Having control over your fertility and being able to articulate your own needs and assert yourself, it does make a huge difference. The first step is women being able to manage their own bodies and their own reproductive health. I think there’s this interest from men, as it’s sort of been a mystery to them too.
With SDM, you have to have a cycle that’s between 26 to 32 days – can you tell us more about that?
Yes, the medical guidelines are that you are allowed to have one cycle outside of that range in a given year. You would still then be able to use the method effectively. But if you have more than one cycle outside that range in a given year, we would recommend using a different method than SDM. It’s not for all women, but about 55% of women have cycles that are always within that necessary range.
It’s the same. The way the method was developed, it was based on data from the World Health Organization and they had data on thousands of women from around the world. It was then tested in three countries – the Philippines, Peru, and Bolivia. They found very similar cycles from one country to the next. The only time you’re likely to see real differences between cycles and regularity is when you’re dealing with a real emergency situation. So – incredible malnutrition or [living in] a warzone – these will affect a woman’s cycles. But otherwise, they appear to be the same wherever you are. There is a knee-jerk perception that women in the U.S. will be different to women elsewhere, so it was really important that SDM was studied in multiple countries and that there were ongoing efficacy studies.
I’ve written previously about Depo-Provera and how it can provoke continuous bleeding, or even cause bleeding to stop completely, and how this might be problematic for women living in regions with strong menstrual taboos, lack of menstrual care products, or lack of hygiene facilities. What’s your experience of this?
I’ve been in many meetings where Depo-Provera has been the focus, with a desire of getting this out to women. The solution to the side effects tends to be to provide better counseling so that women can manage those side effects. I think this is a dangerous situation. Women should have options and they should use whatever works for them, but they should have all the information about the pros and cons and really have an understanding of the method. I don’t think it’s acceptable to tell them that they just have to deal with those side effects and manage them. Especially when those side effects can be much worse for a woman in a developing country than for a woman in the US. If I’m bleeding every day for three months, it’s going to be a serious problem if I don’t have access to sanitary pads. The argument seems to go – if it’s a method the doctors control, then we know they won’t get pregnant, so let’s develop new delivery systems that allow doctors to control the hormones and put them in the woman’s body. I’m hopeful that we’re seeing a shift, and that’s what we’re working towards. Let’s take a woman-centric approach and ask, “What’s your ideal situation and how can we get you closer to that? What meets your needs — and not just the medical community’s needs?”
Do you see women switching from Depo-Provera to SDM?
We do. But there is a transition period, as with all fertility awareness methods. That time when women are switching contraceptive methods is the most dangerous time for an unplanned pregnancy. It can take a few months before a woman can use SDM without needing to use condoms throughout the cycle.
You mentioned earlier the resistance to hormonal contraceptives in the developing world. Can you speak to that a little more?
There has been a history of contraceptive programs in the developing world that has not always been the best. So there is distrust around family planning programs in general. There are also concerns around side effects. Then there are everyday challenges like a lack of providers and clinics. If you’re focused on feeding your family, you can’t take a day off and sit in the clinic while it takes them 12 hours to see you. With the side effects in particular – if you had to walk two days to get your Depo-Provera shot and now you’re having really bad side effects, that’s really scary and it’s really hard to go back again. With Cycle Beads, we’ve been able to work with community health workers who aren’t doctors or nurses even, and can actually see people in their homes, because the method is quite simple to teach and explain. That’s been helpful in getting it to some of those places where it’s really important, where people have real challenges getting to a doctor and sometimes have a suspicion of clinics and what they’re doing. On top of it, you don’t have a lot of options. Here in the US, you can switch between many kinds of birth control pills to find one you prefer. Whereas in developing countries you have got one pill — or maybe two — and if you’re having side effects with that one, there’s not another option. The most effective method is the one a woman chooses for herself and not the one her doctor chooses for her.
I’d be interested to know what the uptake is on the second shot of Depo-Provera after the first three-month dose.
To be frank, I don’t know. There’s a new version of the hormonal shot (Sayana Press), and they were excited about the uptake they were having around the marketing campaign and that question was coming up. They had no answers yet. To me, that’s the number-one critical question. That’s how you find out about your impact. It has nothing to do with the first three months when you told the women it was the best thing in the world and they’d never have to think about contraception again.
You deal with bias around fertility awareness methods in general in the medical community, but we see that it fulfills a real need. People do want effective family planning, but they don’t want side effects. We have to find ways of giving them that.
Holly Grigg-Spall’s book on how society has become so dependent on hormonal birth control, Sweetening The Pill, is being made into a documentary. To support this vital project, check out the Kickstarter campaign here.