Birth Control – Prevent Pregnancy Before it Begins
Written By: Bonnie and Daena
As abortion doulas, one of the many ways we provide support is by educating people about their options. At some point during our time with a client, the inevitable question arises: how can I avoid pregnancy in the first place? The world of modern contraception can be overwhelming, confusing, and inaccessible. People and doctors have been trying all sorts of things to avoid pregnancy for a very long time, some more effective and safer than others. And just because it’s available or prescribed by doctors doesn’t mean there aren’t long term effects (ahem – Depo-Provera is still happening and Dalkon Shield in the 1970s).
As doulas and herbalists, our role is not to steer a person in any one direction, but to shed light on the available options and to educate those we work with. Only then can a person make a truly informed decision; if they don’t have all of the information, then it is not a truly informed choice. Listen to your body and do your own research based on your needs.
We couldn't include all options available, so we are covering some of the most common. They are always evolving and this post is a non-exhaustive list. If anyone is in Vienna, please go to the Contraception and Abortion Museum and tag us in the pics!
IUD (hormonal and non-hormonal options)
“Intra Uterine Devices” aka IUDs are small T-shaped devices placed inside the uterus. There are two categories: hormonal and nonhormonal.
Nonhormonal options available in the US are the Paragard and the Miudella (good for between 10-12 years), which are both made of copper. While it may impact the amount of bleeding and cramping for the first few months, the copper IUDs don’t stop ovulation or prevent the natural hormonal cycle. The copper ions act as a spermicide, impeding sperm that make their way into the uterus and preventing fertilization if an egg is present. The copper also causes localized inflammation, causing the uterine lining to not be able to support a pregnancy and preventing implantation.
Hormonal IUD options in the US include the Mirena and Liletta (good for 7-8 yrs), Kyleena (5 yrs), and Skyla (3 yrs). These act by releasing low levels of progestin, a synthetic form of progesterone, into the uterus. It is thought that the progestin remains more localized to the uterus.
IUDs are different from taking oral hormonal birth control, which has a systemic, more widespread hormonal effect.
Hormonal IUDs have three ways they can prevent pregnancy
By thickening cervical mucus (which blocks sperm from entering the cervix and thereby making their way into the uterus to fertilize an egg)
Disrupting the integrity of the uterine lining, preventing a fertilized egg from being able to implant into the uterine wall
Preventing ovulation from happening altogether
The pros of both types are that IUD’s are 99% effective at preventing pregnancy, and you do not have to remember to take something every day.
The long-lasting nature of IUDs make this choice appealing, particularly because the current administration is actively stripping away reproductive healthcare access.
Some of the cons of this type of IUD include similar complaints to other hormonal contraceptives: the side effects of taking exogenous hormones. Some people complain of having headaches, breast tenderness, weight gain, mood changes, etc.IUDs also do not protect against sexually transmitted infections.
Having an IUD inserted can be quite unpleasant and even painful, depending on the medical provider and the options for pain management offered.
Historically, many providers have been taught that the cervix has no nerve endings – a belief that any cervix-haver can attest is blatantly false! (Check out this art display by Emily Kampa.)
Nowadays, more providers are acknowledging that options for pain management during IUD insertion is a must, so it’s important to find a provider that will offer different options and listen to your needs.
Birth Control Pill (hormonal)
Most people are familiar with or have at least heard of “the pill.” This is referring to pills that contain hormones, which have an impact on your monthly cycle. Under the umbrella of “the pill” there are many types that work in different ways.
There are pills that contain solely progestin – a synthetic form of progesterone, or there are “combo pills,” which contain both a synthetic form of estrogen as well as progestin. Combo pills prevent ovulation, as well as thicken cervical mucus and thin the lining of the uterus, preventing implantation. Progestin only pills also thicken cervical mucus and thin the lining of the uterus. Some of them prevent ovulation too, while some of them don’t.
The level of hormones within each pill depends on the type, and some pills release a higher amount of hormones at a certain time of the month, while others have the same amount of hormones in each pill throughout the month. Additionally, some hormonal birth control you take for 21 days, then you take 7 of the “inactive pills.” These seven pills have no hormones and mimics a typical monthly bleed. Other types have you take 84 pills, then follow up with 7 inactive ones, resulting in bleeding only 4 times a year.
The pros that many people share about taking hormonal birth control include having shorter, lighter, less painful periods, a decrease in PMS symptoms, and potential relief from some endometriosis and PCOS symptoms, such as debilitating pain and hirsutism.
Cons about the pill are the undesirable side effects that many folks experience. These include things like unwanted weight gain, headache or migraine, breast tenderness, lowered libido, depression, irregular bleeding, etc.
The combo pill can also increase the risk of blood clots, stroke, or heart attack due to the estrogen, making it a less desirable choice for people who already have a preexisting condition that makes them more likely to develop any of these.
The pill also does not protect against STIs.
Another big challenge about taking hormonal birth control is the requirement to remember to take it every day. Some progestin only pills must be taken every day at the same time for them to work, while some just have to be taken each day.
With perfect use, the pill is considered to be 99% effective. The reality is that most people are not perfect, which brings its efficacy down to about 91%--or lower if pills are skipped altogether, making pregnancy more likely.
Emergency Contraception (hormonal)
Most often pills (but some herbs too!) are to be taken within 3-5 days after unprotected intercourse and work by disrupting ovulation by impacting the hormone progesterone, which is needed for implantation.
Read more about Emergency Contraception here.
Implant (hormonal)
Also called Nexplanon, this is a small plastic rod inserted just under the skin in the upper arm. It contains progestin, so like the progestin-only hormonal pills, it works by thickening cervical mucus and preventing ovulation from happening. It lasts for up to 5 years and is another option that allows someone to avoid pregnancy while not having to remember to take a pill everyday.
And, like the progestin-only pills, it can have the same unwanted side effects, such as mood changes, irregular bleeding, headaches, breast tenderness, etc. Rarely, a person can have a reaction at the insertion site. It requires an appointment to be removed since it is underneath the skin and it does not protect against STIs.
Fertility Awareness Method aka FAM (non-hormonal)
The Fertility Awareness Method is a non-hormonal birth control based on personal observation and identification of the fertile window. Though often conflated or used interchangeably the Fertility Awareness Method is not the same as the Rhythm Method or Family Planning Method. FAM involves tracking your cycle and your body’s cues to know when ovulation is happening. This is often referred to as “charting.”
It requires daily charts that include taking the basal body temperature at the same time each morning before they’ve gotten out of bed and the changes to the cervical fluid. During the fertile window–that is, the time of the month when someone can get pregnant–a person must use a back up barrier method during intercourse, or avoid it altogether.
Because every person and cycle has some level of variation, it can be confusing at first to understand how to tell when ovulation is occurring each month, and having a FAM practitioner (find one here!) to help guide you for the first few cycles is encouraged.
With perfect use, the Fertility Awareness Method is up to 98-99% effective at preventing pregnancy. When it is not used correctly, it is only about 76% effective.
Barriers (non-hormonal)
The only protection against both pregnancy and sexually transmitted infections are barrier methods.
That includes condoms (internal and external), diaphragms, cervical caps, and sponges. These are all nonhormonal and must be used each time during intercourse. The efficacy varies depending on the method, but with perfect use all barrier methods are highly effective at preventing pregnancy.
Spermicide (non-hormonal)
This can be cream, gel, sponge or inserts and need to be inserted in the vagina each time someone has sex. They do not protect against STIs and repeated use can cause irritation or discomfort. Some plants have been used and researched with good promise as safe and effective spermicides.
Sterilization (non-hormonal)
This is a permanent form of birth control and can be performed on people with a penis (vasectomy) or a uterus (tubal ligation). A vasectomy is generally considered more effective, safer, and a less invasive procedure than a tubal ligation, though it takes up to 3 months to work. These are in clinic procedures and each state has different regulations and requirements.
A Nuanced Approach
A common pattern we see with birth control prescription is when someone struggling with menstrual issues makes an appointment with a provider to find a solution. This person may have painful periods, very heavy bleeding, unpredictable cycles, ovarian cysts, endometriosis or PCOS symptoms–and often the only option given to this person is to be put on hormonal birth control. This may help in the short term; if the birth control prevents ovulation, then it is preventing an actual period, thus, most menstrual-associated symptoms will temporarily disappear. The problem is that it is a bandaid, and doesn't actually address the root cause of their hormonal imbalance. And in some instances, it can actually make the imbalance worse down the road. Unfortunately, many providers seem to use birth control as the only tool in their toolkit, without really working to understand what could be driving their patient’s symptom picture. A common story shared by many is the feeling of not actually being listened to by a provider, with an option that leads to a dead end.
This is where working with a holistic practitioner can be helpful. Naturopaths and clinical herbalists, for example, are trained to work together with a client to understand the underlying root cause of a person’s symptoms. Addressing the root often includes looking at a person’s physical, emotional, and mental wellbeing, as well as their lifestyle and diet.
Given this, it’s also important to acknowledge that for some people, hormonal birth control is truly the right fit for them and is even life saving. This is what it means to use a holistic lens: to look at the actual person in front of you, instead of applying a one-size-fits-all approach.
The Bottom Line
It’s important to remember: there is no birth control option that is 100% effective 100% of the time. Each of the current options have pros and cons, and each person’s body is different. It's important for every person to make the best choice for them based on their body and their circumstance.
While hormonal birth control may not be a good fit for you, for others avoiding pregnancy is imperative. Having an unintended pregnancy and going through an abortion takes a toll on the body, not to mention the time, money, and energy it takes to access one. And medically speaking, at any point during a pregnancy, it is more physically risky to continue that pregnancy than to have an abortion.
Though we as herbalists, doulas, or care providers may not make the same decision for our own bodies, our job is to educate our clients about the existing options and then trust that whichever option they choose is truly the best one for them, without judgement.
If you’d like to learn more about contraception options, their history, and how they work, keep an eye out for our upcoming self-paced contraception class!
About the Authors:
Daena is a clinically-trained herbalist, writer, and co-founder and director of Holistic Abortions, a grassroots group working to increase access, understanding and availability of various abortion methods as a means of liberation from systems of harm through education, direct care, and culture shifting work.
Bonnie is a clinical herbalist, flower essence practitioner, and full spectrum doula. She practices on the land of the Ute, Arapaho, and Cheyenne out of Denver, CO. She believes that reclaiming our connection to plant medicine and our bodies is a profound act of resistance, and her work focuses on all aspects of reproductive health, with a particular passion for abortion, miscarriage, and birth. She brings herbalism, nutrition, and ritual together to provide a client-centered experience.