Anxiety in the age of birth control

ANXIETY IN THE AGE OF BIRTH CONTROL

WORDS BY Cameron Gorman

ILLUSTRATIONS BY Mark Tabar

PHOTO BY Tessa Poulain

What was at the root of my contraception spiral?

If you feel my arm in a certain place – press down on the spot of soft skin inside of my elbow – you’ll feel a sudden hardness in the flesh. It’s a little plastic rod the size of a matchstick called Nexplanon. For the next two and a half years – until August 14, 2021, according to the flexible plastic card I carry in my wallet – it will release progesterone into my bloodstream.

I like my Nexplanon – though it was very painful to insert, though sometimes when I bathe, it itches like fire. I like it because the Nexplanon contraceptive implant, according to its website, is supposed to be almost as effective as sterilization in preventing pregnancy. It isn’t fallible by human error. It just sits there, held in place by my skin, waiting.

I don’t remember the first time I learned about birth control, but I do know that, until college, I didn’t have a clue about it. At my boyfriend’s urging, 19-year-old me walked through the doors of the Women’s Clinic at DeWeese Health Center. I was scared, and I had never done this before. I told my doctor so. Though my memory has eroded the exact details of my time in the office, I remember feeling a pressing in my chest. It must have been excitement over this, the idea that I would be able to take control over something that had been worrying me. I would finally be protected, and once I was protected, I would be safe. I knew things were better now than they had been.

“The birth control pill was kind of rushed to market, and that the early women who were taking it ended up, to some degree being, in the worst-case scenario, guinea pigs … they were testing out the glitches, and they were finding what might go wrong with the product,” Suzanne L. Holt, the director of Women’s Studies and a professor at Kent State, says.

But this was not the age of the Dalkon Shield. What kind of birth control was I looking for? I did not know. Maybe, I said, the pill. After all, the pill was the only kind of birth control I knew anything about. I could handle it, the pill and its diminutive name. It wasn’t long until I had taken the prescription to CVS, read the little packet that came with the blue envelope carefully, and unfolded its cardboard wings to reveal perfect lines of pink and white.

This is similar to the experience freshman exploratory major Olivia Wink had as she began looking for a method of birth control. Wink, who’s also the president of Students Against Sexual Assault, says she didn’t learn about any birth control options – save condoms – in school.

“I knew some friends who were taking the pill, but I was never really interested in it because I knew that they had a lot of side effects, and we learned about different methods of birth control in Sex Ed in eighth grade, but … it was not helpful whatsoever because, obviously, Ohio’s education doesn’t have to talk about other options, so I never really knew what was out there,” Wink says.

Neither did I. Looking back, I wonder if I should have given my decision to go on hormonal birth control more time, done more research or asked for more advice.

Kim Myford, who has a Master of Science in Nursing and is a Certified Nurse Practitioner with Women’s Health Services at Kent State, says “anything” involved with hormones can have an effect on one’s anxiety or mood – and when I went on the pill, I had already been diagnosed with depression and anxiety.

“If someone has severe anxiety or depression, caution should be used in choosing contraception and with the start of contraception when anxiety or depression symptoms can worsen,” Myford wrote in an email.

Who would I have asked? I don’t think I told my mother that I started the pill – when I told her I had the implant, a year later, she told me not to tell my grandmother.

“If young people don’t have family members that are talking to them about it, and then they also don’t have comprehensive sex education, which many school districts throughout the state of Ohio don’t, they have abstinence-only education, then they just might not have a source for information about birth control,” says Leah Pusateri, a community education manager with Planned Parenthood of Greater Ohio.

Pusateri says that Planned Parenthood attempts to fill the gaps – to provide education about birth control options and other safe sex topics. But Wink didn’t have a Planned Parenthood where she lived. Instead, she began doing her own research. She decided that an IUD – intrauterine device – would be the best option.

“I felt like not having to remember to take a pill … I knew that I would just like always forget to take it, and I didn’t want to have to worry about it so much,” Wink says. “I chose the IUD so it would cause me less anxiety about having to remember to take it all the time.”

When I took my first birth control pill, I took it at 10 at night. I still remember the time – not too early, not too late. I couldn’t forget, or I would be off. My stomach could not settle with the pill. Every night, I set alarms – blaring through dinner, through quiet nights on the sunporch. I don’t think that I went to a nighttime movie in a year – how could I? When I went out, there was that silent deadline.

“When we talk about the methods, we sort of let them know some of the most important things they need to know about them. So, for example, with the pill … that it needs to be taken preferably at the same time every day, without days being missed,” Pusateri says, “and young people seem to express some concern about that, about being able to keep up with that schedule.”

I wondered, as the summertime began to wake and school no longer lingered on my mind, if I should learn more about the pill. Perhaps I was looking to give myself permission to have more freedom, to take the pill a few minutes later on some days. Anything to relieve myself of what had started to feel more and more like a weight around my hands. And yet – what I found was not peace.

I lingered in digital spaces like r/birthcontrol, my fear blooming. Gradually, I began to see patterns in the posts. Women would come to the chat rooms posting frantically about taking the wrong pills on the wrong day, taking antibiotics, drinking tea with St. John’s Wort. I looked at my own tea cabinet with a pit in my stomach.

When Wink did online research, she says she found it helpful – some of the time.

“I felt like overall it was pretty helpful, and it didn’t seem like misinformation, but of course I can’t really know that for sure,” Wink says.

Those on the boards she frequented, she says, had varying experiences – some would recommend birth control methods while others described “terrible” experiences with their chosen devices and medications.

“The United States has a kind of backwardness about birth control that’s very much a study in contrasts with, say, Canada or Europe,” Holt says. “... And whenever you have a kind of cultural response or political response where you’re dragging your feet or you’re looking for excuses, you tend to kind of generate misgivings and fear in an audience.”

But if I had no one to ask, I thought, why not Reddit? After all, like me, Wink admits she wishes she’d known more about birth control.

“It was just kind of frustrating that I didn’t really have a basic knowledge of anything, and having to Google really simple questions about stuff,” Wink says, “and it just felt like kind of – not like humiliating, but kind of embarrassing that I didn’t know already ‘cause it feels like you’re supposed to know all this stuff before you’re, like, ready to make that decision.”

If you have no one to ask, why not the internet? Why not consult with a web page that could pass for answers? Visit the subreddit today, click on the organizing tag “Mistake or Risk?” and prepare for the flood. Even visiting the forum now puts an anxious knot in my throat. Many things about it scare me – the tight tenseness of the fear here, the many different answers to the same questions – some of them things I asked.

I remember, at some point while I was on birth control, I started to feel sick – physically, on top of the sickness in my stomach that had come with constant Googling, tracking my time exactly, calling Planned Parenthood in the hallways of my internship, in a hushed voice, to ask if I should worry about throwing up hours after I had taken my pill. Sleepless nights turned into doctor’s visits turned into blood tests. I had strep and I had mono and I needed antibiotics.

In the Minute Clinic, receiving that news, I shuddered. One thing raced through my mind – interaction. I was right to be worried.

“There are medications, prescription and OTC, in different categories that can affect birth control effectiveness. This is evaluated when medication is prescribed to patients,” Myford writes.

But asking your pharmacist if the antibiotics would reduce the pill’s effectiveness, like I did, will get you one response: yes. The Planned Parenthood website gives you another: “Only one antibiotic is known to make the pill less effective. That is rifampin, a special medication used to treat tuberculosis.”

Sierra Clark, the graduate assistant at the Kent State Women’s Center, uses the pill for medical reasons – it helps to control her polycystic ovary syndrome. She needs the pill to manage her symptoms, and still, she is often unsure.

“I am a public health student, and I want to be a doctor and I do a lot of cancer research, so I feel like I’m fairly educated on reproductive health,” Clark says, “but I still have questions … although I consider myself pretty educated, I still have anxiety sometimes.”

Sitting slumped and exhausted in the heat of my sunroom, close to too tired to drink orange juice, I might have broken in some way. I was taking antibiotics I was told would make birth control less effective and would weaken the very thing that was supposed to bring me peace.

I wanted this thing to work. I needed this thing to work. I followed the instructions exactly – I took the medication to the minute. I tracked the clock with my eyes when I swallowed, checked the package for dust to make sure I hadn’t missed even a fragment of a pill. And now, I languished, sick. Compromised. I could not be perfect.

“It’s always been true with birth control, no matter what the method is, that there’s a pretty severe set of instructions that if you don’t do it right, it might not be effective,” Holt says.

Holt recalls that “early numbers” reported an efficacy close to 100 percent – with perfect use.

“But if you kind of just loosely follow the instructions, I think it was anywhere from like nine or 10 out of 100, so 10 percent of women could get pregnant. So how bad would that feel, to actually be on birth control, but maybe not take the pill the same time every day and all of a sudden you find yourself – you thought you were protected and you weren’t.”

I wondered, sometimes, if it would be worse to know all of this or to be ignorant. I had friends who took the pill at different times, who forgot to take it at all. They shrugged off my worries. I controlled what I could. I secretly adjusted the temperature gauge in the dining room, where I kept my pills in a drawer under a clock though the air conditioner was often off. (I thought it was the coolest, driest place in the house.) I thought about buying a temperature ray gun from Walmart to make sure the proteins in the pills weren’t cooking like someone on the subreddit warned they could.

One night, I could not sleep. I sat up in bed, my back aching. I rubbed my hands through my hair and I scratched at my skin and I sweated cold. My mind turned one thought over and over again, something I am afraid even now to type onto the page.

What if? What if something had failed after all? What if I had done something wrong? What if it was already too late?

I called my grandmother in the dead of night, and I told her, sobbing, that I needed her to take me to buy a pregnancy test. Don’t tell my mom, I begged her. I knew she would not. I told her I could not go to sleep, that I would wait until seven or eight, that I would go with her and she could get it for me.

Online forums like r/birthcontrol provide a space for women to share anxieties and information amongst themselves.

I begged her – and when she said yes, I waited up until she arrived, sat shaking in the car while she went into a CVS. I cannot remember much of that night, only a year or two ago, except for when I took the test, while she waited in the kitchen.

It was negative. Of course, I thought. Of course, but I don’t know, but of course. I was exhausted. I ate toast in her kitchen, and I felt like something had to change.

I decided I had to get something more permanent. Something I could not damage or do wrong.

(Now that I have it, I still worry, still read the ingredients of everything I drink.) I settled, finally, on the implant. And, as I thought about getting it, just for a moment, I am sure I wondered why.

I wonder if Wink sensed this, too – the underlayer, the thing that made us both seek out procedures which had been painful on our bodies (“I’d say that was one of the most painful I’ve had in my life,” Wink says) for peace of mind.

“My parents had told me that if I had gotten pregnant and had a child that I wouldn’t be able to go to college, or that I would have to support myself fully, like pay for everything,” Wink says.

Was this something I’d thought about, too, in the back of my mind, while waiting for my appointment at Planned Parenthood? I’d gone back for this story – it had smelled like disinfectant there. When I looked at the chairs in the waiting area, I saw the past of myself. I looked at a scared 20-year-old, unsure about her own body, about what this thing might do to that body. Afraid of failing not just herself, but everyone around her.

“If it’s possible to blame the woman, we blame the woman,” Holt says. “I think it would be almost impossible to be a young woman in our culture and not know that. So, we all pick that up pretty early on, as women, to know that if something goes wrong, it’s going to be on us … whether or not you ever form that sentence, you know.” Did I know? I think of myself then, outside the waiting room. On a dark wood table, near a window, was a book of picturesque scenes and artwork, open to a page of mountain goats. The long hallway stretched out in front of me. I took a breath, and I went in.

In two years, the plastic under my skin will run out of its hormones. They will need to inject my arm with burning numbing agent, re-open it to extract the spent white rod, like a perfect bone. They will need to replace it, and I will let them. No matter how much it hurts.

CAMERON GORMAN | cgorman2@kent.edu