Using birth control involves risk. So does getting pregnant. In fact, because pregnancy carries so much risk, the medical and pharmaceutical industries justify the risks and side effects of birth control as either equal to, or less than, those of pregnancy. This is a false dichotomy, however, as safe, effective methods exist for women to prevent pregnancy without any of the risks commonly associated with contraceptive use.
Side Effects are Not Two Sides of the Same Coin
Many of the risks and side effects associated with pregnancy and birth control appear—at least on the surface—to be highly similar.
Blood Clots and VTE
Pregnancy: Women who are pregnant are 5 times more likely to develop a blood clot than women who are not pregnant. According to Stoptheclot.com, while pregnancy does not directly cause blood clots, it poses a four-fold increased risk for the development of a blood clot. The risk increases during the postpartum period, increasing as high as 100-fold during the first postpartum week, and decreasing to 20-fold during the weeks after. According to American Family Physician, “Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), complicates 0.5 to 3.0 per 1,000 pregnancies and is the leading cause of maternal mortality in the United States.” Even though these deaths are preventable if warning signs are recognized early, 1 out of every 100,000 pregnant women will die from DVT/PE related to pregnancy annually.
Birth control: Women who are on hormonal birth control are 2-4 times more likely to develop a blood clot than women who are not on birth control. Some forms of birth control increase the risk for blood clot development more than others. For example, it is estimated that the risk of VTE increases 3 to 5 times in individuals using second-generation combined oral contraceptives (COCs) and up to 6 to 8 times in those using third-generation COCs.
Transdermal patches and vaginal rings, in particular, may significantly raise a woman’s risk of VTE. Alarmingly, a 2012 study published in the British Medical Journal found that “women who use transdermal patches or vaginal rings for contraception have a 7.9 and 6.5 times increased risk of confirmed venous thrombosis compared with non-users of hormonal contraception of the same age.” Merck, the manufacturer of the Nuvaring, has long been embroiled in class-action lawsuits from young women who experienced VTE, stroke, heart attack, and even death as a result of Nuvaring use.
No matter the particular form of birth control, risks are higher for those with clotting disorders and/or a family history of clotting disorders. However, testing for clotting disorders is not routine, and many women and their families may not discover the presence of a clotting disorder until a VTE or VTE-caused death occurs while an individual is using birth control.
Anxiety, Depression, and Suicide
Pregnancy: Pregnancy may increase one’s risk for depression. Because of this increased risk for depression, pregnancy may also increase one’s risk for suicide. Postpartum depression, anxiety, and psychosis is the most-discussed forms of maternal mental health issues, but some women experience depression, anxiety, and an accompanied increased risk for suicide while pregnant. Postpartum depression and psychosis may be a symptom of a wider hormonal imbalance.
Birth control: The link between birth control use and anxiety/depression, and increased risk for suicide is well-documented, although not well-understood. One theory is that hormonal contraception depresses the body’s stress response, making it harder for women to cope. In fact, the bodies of women on hormonal birth control exhibit the same signs as the bodies of individuals under chronic stress. The risks for depression and anxiety are highest for teens on hormonal birth control, with implications reaching into adulthood.
Cancer:
Pregnancy: Both pregnancy and breastfeeding are known to reduce one’s risk for developing breast cancer. Having 3 or more pregnancies may increase one’s risk for cervical cancer, but the reasons why are not well known.
Birth control: While birth control may lower one’s risk for ovarian cancer, colon cancer, and endometrial cancer, it may also raise one’s risk for breast cancer and cervical cancer.
Autoimmune Disorders:
Pregnancy: In pregnancy, many women with pre-existing autoimmune disorders—in particular, Multiple Sclerosis and Rheumatoid Arthritis—experience amelioration of symptoms. Lupus symptoms, however, may become worse.
Birth control: In women with a genetic predisposition towards an autoimmune disorder, birth control may raise one’s risk of developing the disorder. Research has noted potential links between birth control use and the development of Multiple Sclerosis, Crohn’s Disease, and Lupus.
Given that hormonal contraception essentially “tricks” one’s body into thinking that it’s pregnant, the apparent similarities in risks between birth control and pregnancy shouldn’t be surprising. But well-hidden trick though hormonal contraception may be, it’s not a perfect disguise. Although the synthetic estrogen in hormonal contraception is derived from natural estrogen, synthetic progesterone (referred to as “progestin”) is not derived from natural progesterone. In fact, the vast majority of progestins used in hormonal contraception are synthesized from testosterone molecules that have been manipulated to make them mostly compatible with a woman’s progesterone receptors. However, because of the imprecision of the fit—and because progestins may also bind to testosterone receptors—hormonal contraceptive use brings with it some different risks and side effects from those experienced during pregnancy, when natural progesterone levels are heightened. Unsurprisingly, some of those side effects (at least for the contraceptives containing testosterone-derived progestins) are masculinizing, affecting not only the body (like with unwanted facial hair growth and acne) but the brain as well (including shrinking some areas and enlarging others). Pregnancy, of course, does not have this effect.
Limited vs. Long-term Exposure
The comparison of risks between pregnancy and contraception is also imprecise because of the fact that pregnancy represents a relatively short time of increased exposure to particular risks. For example, while pregnant women are at a heightened risk for blood clots and VTE, the risk is highest during pregnancy and in the immediate postpartum period (so, about a year, give or take). Consider also that the increased risk for depression that comes with pregnancy and the postpartum period spans roughly two years (9 months of pregnancy, plus one year postpartum) Contrast these risks with hormonal birth control, which also carries well-known risks for the development of blood clots and VTE, and depression, anxiety, and suicide, and which may be taken for years—possibly even decades—at a time. After all, according to the Guttmacher Institute: “In the United States, the average desired family size is two children. To achieve this family size, a woman must use contraceptives for roughly three decades.”
In May 2019, Scientific American dedicated an entire issue (titled “Inconceivable”) to the gaps in scientific knowledge of women’s reproductive health. In one article, “The Point of a Period,” evolutionary biologist Beverly I. Strassmann’s meta analysis of studies on the progestin content of hormonal birth control “concluded that some types of the pill exposed women to a quadruple dose of progestin relative to the progesterone their naturally cycling body would produce.” Furthermore, the article goes on to point out, “nobody knows for sure what the exposure to synthetic hormones will mean long term for women using the pill to suppress their cycles indefinitely.” The article ends with a chilling quote from Elizabeth Kissling, a professor of women and gender studies at Eastern Washington University: “What we have now” with women using birth control for long-term suppression “is the largest uncontrolled medical experiment on women in history.”
The long-term exposure to synthetic progestins is, essentially, a gamble, with far-reaching ramifications that we are only beginning to uncover. So while pregnancy also comes with known—not insignificant—risks that may appear, on the surface, to be similar to those associated with birth control use, the risks differ in degree and kind because of the length of exposure.
Fertility Awareness is the Neglected Better Way
While some women may have very good reasons for avoiding pregnancy, it is important to remember that pregnancy itself is not a disease. But this is exactly the false equivalency with which women are presented when the risks and side effects of contraception are dismissed with comparisons to pregnancy’s potential risks and side effects.
Especially in an era with highly effective forms of fertility awareness-based methods of family planning, which carry no risks or side effects, the idea that women must either suffer through birth control or an unplanned pregnancy is a false choice: safer options are available.