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The Pill at 50: Don't Stop Believin'

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On the now-famous "Madonna" episode of TV-musical sensation Glee, we witness three hot sex scenes--an adult woman "taking charge of her body," a teen trying to keep her new boyfriend happy, and a young man worried he is still a virgin, along with his seductress teen who apparently will sleep with anyone. To the tune of "Like a Virgin," the women are making decisions, enjoying themselves, but then--surprise !--we find out it's all a dream/fantasy sequence.

The "ladies" back off. The guy goes through with it, but with the one who, y'know, isn't really a "lady" and--surprise is the only non-white character--and he doesn't like it. Sigh.

Reflecting on the 50th anniversary of the pill, and whether to celebrate, commemorate, or agitate, I keep coming back to this Glee sequence. Of course there was no discussion about birth control--even though one of the show's characters is a pregnant teen.

On this golden anniversary, the reflection is not as much about the pill as it is about us.

It's about the contradiction of bombarding our kids with unhealthy and over-sexualized images every day, and yet being reluctant to teach young people the importance of having respectful, honest relationships. Things like talking about HIV status, getting tested, using birth control if they need to and saying no if they want to. Helping them have healthy relationships and get out of unsafe ones.

It's about not being able to walk into a pharmacy and get emergency contraception (EC) off the shelf. It's about the Missouri house voting this month to allow pharmacies to refuse to stock EC, and refuse to even tell a woman where she can get it.

And it's about the fact that nearly half of all pregnancies in the U.S. are unintended, one of the highest rates in the industrialized world. Recent articles in the mainstream press have noted the pill's unfulfilled promise of ending unintended pregnancy. But that has nothing to do with the pill and everything to do with our culture's ability to understand, obtain, negotiate, and use it or any other form of contraception. It's about the gap the Guttmacher Institute and the National Campaign have noted between intention and behavior--feeling it is important to avoid pregnancy but "taking a pass" on contraception.

It's not all bad. Half a century later, birth control pills are much safer and just as effective. About 12 million women use the pill. A woman no longer has to choose between having a family or a career and a couple has more options for controlling whether, when or if they have a child. Women's economic status overall has improved--and that is opening up new challenges and opportunities for men in their roles as caretakers beyond bread winners.

But decades after the "sexual revolution" that supposedly came with the pill, we still haven't accepted sex as a normal, important part of a healthy adult relationship.

Imagine for a moment that we did embrace sexuality. That we didn't feel the need to hide it, be guilty or ashamed of it. That that the use of contraception during sex wasn't just a way of preventing pregnancy but also a way that allows someone to fully experience their sexuality.

What would that look like?

It would mean a woman could walk into a pharmacy and obtain the pill over the counter. It would mean insurance companies would make her refills easy, convenient and affordable. It would mean that ads for birth control options would feature as many loving couples talking about having sex as ads for erectile dysfunction (no kidding - check out ads for Yaz, you never see a guy!). It would be as normal for a man to pick up his partners' pill pack on the way home as picking up some milk.

It would mean the FDA wouldn't politicize every decision about contraception and instead would make decisions based on the best medical science. And that our Administration and Congress would be as stoked about funding contraceptive research and development as they are about getting astronauts onto Mars.

But imagining doesn't make it so, and we don't yet live in that world.

So while we all seem to agree that we want to limit unintended pregnancies, let's start working toward solutions that include healthy sexuality.

Let's start by recognizing that even this discussion about the pill and its impact is taking place primarily through the voice of white middle aged women and ask ourselves why. Let's understand that removing barriers to birth control must include a better understanding of the disparities in health outcomes by race and ethnicity. Let's embrace solutions that go beyond a dominant culture's approach to unplanned pregnancy. And let's be willing to dig deep to get beyond our sexual fears, stereotypes, and stigma.

And Glee? We'll keep our eyes out for that episode in which one or more of the "good girls" decides to become sexually active because she wants to, uses birth control, enjoys it, and doesn't get "punished."

What's the verdict on the pill fifty years later?

The verdict is that the pill works just fine. It's our struggle to come to terms with our sexuality in today's world - that's where the jury is still out.

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