The floor to the Experts – Sabrina Debusquat, French science journalist and feminist committed to contraception without side effects

Sabrina Debusquat is a science journalist and health specialist. As such, she is a member of the Association of Scientific Press Journalists in France. She wrote two books on contraception: « J’arrête la pilule »and « Marre de souffrir pour ma contraception. Manifeste féministe pour une contraception pleinement épanouissante », while developing an activist commitment in favor of a better sharing of contraception between men and womenj and without side effects. Elle tient également un blog santé Ça se saurait.

Few weeks after the Generation Equality Forum in Paris, we spoke with her about her commitment and recent developments in the debate surrounding contraceptive issues.

Expertes Genre : Qu’est-ce qui vous a menée à écrire ces deux livres, à la fois sur le plan personnel et professionnel, et quel fut le cheminement parcouru entre les deux ?

J’arrête la pilule is a journalistic investigation which took me a year and which unfolds in several parts, with one theme per chapter: the history of the pill, why we are where we are today in terms of the dangers of the pill and the dangers of the pill in terms of women’s health but also the environment.

The impetus for this investigation was the fact that I myself had written a testimony on my personal blog about stopping the pill in 2014, in which I explained the beneficial effects I had experienced. And then it was as if I had opened Pandora’s box. I was able to realize that many readers could see themselves in my testimony. From there, I started to structure my investigation around the questions that women were asking themselves and that I had collected via my social networks. The questions that came up most often were those related to the health risks of the pill (breast pain, loss of libido, increased risk of venous thrombosis and pulmonary embolism with certain third and fourth generation pills, etc.), but also for the environment (feminization of male fish, reduction of fertility and disturbance of the sexual behavior of fish but also of mammals under the effect of the rejection of the hormones of the pill in the environment with potential repercussions on male fertility in human beings, to know more).

The other dimensions of the investigation came much later. The historical component, in particular, was included because it helped to understand why we are where we are today.

In addition to the testimonies and the historical part, I did a scientific investigation that was reviewed by seven scientific reviewers (toxicologists, general practitioners and specialists), including Ellen Grant, one of the first scientists to have tested the pill in 1961 in England.

The survey was released in September 2017 and really sparked a public debate on a topic that was very little talked about at the time. At that time, I could observe a real split between the old and the new generations, in which I embodied a new generation that had a more critical look on hormones and chemistry. I realized that it was a very complex subject and that we had a kind of “pill Stockholm syndrome” linked to the fact that the pill was considered a crazy feminist achievement, very much linked to contraception. Since the pill was legalized in France at the same time as contraception, the two are closely linked in our minds.

Faced with the distress of women and the fact that things were still not moving despite this new debate, I released the second book. This one is not, this time, a journalistic investigation but a feminist fight against the misogynistic arguments that I received at the time of the first book from doctors on TV shows, who completely minimized the experience of women. And I accompanied this second book with a campaign on social networks through the hashtag #Payetacontraception, which is a bit like “a #Metoo of contraception”. The idea was really to free the word on this subject, in particular through a op-ed signed by many young french feminists in which we asked the government for funding to develop contraception without undesirable effects. Four years later, I unfortunately note that little has changed and that, as far as contraception is concerned, we are still relying on the achievements of our grandmothers, whereas we have a new generation that wants to move towards better shared contraception with no undesirable effects.

Gender experts: In recent years, we have witnessed more and more questioning of certain contraceptive methods, particularly by the younger generations. At the same time, timid research and initiatives have been launched for the development and promotion of alternative contraceptive methods, especially for men. What can we expect from the dynamics currently at work?

Unfortunately I don’t think we can expect much from the pharmaceutical industry. The pharmaceutical industry has no interest in moving away from the paradigm of hormonal and medicalized contraception that produces adverse effects, for obvious financial reasons. As far as male contraception is concerned, very little investment is made in research and development because the industry considers that there is no market, implying that few men will be interested. This is why I believe that change will come from the grassroots, with dynamics coming from patients who are fed up with the contraceptive status quo and who are testing, sometimes at their own risk, contraceptives with no undesirable effects or better shared, such as the male contraceptive ring or thermal male contraception.

The idea would be to achieve a contraceptive that is shared between men and women, without adverse effects or environmental impact. I think that’s where we’re headed, but it’s going to take some time, maybe a century or two.

There is an effort that must also come from the States in terms of contraceptive education for young people, which would mean telling young women that they do not have to take the pill and that a properly used condom is more effective than an incorrectly taken pill. Young women should also be taught about their bodies and their menstrual cycle, which would allow them to understand that the cycle can be played with to better understand conception and contraception. On the other hand, contraception is an intimate problem that is circumscribed by societal choices. However, at present, the evolution of mentalities is not followed by tools to accompany it. This prevents us from truly implementing contraception without adverse effects that is accessible to young people. Physicians are untrained and prejudiced about cycle awareness methods. There is also a huge problem with research funding. I think it’s crazy that we have found enough resources to go to the Moon, but that at the same time we have left completely untouched one of the problems that has haunted womankind since its beginnings; and that concerns everyone, in all eras. I like to say in my lectures that everyone loves to have sex but nobody is interested in contraception.

The idea would be to achieve a contraceptive that is shared between men and women, without adverse effects or environmental impact.

Sabrina debusquat, scientific journalist

Gender experts: Sexual and reproductive rights were at the heart of the Generation Equality Forum and have been at the center of the news in recent months. In your opinion, does the vision of these rights conveyed by States and by international institutions such as the World Health Organization (WHO), the United Nations Population Fund (UNFPA) or UN Women, as well as the actions promoted, make it possible to respond to the issue raised in your writings of true autonomy for women in their choice of contraception?

I think the vision of these institutions is extremely important because it helps to convey the importance of contraception in many countries, even though this very idea is currently being questioned in a context of backlash.

On the other hand, when I was invited to the 50th anniversary of the UNFPA to present a report on contraception, along with organizations such as Médecins du Monde and Planned Parenthood, I was able to see that the approach of these institutions was not at all avant-garde insofar as they did not take into account feminist evolutions. I raised the alarm by saying that many women no longer expected anything from the medical profession, stopped their medical contraception because of the side effects and switched to other contraceptives. For example, in France, we currently have a 20% decrease in pill consumption. This has not yet led to a real increase in abortions, but the risk is real.

The reality is that women’s requests to no longer suffer from the undesirable effects of their contraception are not taken into account, which can generate situations of danger or distress. We mistake this movement for a regression or a passing trend, whereas I think it is a real movement that is here to stay. If we don’t take it into account because we refuse to see the negative sides of the pill or because we are afraid of backlash and want to preserve our gains, we risk stagnating women’s rights.

I also think it is important to point out that it is not only Western women who would benefit from the research and development of non-medicalized contraceptive methods without side effects, but all women in the world. This is the case in particular in developing countries where regular medical follow-up is more difficult, but also for certain women in vulnerable situations such as climate or political refugees.

The situation is urgent and we must start mobilizing now if we want future generations to benefit from these contraceptives. For this, the States must put the budgets. For example, in India, the government has invested in the development of a reversible male contraceptive with virtually no side effects. This is proof that today, it is not thanks to Western countries that we are making progress on this issue where research is underfunded, notably because of conflicts of interest. We must stop thinking that it is a question of comfort when we know that 83 women in France die each year because of their hormonal contraception. If we extrapolate these figures to the whole world, it is far from being a minor phenomenon. Also, at a time of empowerment and rediscovery of our sexuality, the problems of libido related to the pill are not negligible.

However, it is difficult for feminists, in the midst of a backlash, to criticize hormonal contraception for fear of giving marbles to conservative movements, which leaves the risk of a sacrificed generation and a status quo. I believe that if we all work together on this fundamental movement, things will change. Even if I feel the beginnings of a stir within the feminist movement, I don’t think it’s enough to bring this fight to the institutions in the framework of events like the Generation Equality Forum. I thought there would be a #MeToo of contraception but it’s unfortunately struggling to emerge.

However, it is difficult for feminists, in the midst of a backlash, to criticize hormonal contraception for fear of giving marbles to conservative movements, which leaves the risk of a sacrificed generation and a status quo.

SABRINA DEBUSQUAT, JOURNALISTE SCIENTIFIQUE

Gender experts: The Generation Equality Forum ended in early July. At its conclusion, a Global Gender Equality Acceleration Planfor the next five years was published. What is your assessment of this Forum and of the commitments that came out of it, particularly with regard to the freedom to dispose of one’s body and sexual and reproductive health and rights?

During this Forum, it was interesting to note that the word “autonomy”, especially concerning contraception, was put forward. On the other hand, it was understood in the “classic” sense of the term, i.e., facilitating access to contraception to allow greater autonomy for women who are no longer constantly preoccupied by unwanted pregnancies. Through the themes related to non-binary or transgender people, the issues of discrimination and physical integrity were also addressed, but I deplore the fact that the bodily integrity of women who would like to no longer suffer adverse effects related to the use of medical contraceptives was not. There was also no real question of making women more autonomous with regard to their contraception through the promotion of non-medicalized and effective contraception (such as the symptothermal method or the diaphragm). In my opinion, what has been said and decided in this Forum does not change at all what has been said for many years concerning contraception.

Medicalized contraception, which forces women to depend on the medical profession and the pharmaceutical industry, remains the norm, and adverse effects seem to be a non-issue, in the name of effectiveness, which remains the primary objective. Of course, a Forum that addresses the subject at the global level must take into account the specific problems of women in each country, and the desire to have access to contraceptives without adverse effects remains a subject that is mainly of concern, for the time being, to women in rich Western countries. I would like to recall, however, that promoting the development of and access to contraceptives without adverse effects and with which women are completely autonomous would benefit all women throughout the world, including those who have difficulty accessing medical services as well as those living in more privileged conditions.