As I watched The Business of Birth Control, I remembered my own years-long battle to find an effective birth control method. I tried multiple dosages of The Pill, just doing nothing, and even the arm implant Nexplanon before landing on my non-hormonal copper IUD. It’s fine at preventing pregnancy, which is barely a problem as my primary partner is now a fellow ciswoman. My period still sucks ass. I’m regularly laid up for a day or two each month because of my endometriosis.
I should be this documentary’s ideal viewer. Instead, I walked away from my laptop asking why this documentary was made—there were so many possible storytelling threads to pull, and they were left to hang loose.
The Business of Birth Control—inspired by Holly Grigg-Spall’s book Sweetening the Pill—is the latest documentary from executive producer/actress Ricki Lake and director Abby Epstein. The team first paired up to create the 2007 film The Business of Being Born and have continued to make films in the women’s health arena. This documentary seeks to untangle the relationship between hormonal birth control, health care industry and feminism. According to the synopsis sent to press: “Weaving together the stories of bereaved parents, body literacy activists and femtech innovators, the film reveals a new generation seeking holistic and ecological alternatives to the pill while redefining the meaning of reproductive justice.”
While I didn’t agree with the supposition that reproductive justice needed to redefined (activist Loretta Ross has done a great job explaining what it is), I was excited to watch this documentary. Finding the right birth control for you does suck, as almost anyone who has been to a well-woman visit can tell you anecdotally. I was so interested to see what kind of data they had found to support my lived experience, which activists would be included, and how they would situate birth control in the larger picture of reproductive health. Instead, The Business of Birth Control felt like it was made by a second-wave feminist who simply didn’t want to advance their way of looking at the world.
Arguably, the most affecting parts of the film are the interviews with grieving parents about their daughters who died as a result of hormonal birth control side effects. Viewers then spend so much time with these parents, who are just beginning a fight against big pharma, with very few victories to show on screen. Their biggest victory seems to be attending a conference about contraception and meeting with a duo of traveling sex educators. The documentary would have been better to lessen the number of talking heads (I lost count) and focus solely on these families mourning their daughters and trying to make sure this doesn’t happen to anyone else. Instead, the narrative is driven by 20-45 second interview clips with doctors, activists, midwives, educators, etc., who are simply less interesting than the people who have experienced significant loss.
Consideration of this documentary can’t be done without addressing its laser focus on young ciswomen. The Business of Birth Control opens with the following statement: “The filmmakers want to acknowledge the use of gendered language throughout this documentary. While menstruation is experienced across the gender binary, the film itself specifically focuses on the historical and lived experiences of cis-women who menstruate. The emphasis on this narrative is not an intentional erasure of the men and nonbinary folks around the world who also experience menstruation. We, as well as those featured in the documentary, are always learning and seeking to do better.”
A discussion about the expansive view of gender is relegated to the last five minutes, but, even then, the phrase “people who have actual uteruses” is tossed around. On my most generous reading, this was an off-the-cuff remark trying to be inclusive of the gendered experience.
It’s okay for a documentary to have a point of view; in fact, I would argue that a documentary that’s all about showcasing how certain birth control methods may be deadly has a distinct point of view. But the acknowledgement of this film’s trans-exclusion (and again, ageism, the focus is on young people always) doesn’t make the exclusion go away. It just makes its inability to grapple with the many ways people use birth control more apparent. The film still largely focuses on people who are using birth control to prevent pregnancy and its hormonal fringe benefits, like acne reduction.
Near the end of the film (with about 10 minutes to go), conference attendees start to mention reproductive justice. Another mentions that not all who identify as women menstruate. To throw this section at the end of the film really feels like someone told the filmmakers that their focus was transphobic during edits, and so they rushed to fix it. Trans people have always existed; The Business of Birth Control just chose the easiest storytelling path by narrowing their film’s focus to only ciswomen.
In addition to its TERFy narrative, the film criticizes proponents of birth control for lacking nuance, particularly in women’s health space. They push back on how liberals won’t criticize birth control for fear of giving ammunition to the right, but ultimately fails to grapple with the fight for birth control options for poor women. Birth control is largely painted as a problem for the middle class and up, for people with time and money to be educated. Instead, birth control is a problem for all people, especially after the fight to include birth control coverage in the Affordable Care Act. Having a more in-depth discussion of long-acting reversible contraceptives (LARCs) would’ve let the filmmakers address their anti-hormonal birth control point of view, while pushing another highly effective option: the copper IUD, a nonhormonal LARC. The only alternative to The Pill is not learning to track your cycle via basal temperatures, or unsecure apps on our smartphones. The point of the sexual revolution was to give us choices in how to safely avoid pregnancy. It’s disappointing filmmakers want to dismiss all birth control options, including LARCs for the most lazy among us.
Instead of using The Business of Birth Control as a way to open the door to a larger discussion of reproductive healthcare equity, they dismiss it. They show a clip of Ilyse Hogue, then-president of NARAL Pro-Choice America, delivering a talking point that should have been addressed more heartily by the film: The best way to bring down the number of abortions is to have ready access to birth control. The documentary seems to have no answer for the question, what if I don’t want to track my cycle? More robust discussions of LARCs instead of education about the cervix could have bolstered their argument.
Hormonal birth control is a problem, but it’s not the problem. As a reporter who is regularly reading the research, writing about abortion, researching Medicaid and all the parts within reproductive healthcare, the problem is much bigger than this one stagnant part of science. It takes the documentary nearly 70 minutes before it gets to a lengthy discussion about the failure of reproductive medicine (including maternal mortality) in America—and it’s just under 92 minutes long.
To give the film some credit, one featured doctor does make this point: “The problem is not the individual doctor. It’s actually being steeped in a system that has been misogynistic from day one.”
The answer to the problem is not more female doctors or more feminist-coded healthcare clinics like Tia, a women’s healthcare company that still doesn’t offer abortion services, whose founders are interviewed near the end of the film. Birth control and abortion cannot be untangled from each other. Reproductive healthcare services cannot be cherrypicked as a focus because once legal abortion is toast in this country, conservatives are coming for birth control. It’s like declaring victory over a 3-headed snake simply because you managed to cut off one head.
I shut off the film with the impression that so many of these people interviewed had simply thought they were the first person to have realized that there are problems with reproductive healthcare in this country. The fight at the heart of the film is correct: Science and regulators do not en masse care about reproductive healthcare. It’s just not the polemic against hormonal birth control it wants to or should be.