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Why Isn’t Birth Control Getting Better?

The 43 million American women who use it want better options.

One of the worst feelings in the world, if you are a modern, feminist-inclined woman, is when you realize that your life kinda resembles a birth-control commercial. On more occasions than I can count, I've found myself in a large group of women, most of us heterosexual, sexually active, and in our twenties, sitting around complaining about how we’re completely unhappy with our chosen contraceptive method. (Better than sitting around talking about how yogurt turns us on, I guess.)

There are the friends in long-term relationships who, after enduring years of diminished sex drive, have convinced their boyfriends to switch to condoms. The friends who are prone to depression and can't take the Pill because the next thing they know they'll be crying at This American Life—even the light-hearted episodes. The friends who tried the NuvaRing but found it dried them out like an old lady. The friends who are actually doing quite well on Yaz, thankyouverymuch, but still have lingering worries about blood clots and strokes—worries that are, according to a new study, completely warranted. And on and on.

Where's the outrage?

The statistics on women's satisfaction with birth control should be enough to make Big Pharma invest in some serious R&D: Virtually every woman in America (99 percent of us) will use some form of contraception in our lifetime. In the United States alone there are 62 million women of childbearing age, 70 percent of whom are sexually active but do not want children. In other words, at least 43 million American women need birth control—and that's not even counting the men who sleep with them.

We also need better birth control. A 2004 survey found that 20 percent of women were not satisfied with the contraceptive method they were using. On average, women try four different types of contraception during their lifetime. Studies continue to show that even low-dose hormonal contraception exacerbates depression and decreases libido. And last year, a study in the Journal of Family Practice found that only 57 percent of women on the Pill were happy with it.

Fifty years after the invention of the birth-control pill, we are all so busy celebrating our contraceptive options—and defending our access to them—that we tend to forget how few we have. The basic science behind most contraception remains virtually unchanged since the 1950s, when researcher John Rock discovered that a combination of estrogen and progesterone would allow a woman to control her fertility. Sure, scientists have tweaked the hormone levels and delivery methods, but every single one of these innovations is still based on synthetic hormones.

The fact that nearly all birth control is based in the same science will come as no surprise to any woman who has tried to find a non-hormonal contraceptive choice. Her celebrated options are very quickly reduced to using condoms, charting her cycle and abstaining when she's ovulating, or abstaining altogether. When young women I know have inquired about getting an IUD, a shocking number have been dissuaded by their doctors. (Here's more on that.) And despite frequent assurances that a male contraceptive pill is "on the horizon" or "in development," it's nowhere close. "The joke in the field is: The male pill's been five to 10 years away for the last 30 years," Dr. John Amory, a researcher at the University of Washington, told CNN.

Where's the innovation?

"I think a lot of the last decades of work by the industry has been in taking hormonal methods and changing them a little bit, tweaking them, as opposed to huge leaps and revolutionary changes," says Jill Schwartz, medical director of CONRAD, a reproductive health research institution. Yet even she is not optimistic that women would be willing to try an experimental new method. "It's economic. It's going to cost so much to make a new product... But it's not going to be a huge market share. So for industry it's not enticing."

Are pharmaceutical companies so busy inventing illnesses and wooing doctors that they can't bother to invest in R&D for a product for which 99 percent of American women are potential consumers—not to mention the rest of the world? Have social conservatives made birth control so controversial that even the most forward-thinking university researcher can't find funding for this research and even the most profit-thirsty CEO doesn't want to go through the FDA approval process? Or is the human reproductive system really so complicated that we unlocked the only way of controlling it way back in 1951? My friends and I would like some answers.

Photo (cc) by Flickr user blmurch

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