Fifty years on, birth control pill fails to make major impact in Lebanon

30 December 2010

BEIRUT: Exactly 50 years after it was first introduced and promised to revolutionalize family planning, and through it the roles and lives of countless women across the world, the contraceptive pill has failed to achieve the impact many had hoped for.

Only some 15 percent of Lebanese women are thought to use this highly effective method, with 37 opting for any kind of modern contraceptive. Somewhere close to 60 percent of women aged 15-49 do use other techniques, but this figure is relatively low for a middle income country, with Iran boasting rates of almost 80 percent and Turkey upward of 70 percent.

A lack of education, general doctor disinterest and the persistence of old wives tales among the public, in addition to elements of the medical community, have all been blamed for the perceived shortfall.

However, with more women wishing to enter the workplace and many more opting to marry later and have fewer children, there is big hope that the next 50 years may finally bring the much sought-after freedom to choose one’s reproductive fate.

“If I were a woman, I would think that the contraceptive pill was the best medical invention ever made,” said Dr. Faysal al-Kak, the president of the Lebanese Society of Obstetrics and Gynecology. “There is a lot of misrepresentation, but it is completely safe … to the point that I would advise almost 90 percent of [sexually active] women to take it,” he said.

Since first appearing on the market in the 1960s, the pill has evolved in leaps and bounds from the first, extremely estrogen-heavy composition. Now in its third or fourth generation, most models contain a mixture of progesterone and estrogen, and have largely eliminated unwelcome side-effects such as nausea.

The lower hormone doses mean that more women can take the pill and can do so for longer, without the need to take “breaks” as is sometimes assumed. While the cut-off age for this contraceptive method was once set at 35, new medical evidence suggests that it remains safe even in older women, provided that they do not smoke.

Available without prescription and for as little as $2 for a month’s supply, the pill should, in principle, be within the reach of most women. Regardless of its accessibility, however, the vast majority who could be benefiting from it are not.

“Even with the opportunities and freedoms it affords women, few come in to ask for it,” said Kak. “This is representative of the lack of empowerment women continue to feel in our society.”

“I think as [doctors and gynecologists] we have to be the front leaders of women,” Kak added. “When you come to me, I see you as a case of woman’s rights, not just as a medical case. Women deserve to get the whole package, if I didn’t believe in this, I should kick myself and go do another job.

“But this is not practiced in our culture, where the interests of woman are often not put first. Quite on the contrary [medical advice] is sometimes abused, manipulated and twisted.”

The pill is not advised for people with certain cardiovascular problems, but its links to breast cancer, often touted as a reason to avoid it, have been almost totally dismissed by recent medical studies, said Dr. Jinan Usta, from the family medicine department at Beirut’s American University Hospital.

Its supposed long-lasting effect on fertility rates have also been disproved, with 70 percent of women returning to normal fertility within six months and the remainder within one year, said Kak.

“I have been taking the pill for a while and started when boyfriend and I got serious,” said 26-year-old Jannan.

“I’m an economics major, I work in a bank, often up to 10 to 12 hours a day, and my spare time pretty much consists of me lying to myself that I will start exercising and just sleeping instead.

“I definitely want children but that day is still a long way off,” she said. “Thank God that I can at least control this aspect of my life. My mother had me when she was 22 and my sister got pregnant by accident when she was my age because she was scared of taking the pill. She’s happily married with three kids, but she used to be the most ambitious one out of us. It’s not the way I want to live my life.”

The truth is, however, that the pill offers opportunities to women of all social spheres and not just those that want to put career first.

“Many women in sexually abusive relationships, who are subjected to marital rape, take it in secret to make sure they don’t get pregnant from these instances,” said Usta.

“This use of the contraceptive is actually quite common and happens much more than people think.”

Regardless of the debilitating effect numerous pregnancies can have on a woman, childbirth is also still being used as an easy method of controlling women, said Kak.

Women are sometimes shamed into not taking an oral contraceptive by accusations that it encourages promiscuous behavior and leads to an increase in sexually transmitted diseases, but scientific evidence thus far points totally the other way, he said.

“Contraception is not going to make you do anything that you are not inclined to do already,” Kak added. “If you don’t believe in sex before marriage, knowing that the pill is an option will not change your mind.

“But if you are going to be active, it is far better to be prepared and not to risk an unwanted pregnancy.”

While numerous clinics, alongside a host of far-less official practitioners, do perform abortions, these services remain illegal and are always seen as a method of last resort.

“If you get to the stage that you are seeing more abortions, it is not proof of more rampant sexual behavior; it is evidence that the national reproductive health strategy is failing,” said Usta. “Most of the information available is either word-of-mouth or the internet. We desperately need more education in schools and better guidelines for doctors and pharmacists.

“We have had the contraceptive pill for 50 years, and it is time to change the misconceptions … Women should be allowed make their own choices.”