Pop Public Health: “The Pill”

Country legend Loretta Lynn married at 15 and had 4 children before age 20. (And a few years later had twins!) Her musical success in the 1950s and 60s was a triumph for women, who had few country icons. Many of Lynn’s most successful songs discussed her family life, motherhood, and being a real country woman. “The Pill,” recorded in 1972 and released in 1975, blasted conversation about birth control in rural communities into the mainstream.

Oral contraceptives, known as “The Pill” have not been available for that long. The 1965 Supreme Court case, Griswold v. Connecticut, decided that married couples had a right to use the pill to prevent contraception and Eisenstadt v. Baird decided that single people had a right to use the pill in 1972.

In ‘The Pill,” Lynn proudly sings in the chorus: “This old maternity dress I’ve got / Is goin’ in the garbage / The clothes I’m wearin’ from now on / Won’t take up so much yardage / Miniskirts, hot pants and a few little fancy frills /Yeah I’m makin’ up for all those years /Since I’ve got the pill.” In total, she sings that she’s “got the pill” 7 times in a song that’s just about two and a half minutes.

When Lynn’s label released “The Pill” in 1975, it immediately caused controversy and many country radio stations refused to play it. A 1975 People magazine article noted:

From his pulpit, a preacher in West Liberty, Ky. recently denounced country singer Loretta Lynn and her new song The Pill. The effect was to send much of the congregation scurrying out to buy the record. More than 60 radio stations from Boston to Tulsa have banned the song, but through word of mouth and the FM underground The Pill is selling 15,000 copies a week. For Loretta Lynn, the most honored woman in country music, it is her biggest hit ever.

Lynn’s response to critics of her song was as frank and cavalier as the lyrics: “If I’d had the pill back when I was havin’ babies I’d have taken ’em like popcorn. The pill is good for people. I wouldn’t trade my kids for anyone’s. But I wouldn’t necessarily have had six and I sure would have spaced ’em better.

Lynn later stated in an interview with Playgirl that she’d spoken with several rural doctors who told her that “The Pill” had been especially helpful in communicating the benefits of oral contraceptives to women in rural communities.

Mainstream acceptance of contraception was and is still a huge issue for people of reproductive age. Just last week, The Trump administration “moved to expand the rights of employers to deny women insurance coverage for contraception.” The 55 million women who had the right to copay-free birth control are now at risk of employers using personal religious beliefs to deny access to contraceptives. Without insurance, birth control pills can cost $50 per month, a birth control implant can cost up to $800, and intrauterine devices can cost up to $1000. Certainly all of these are less expensive than pregnancy, giving birth, or raising a child, but the cost of preventing pregnancy can be significant enough that women may not be able to afford reliable methods of contraceptives.

Sexually active people of all ages, religions, and race are all very likely to use or have used contraceptive methods to prevent unintended pregnancy. It’s unfortunate that the current political administration is attempting to curtail access to reliable and safe contraceptive methods. (Call your senator!!) It seems like, in 2017, we could also use a few new popular songs about birth control, right?

What is Reproductive Coercion?

Reproductive Coercion is getting some surprise attention this week after actors Nikki Reed and Ian Somerhalder went on Dr Berlin’s Informed Pregnancy Podcast and related their pregnancy story with a few red flags. (Note: Dr. Berlin is a prenatal chiropractor, chiropractors are not medical doctors.)

I’ve linked the podcast so you can listen for yourself (the section in question is within the first 8 minutes) as well as a Jezebel article that includes a partial transcript, but basically, Reed says Somerhalder knew way before she did that he definitely wanted children, after they were married Somerhalder wanted to have children around the same time his best friends’ did, and then one night on vacation with aforementioned best friends, he popped Reeds’ birth control pills out one by one into the toilet while their friends filmed it and Reed was “freaking out.” Somerhalder ends the story by admitting really he was the one who decided to get pregnant, rather than his earlier use of “we.”

Is this reproductive coercion? And what is reproductive coercion anyway?

Reproductive Coercion (RC) is a type of intimate partner violence where one partner seeks to limit or control the other partner’s ability to make choices about their reproductive health. RC is a spectrum of behaviors, which can range from pregnancy promoting behaviors like tampering with birth control, sexual assault, and preventing someone from seeking an abortion if they want one, to behaviors that attempt to pressure, control, or harm a pregnant person with the aim of ending the pregnancy against their will.

When you listen to the actual audio, it seems as if they’re trying to make this into a cute, jokey story, but I can’t shake the red-flag-feeling. Reed’s response on twitter, shortly after media outlets started picking up on the story on Friday, characterizes the controversy as something the media has blown out of proportion, while most fan replies to her tweets are encouraging and insist that they knew it was lighthearted.

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Here’s the thing – the narrative was their own. There are many times that a controversy over how something was reported in a profile of a celebrity – which come from much longer interviews that are condensed for publication and may only feature select quotes, but this came from a podcast where Reed and Somerhalder were speaking openly and unedited. The multiple journalists and outlets that picked up on the podcast (a podcast which I imagine rarely makes national headlines) raised the red flag over Somerhalder’s description of tossing her birth control in the toilet while Reed was upset, and that Reed asks about the video that was taken and wonders if she was too drunk to remember. These elements are alarming facts, and I when I listened to the actual audio the way they were told didn’t make me feel any better. Maybe they didn’t tell the story in an artful way, but these are tactics that are part of the spectrum of behaviors known as RC.

Reed and Somerhalder later put out a joint statement addressing the allegations of reproductive coercion:

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Celebrities are very often not experts on the topics they become associated with. This is true. However, it is a rare moment in pop culture that a relatively little-known public health problem is gaining some attention, which is ultimately a good place to start a conversation.

Mapping Abortion Access

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This visual representation of abortion access in the USA from The Pudding is really fantastic and informative –albeit depressing.

Since 1973, abortion has been legal (up to the third trimester of pregnancy) following the Supreme Court decision in Roe v. Wade that asserted that pregnancy termination is part of a pregnant person’s right to privacy. Prior to Roe v. Wade, death due to unsafe, illegal abortion accounted for a significant percentage of maternal deaths. Access to safe and legal abortion dramatically reduced maternal deaths and abortion is now one of the safest surgical procedures (safer than giving birth!)

The maps that The Pudding put together (a site I’d never heard of before but I love “visual essays” so goodbye to all of my free time) are really great because they help visualize the specific barriers that people seeking abortion face both in clinic location (the above screenshot) and availability of services according to location and gestation (below screenshot).

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Abortion is legal, but what is legality without access?

In the spring semester, I worked on a group project for a class about abortion access in Pennsylvania, and we plotted clinics that offer abortion services on a map. It becomes abundantly clear, when looking at the map, that the 20 or so providers are clustered in mainly urban areas. But people live in those in-between areas too! Population density is greater in those urban areas, but when you look at 2010 Census data, you can see that there are huge areas of the state where physical access is severely restricted. And these plots don’t even get into the specific restrictions each clinic may have on what types of services they offer.

As The Pudding explains, TRAP (Targeted Regulations of Abortion Providers) laws frequently limit access to abortion by instituting arbitrary rules for “safety,” but are actually medically unnecessary, political moves. It is expensive and time consuming to fight them. (If you’re interested in this – I recommend watching the documentary Trapped.)

Abortion access is an issue I care about a lot, but I think it’s really important to have these kinds of visual representations of data and access because it can succinctly and clearly translate these complicated issues. So check out the maps that The Pudding put together

Links Roundup: The Wellness Industry

Maybe I’m the target demo, but wellness seems pretty inescapable right now.

In the context of the “wellness industry” that is primarily marketed toward women, wellness is not just personal health but also a kind of moral superiority. The idea of wellness that is sold by Goop, fitness influencers and celebrity chefs on Instagram is a hard nut to crack because truly, people are ill, our modern diets and lifestyles make feeling healthy and maintaining good health difficult, and striving to attain better health is something that all people should be interested in, but it’s also very aesthetically rigid, expensive, and scientifically ambiguous.

Health trends change over time (running used to be weird!), and the wellness industry that promotes everything from “clean eating,” jade vagina eggs, crystals, natural deodorant, exercise regimens, supplements, fasting, and juices (and more!) is diverse and also runs a spectrum of helpfulness.

However, like all trends, I think we should be critical of what we’re consuming (literally and figuratively) and take a step back to examine what exactly we’re being sold. I do partake in some of these kind of crunchy, wellness related fads and enjoy them (chlorophyl water is pretty refreshing, although I don’t think it had any particular impact on my wellbeing), but I try to take everything with a grain of salt. It’s hard to be a woman in the world and not know someone with some kind of disordered eating, and I admit that when I see food bloggers using words like glow, warming, and nourishing about recipes I feel kind of the same way some people do when they hear the word moist. There’s is nothing inherently wrong with it, it just feels like something’s not quite right.

I think the part of these trendy, wellnessy-marketed things that troubles me the most is the idea (sometimes overt, sometimes implied) that attaining whatever your chosen leader’s form of wellness is something that can put you on a path to self-actualization or moral superiority. I think many people can feel empowered by feeling more in control of their health and lives, but kind of how many people who aim to lose a lot of weight and do but don’t become the happy carefree people they assumed they would be when they finally reached their goal weight, there are no magic fixes to what ails you and believing there are is a slippery slope to disappointment.

Anyway, I have a lot of ambivalent feelings about wellness, but I think these articles are all really helpful for understanding the salience of this industry and what we as consumers should consider:

Why we fell for clean eating (8.11.17 via the Guardian) Really comprehensive history of the evolution of “clean eating” and the wellness industry.

You can’t found a new faith system with the words “I am publishing a very good vegetarian cookbook”. For this, you need something stronger. You need the assurance of make-believe, whispered sweetly. Grind this cauliflower into tiny pieces and you can make a special kind of no-carb rice! Avoid all sugar and your skin will shimmer! Among other things, clean eating confirms how vulnerable and lost millions of us feel about diet – which really means how lost we feel about our own bodies. We are so unmoored that we will put our faith in any master who promises us that we, too, can become pure and good.

We exercised with Nina Dobrev and the experience nearly killed us (7.20.17 via Jezebel) For a lighter take on the hegemonic aesthetics of wellness, I really enjoyed this.

Women are flocking to wellness because modern medicine still doesn’t take them seriously (6.15.17 via Quartz) I liked this article because it is more validating of seeking “wellness” than most articles (there are legitimate reasons people, especially women, look for alternatives!) but also drops some important points like this:

But it’s important to remember that the dollars we drop on salt lampsand Moon Dust aren’t the same thing as agitating for change—and that retreating into wellness is only an option for the privileged set. Medical outcomes in the US are largely predicted by race and socioeconomic status, and it is minorities and poor people who face the worst consequences when toxins get dumped and regulatory systems break down.

Dear Gwyneth Paltrow, we’re not f**king with you, we’re correcting you. XOXO, science (5.22.17 via Dr. Jen Gunter) Dr. Gunter is a damn delight, and taking on the snake  oil salesman ways of Goop is a frequent topic on her blog. This is one of several take downs Dr. Gunter has done, all of which are informative, science and fact-based, and often hilarious as she deconstructs Goop’s latest fad with incredulity.

Wellness, womanhood, and the west, how Goop profits from endless illness (4.28.17 via Jezebel)  Stassa Edwards is really fantastic and you should read this whole thing.

Learning to chew, swallow, and shit at Viva Mayr, an Austrian Detox spa for the ultra wealthy (3.15.17 via Jezebel) I read this with an open, non-judgemental mind, just because I think it was really interesting to hear about how Detox spas like this work. It reminded me of an older article from the Cut on a celebrity weight loss “wellness” retreat, and I think both articles provide some important observations on the pros and cons of these spas/camps/retreats that you really cannot make without some first hand experience.

Links Roundup: Opioid Addiction

Opioid abuse is a growing epidemic in the United States, and frequently makes headlines. I think it’s particularly hard to get nuanced stories about the opioid epidemic because drug use is highly stigmatized and many journalists, even sympathetic ones, frequently write stories pumped with *shocking* details and descriptions, which is less humanizing than what they’re probably hoping for.

That said, it is a significant issue, and one that is tied to the over-prescription of opioid painkillers. Prescriptions are down since 2010, but even short-term prescriptions for opioid painkillers increase one’s risk of developing an addiction. In 2015, drug overdose was the “leading cause of accidental death in the United States,” with 38% of those drug overdose deaths from prescription pain killers and 25% from heroin.

I find reading stories about the opioid crisis, especially in my home city of Philadelphia, to be particularly difficult not because of the subject matter, but because of many people’s total disdain and disgust for people who use drugs. Reading comments on the internet is always a (mentally) dangerous endeavor, but people are particularly cruel about drug addiction, and this simply does nothing to help the crisis.

The above video from Vox is a really helpful primer on one of the reasons why heroin deaths are spiking, but I also read 2 articles this week that I thought offered some really important, nuanced perspectives on what the lives of opioid drug-using women are like:

Sex Workers and Drug Users Speak Out in Philadelphia – The Fix

Establishing a sense of empowerment and community is crucial – even lifesaving –for sex workers, said Amanda Spitfire and Aisha Mohammed, Project SAFE volunteers and the evening’s organizers.

“A lot of the stories were really painful, involved a lot of pain and sadness and hardship and difficulty, and I think that that’s really important to recognize that that’s a part of it, too,” Mohammed said after the event. “But that’s not a reason to abolish the sex industry altogether. Those are the reasons to make it safer – to make conditions safer and better and more lucrative for people who are doing it.”

Getting An Abortion In Alabama Is Hard. The Opioid Crisis Is Making It Even Harder. – Huffington Post

Although the patient Parker and Johnson were talking about was from Birmingham, she was 21 weeks and 1 day pregnant, which meant her procedure would have to be a dilation and evacuation, or D&E. Parker would have to use drugs to soften her cervix to conduct the abortion procedure in order to be able to insert his instruments into her uterus and remove the fetus.

…The clinic wouldn’t be open again until the following Wednesday, by which point she would be perilously close to the 22-week cutoff. … To add to the patient’s concerns, Alabama has been aggressive about prosecuting women who use drugs while pregnant. Given the abortion restrictions in surrounding states, given the looming public holiday and given this woman’s desire not to become a mother, Parker and Johnson both knew they were her last best hope.

It’s a complicated topic, but I hope that when readings articles about opioid addiction that you look for articles that present facts in a neutral tone and with respect for the people they’re interviewing.