The Day I Didn't Have to Take the Pill

by Hannah Pivo
AFO Guest Contributor

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I woke up before my alarm went off, as is often the case these days. Rolling to my left, I scanned the bedside table for a slim blue packet, and realized that it wasn’t there. I cast my still-heavy eyes around the room, searching my dresser, my desk, before a second realization kicked in: I did not need to find it.

The question, ‘where is my birth control pack?’ has been among my first thoughts every morning for the past three years. If I am in my own bed, it’s generally easy to find, only buried beneath as many books, water glasses, and gum wrappers as can accumulate in a single day. But when away from home, even for just a night or two, the hunt becomes trickier: Is it in my backpack? My suitcase? Did I even remember to pack it!? No matter where I’ve been or how long it has taken to find it, the sight of bright blue plastic in the morning has brought on a sigh of relief. This daily ritual has continued uninterrupted even during the weeks of my fake, estrogen-induced ‘period.’ On these mornings, the thought ‘where is my birth control pack?’ has led me to recall the fact of my menstruating body before I’ve even gotten out of bed, and prompted me to swallow the placebo if convenient, forego it if not.

Over the years, I’ve developed a habit of reading the day of the week above the at-bat pill before popping it out of its foil nest. Usually, the day I read aligns with the day that it actually is—a reminder that all is well, that I haven’t fallen into an alternate reality while sleeping. On the occasional mornings when the days do not align, a moment of panic ensues. Even if it’s just a day off, a single pill forgotten, I find myself making a harried visit to the Planned Parenthood website, where I consult the ‘What Do I Do If I Forget to Take the Pill?’ page yet again to reassure myself that this is not a big deal, that I should just take two pills today. According to Planned Parenthood, you don’t even need to use back-up contraception until you miss two in a row.

Taking the Pill each morning has meant measuring time by counting pills. As in, three more pills until the weekend and 16 more pills until my ‘period,’ and only one more pill until I need to make a trip to the pharmacy to pick up the next pack. Unfortunately, birth control pills aren’t the only things I’ve counted. I’ve counted calories, pimples, pounds lost and pounds gained, number of times I’ve spoken in a class session, total number of sexual partners, the list goes on and on and on. And in spite of women’s supposedly “inferior” math and reasoning skills, I’ve often managed to add up all these numbers to calculate my self-worth.

But that morning, for the first time in three long years, I didn’t have to. It did not matter where the packet was; I did not need to find it. I did not need to read the day of the week and pop the pill out of its foil and swallow it—with water if there was some at hand, dry with a grimace if not—because at approximately 2:40pm the previous afternoon, my uterus had become host to an Intrauterine Device. IUD. Like UTI or STD or PMS or any of the numerous other acronyms that fill the pages of high school health class textbooks.

“Why an IUD?” the doctor asked when I raised the topic at my annual ‘women’s health’ appointment. Because with my insurance, it will be cheaper than the Pill. Because I’d rather not be bothered by the monthly trip to the pharmacy and the daily task of remembering. Because it has a lower risk of pregnancy than the Pill (the Pill is 92% effective, while both copper and hormonal IUDs are 99% effective).

There were other reasons, too, reasons I didn’t care to share with a stranger, even one who I happily granted access to both my medical records and my vagina. For one, I felt safe on the Pill, but not quite safe enough. It didn’t do all the miraculous things I was promised—perfect skin, regular and predictable periods—so who’s to say it was really doing its job in the pregnancy prevention department? Illogical, yes, but a difficult thought to dismiss when I’m three days into my placebo pills and there’s still not a drop of blood in sight and wasn’t there that one day when I forgot to take it until 1 o’clock in the afternoon and oh my god I better check the Planned Parenthood chart again because what if I’m remembering it wrong and there is a fetus inside of me right this minute?

Another reason that I kept from my doctor is that, often, when a cisgender male learns you are on the Pill—maybe the pack falls out of your purse, maybe you tell him—it’s like suddenly everything changes, like suddenly he’s no longer responsible for sharing the burden of contraception. Like now, with the risk of conception miraculously removed from the realm of possibility, he can enjoy sex condom-free and worry-free because even if pregnancy does somehow ensue, he is not liable because the Pill was supposed to take care of that! (What about STDs, you might ask? Well, yes, what about them?) With an IUD, however, my contraception has become internal and private. There is no chance he’ll spot it next to my toothbrush in the bathroom; I alone hold the power to alert him to my impregnability, a power I intend to wield much more thoughtfully than my 21-year-old self would have seen a need for.

For these reasons, both the ones I offered to the doctor and the ones I did not, I was confident in my decision. But I was also afraid of the pain. So. Fucking. Afraid.  Because pain is the tale I’d heard most often about IUDs. ‘The worst pain of my life,’ I’d heard, from several close friends. The fear of that pain stopped me from even considering an IUD for months. It took a particularly delayed ‘period’ on the Pill—and the anxiety that ensued—for me to decide that I could, in fact, handle the pain of a very safe, very brief medical procedure. So I made an appointment from which I came home with a bundle of pastel-colored brochures full of smiling, shiny haired women (was I choosing a long term birth control method or a new shampoo?). I sat on my bed and pored over the facts, figures, benefits, and yes, risks of the various options my doctor had presented me with. I picked one. I called and made another appointment for the next week.

It did not hurt as bad as I thought it would. Pleasant? No. Manageable? Absolutely. In a way, I actually enjoyed the moment when I realized, ‘That’s it! That’s where it is! Hellooooo, cervix!’ There was, admittedly, a split second while she was measuring my cervix when I thought to myself, ‘Okay, I’m done now, please let this be over soon.’ But then it was. And then I didn’t even feel the actual moment of insertion that followed. Relief slowly crept into the edges of my consciousness; after all that build up, all those scary stories of ‘the worst pain of my life,’ it was over and it hadn’t even been that bad.

My boyfriend was out of town at the time, and in the end, I was glad that was the case. It was easy to picture what it would have been like if he’d been there. The ride home, me curled up in the passenger seat, grimacing through the cramps, whining, because I knew he’d be quick with kind words, with sympathy, with concern. Once home, he would have lay in bed with me while I held a heating pad to my abdomen, distracting me from the pain. Instead, I drove myself home, sing-speaking to my uterus and cervix, apologized for scaring them, introducing them to their new friend, feeling foolish but also relishing in the rare experience of being hyperaware of my reproductive organs, both their power and their fragility. Being alone, I realized that I did not want to be distracted and I did not need to be comforted. I had done this by myself and for myself; it was thrilling to act so self-sufficiently.

In writing this, I do not intend nor desire to dispute, discredit, or dismiss those individuals, several of my closest friends among them, who have had terrible, painful experiences with IUD insertion. I hear you and I believe you. My lesser level of physical discomfort certainly does not change others’ pain in the moments they are suffering it. Each person’s body is different, there is no way of predicting what anyone’s particular experience will be like, and each of these experiences has its own unique value.
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At the same time, the dominant discourse of pain and the fear it engenders can be detrimental to those seeking long-term birth control options. To combat this, I avidly want to spread the message that the pain is not always that bad. Sometimes, it’s not even bad at all. We should be frank when discussing it, but recounting the pain needs to become secondary to the circulation of more constructive information about the benefits of IUDs—their high rate of long-term effectiveness, their low hormone levels, and their lack of dependence upon user-behavior (this last point lies in particular contrast to other methods like condoms and birth control pills, which require relentlessly consistent action by their users). The current state of contraception development and accessibility is far from perfect, but that’s no reason to further shroud it in pessimism and fear. Rather, we should promote positivity and awareness about the resources that are available, including IUDs.

In proclaiming my support for IUDs, I do not intend to write off birth control pills entirely. They served me well for three long years. During those years, each month when I got my hormonally inducted ‘period,’ I’d whisper an enthusiastic prayer of thanks to Margaret Sanger, the fierce feminist activist whose advocacy made the birth control pill a reality in the 1950s. And on that first morning when I awoke to lingering cramps and realized that, for the first time in a very long while, I did not have to find my packet and take my pill, I had a surprising longing for it. Habits are hard to break. I actually considered taking the next pill in the pack, even though I didn’t need to, because it was a placebo and it wouldn’t make a difference either way. But why put off until tomorrow what I could do today? So, I tossed the packet in the trash, patted my lower belly, and said good morning to my IUD.