The Misuse of History in The Business of Birth Control

“The Business of Birth Control,” a 2021 film directed by Abby Epstein and executive produced by Ricki Lake, tells a selective history of contraceptives in the United States and aims to “empower” women (and persons with uteri generally) to make knowledgeable choices about their choice of preventative methods.^[1] However, as previous critics of the film have pointed out, the film criticizes “Big Pharma,” particularly Merck (manufacturers of the Nuvaring) and Bayer (manufacturer of Yaz and Yasmin pills), and then points viewers uncritically toward fertility awareness methods (FAM) and their accompanying technologies (Lady Comp and Daysy), companies that provided a portion of the film’s financial backing. Additionally, the film’s website offers a “Body Literacy Masterclass,” in which viewers may interact with the experts profiled in the film and may learn more about fertility awareness methods through their recorded videos.

Rather than centering the narrow pill-to-FAM information pipeline, though, this review focuses instead on three ways that the filmmakers use history to examine the modern contraceptive movement and pharmaceutical manufacturers and build their case for FAM. Examining the film’s perspectives on Margaret Sanger, the feminist women’s health movement, and the connection between race, pill testing, and forced sterilization shows not only that the filmmakers misread these histories in service of their argumentative interests, but also that misinformation in the film could lead present-day viewers to make ill-informed choices about contraceptives.

First, the main historical figure that the film addresses is Margaret Sanger (1879–1966), founder of the organization that would later become Planned Parenthood. It shows photographs of Sanger’s early activism to spread birth control information among poor women in New York City beginning in 1914. However, it glosses over her organizational work and support of medical research on diaphragms and cervical caps to highlight her turn toward eugenics via a 1957 interview with Mike Wallace. The interviews with historians Linda Gordon and Deirdre Cooper Owens center on their comments that Sanger was a lifelong racist and eugenicist, but in fact, her earliest motivation was to prevent women’s premature deaths from self-induced abortion and to give poor women some control over pregnancies when their husbands refused to use condoms. Sanger’s initial efforts provided unaware women information about their bodies and offered recipes for inexpensive, homemade spermicides as contraceptives—not dissimilar to those that the filmmakers claim for themselves.

Second, the Feminist Women’s Health Movement (now the National Women’s Health Network) appears at two points in the film, but its development and activities are misrepresented. The filmmakers include powerful primary source clips of the January 1970 pill hearings held by Wisconsin Senator Gaylord Nelson, in which young activists from DC Women’s Liberation, led by Alice Wolfson, interrupted the all-male witness panel and demanded to share their experiences with the pill. The protests eventually led to the US Food and Drug Administration’s requirement that pharmaceutical manufacturers include printed information for patient-consumers on side effects in all medication containers.^[2] The Feminist Women’s Health Movement appears again when the film addresses the Roe v. Wade decision legalizing abortion in January 1973, but viewers are told that “the energy of the mainstream women’s movement turned away from the body and toward getting power in society.” There is a brief image of women in the shoulder-padded business suits of the 1980s walking along an urban street, and then the film moves on.

The allegation that feminist women’s health advocates turned to workplace concerns and away from bodily needs is simply untrue. “The Business of Birth Control” omits the decades-long efforts of independent health centers like the Feminist Women’s Health Center (FWHC) in Atlanta and national organizations like Planned Parenthood to provide safe and legal abortion in the face of hostility and violence from radicalized groups like Operation Rescue. FWHC and other centers also tried to test cervical caps as a pill alternative following Roe. This falsification of women’s health activism in the 1980s does a disservice to the many volunteer and low-paid activists who paid a steep price in their own health and wellbeing to serve vulnerable communities while handling bomb threats and dealing with uncooperative local police forces. Their activism fits the narrative of the film of women’s empowerment over time, so its omission makes little sense.

Third, the film addresses the deeply problematic testing of the birth control pill (later called Enovid) by pharmaceutical company G. D. Searle on Puerto Rican women, who did not receive full information on its potential side effects and whose complaints about nausea, headaches, and dizziness were dismissed by researchers.^[3] The filmmakers juxtapose this episode and its subsequent harms with the forced sterilization of Mexican women in Los Angeles in the late 1960s and early 1970s by doctors at Los Angeles County-University of Southern California Medical Center Hospital. Juxtaposing these two historical events draws together common threads of racism against Latinx women across three decades. Their point seems to be that since Latinx women’s reproductive health was of no consequence either to pharmaceutical companies or Los Angeles doctors in the past, that history alone is reason enough to dismiss the pill for anyone who might need it now. However, the relevance of these past events to twenty-first-century individuals who are interested in voluntarily taking a lower-dose pill is not clear. It is possible to acknowledge the pain Latinx women suffered in the past without preventing women in the present from accessing a much safer version of the pill.

The film concludes with a visit to a “Cycles and Sex” event, which shows its creators excited to promote the wares of alternative contraceptive vendors and those same vendors in engaged conversation with potential customers. It eerily—if unintentionally—parallels the history of a book the filmmakers mention early on—Barbara Seaman’s The Doctors’ Case Against the Pill (1969).^[4] Doctor’s Case relays similar stories of women’s suffering and death due to blood clots and stroke after taking the birth control pill. The book includes an introduction by Hugh J. Davis (d. 1996), the creator of the Dalkon Shield, an intrauterine device (IUD) that itself would cause twenty deaths and significant reproductive health damage among thousands of users. The Dalkon Shield was a plastic fishhook–shaped device with a long tail that Davis pushed onto the commercial market with inadequate testing and falsified results.^[5] Davis used the introduction to excoriate the pill and also to promote the Dalkon Shield for his own financial interests.

“The Business of Birth Control” has a similar trajectory as Doctors’ Case: it details Big Pharma’s damage to women via birth control pills, then offers a seemingly better alternative. It is unlikely that FAM, Lady Comp, Daysy, FemCap, and the other wares on display at the event have caused or will cause as much damage as the Dalkon Shield. However, claiming to offer women empowering alternatives to the pill while providing only a limited view of them does a disservice to film viewers seeking unbiased contraceptive information. Poor historical analysis likewise shows viewers a black-and-white history erased of the complexity and nuance of past activism. “The truth is hard to swallow,” reads the tagline of the film, but partial historical truths washed down with the filmmakers’ and their financial partners’ own commercial interests don’t taste good either.

Donna J. Drucker

Donna J. Drucker, MLS, PhD, is Assistant Director of the Office of Scholarship and Research Development at the Columbia University School of Nursing. Her books include _Contraception: A Concise History_ (MIT Press, 2020) and _Fertility Technology_ (MIT Press, forthcoming 2023).

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