frameless IUD optimized for small women is approved in the E.U., but hasn’t yet reached the U.S. market.  If you want to know where contraception is headed, take a look at what Europeans are doing. 
• You really can manage your contraception.  A decision about contraception can shape the rest of your life—your happiness, your ability to contribute to the world around you, the wellbeing of your children. Only you can weigh the risks and benefits of any given contraception against each other in the context of your lifestyle and life goals. To make the best decision possible, you need accurate information, and that means knowing what questions to ask, who to ask, and what factors may be biasing answers. An hour on the internet can fill your mind with rubbish about almost any medical technology. Alternately, an hour spent on sites that are rigorously fact based could mean you have more up-to-date information than your peers or even your doctor. (Bedsider.org and Planned Parenthood are among the best.) 

No one is as invested in your future as you are, which makes you your own best advocate. As you try to shape your life according to your dreams and your own moral values, you don’t need information filtered according to ideology, profit, or old patriarchal notions about who should make your medical decisions. Fortunately, new information technologies and contraceptive technologies offer women powerful tools for managing our health. But freedom and responsibility are two sides of the same coin. There’s lots of misinformation out there and Old Boys who are happy to tell you what’s what according to their priorities.  Remember, it’s your body; so do your homework and then take charge.

Valerie Tarico is a psychologist and writer in Seattle, Washington.  She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org.  Her articles can be found at Awaypoint.Wordpress.com.