Controlling the narrative: The evolution of birth control in teenage users

By Holly Adams

Some students’ names have been changed to protect their privacy.


The day after President Trump’s inauguration, the phones at Potomac Family Planning Center were ringing off the hook. People were calling the women’s health and abortion services clinic to ask if they would still provide abortions, birth control and other services that Trump planned to defund during his time in office.                              

Despite attempts at the federal level to defund resources that provide birth control, Montgomery County has many facilities that provide safe and judgement-free spaces for teenagers and adults to receive birth control for contraception and other medical uses. Title X, a federal program established in 1970, has allowed clinics to expand their confidential family planning services to serve low-income women who may not have access to private gynecologists. 

Since the birth control pill became available in 1960, its use, along with other forms of female contraception, has become common. In the United States, 12.6% of women aged 15-49 are currently on the pill, and 62% of women 15-44 use some kind of birth control, according to the Centers for Disease Control and Prevention. 

As birth control usage has risen, the culture surrounding contraception has evolved alongside it. In an informal Black & White survey of 55 female students, 71% reported that they believe there isn’t a stigma around birth control at Whitman, and 86% reported having had a conversation with a friend about birth control.

Use of birth control in younger and older women alike has expanded to address other health issues beside pregnancy prevention. It can treat acne and side effects of menstruation like cramps, premenstrual syndrome, premenstrual dysmorphic disorder and migraines through regulating hormone production, said Dr. Diane Snyder, a pediatric and adolescent gynecologist at Women’s Health Specialists.

“The pill, the patch, the ring, the shot and the implant all work by suppressing ovulation,” Snyder said. “When there’s less bleeding, there’s less pain.”  

Junior Emily went on birth control after an incident her freshman year: She had to leave class because she suddenly felt sick and couldn’t see straight. After going to the doctor, Emily found out she had extreme period-related side effects that caused her to almost faint in class.

After the episode, Emily expressed interest in going on the pill because it would make her period-related symptoms like cramps, back pain and headaches less severe. Her parents helped her get the medication from her pediatrician, understanding that it was for necessary medical reasons, Emily said. Although teenagers go on the pill for different reasons, she still believes there is some stigma around birth control at Whitman. 

“In front of girls, you can talk about it and relate to it,” Emily said. “I would never bring it up in front of guys. I feel like it’s not weird to say you’re on birth control, but you have to say ‘but I’m not having sex.’ You have to explain the reason because otherwise people are going to make certain assumptions about you.” 

Since many students are more comfortable talking to their parents about birth control than past generations have been, they’re able to receive and afford birth control prescriptions through private gynecologists or other physicians, paid for by insurance. For girls who want to receive birth control without parental consent, however, clinics like CCI Health & Wellness Services continue to provide Title X services and keep every appointment they have with patients confidential, said Dr. Melissa Clark, the associate chief medical officer at the CCI Health & Wellness Services. If they don’t want to use their parent’s insurance, they can choose to anonymously pay as a sliding-scale patient which ensures confidentiality, Clark said. 

“A lot do not know that you can actually access birth control as a confidential health care consumer,” Clark said. “It’s completely fair to come in and even just talk about it if you have questions.”

 Locally, CCI Health & Wellness Services has multiple locations — Silver Spring, Gaithersburg, Takoma Park and Greenbelt — that each provide a variety of birth control and family planning services, including pregnancy tests, STD testing, STD treatment, emergency contraception like Plan B, the birth control pill, Depo-Provera shots, IUDs, Nexplanon, prescriptions for the NuvaRing and free condoms.

Junior Rebecca’s parents have always been against her taking birth control and always disregarded her whenever she mentioned that she wanted to go on the pill, she said. After realizing that her parents wouldn’t help her get birth control, Rebecca and her therapist made an appointment with her pediatrician without her parents’ knowledge. From there, Rebecca made appointments with gynecologists and other doctors and was able to start taking the pill as an out-of-pocket patient without using her parents’ insurance.

“The process itself was pretty easy,” Rebecca said. “But having that hidden from my parents and having to remember to take the pill everyday on my own  — that factor of secrecy was probably the hardest part.”                     

At Whitman, 24% of female students are on some form of birth control, according to the same survey. Out of these students, 70% said they’re on it for reasons other than pregnancy prevention. 

Junior Lisa Ota, who went on the birth control pill for pregnancy prevention, believes there’s not much of a stigma around birth control at Whitman.

“I’ve never experienced judgement or anything like that, and I know a bunch of girls are on birth control for other reasons outside sex,” Ota said. “I think there’s a pretty good community.”

While doctors consider the pill generally risk-free, there are some adverse effects that women can experience. These may include short-term nausea and headaches caused by the estrogen in the pill, the patch and the ring, as well as possible weight changes and changes in mood caused by progesterone, another hormone in many birth control prescriptions, Snyder said. At her practice, Snyder offers many different doses of the birth control pill, so patients can find one that works best for them if they’re experiencing any of these side effects.  

Since it was introduced, the pill’s composition has subtly changed, with it now including a lower dosage of hormones. This new composition reduces the likelihood of possible side effects that patients could experience without compromising efficacy, Snyder said. 

Some Whitman students, such as Ota, still experienced some of these adverse effects. She experienced months of poor appetite as well as noticeable changes in her mood after going on the pill. After about six months of these initial effects, her body adapted to the new medication and she no longer experiences these effects, she said. 

The effects of progesterone in birth control can cause some patients to experience changes in mood or undergo more severe mental effects, Snyder said. Kaitlin Payne (‘12) said she experienced random episodes of crying for months after originally going on the pill in high school. These effects gradually went away, but she said the emotional changes were too much for many of her friends to handle, prompting them to stop taking the pill.

Now in medical school, she said that she has seen an evolution in education of other forms of birth control since her time at Whitman. She said that many of her friends were unaware of other forms of birth control in high school such as the implant — a very small rod inserted under the skin in the upper arm — or an IUD, which is inserted in the uterus. 

While still less common than the birth control pill, other forms of birth control like the IUD, an intrauterine device, are becoming more common for teenagers. Morgan, a junior, decided to get an IUD for pregnancy prevention instead of the pill because her mom experienced depression when she had been on the birth control pill as a teenager. 

To avoid any mental effects and the burden of having to take a pill everyday, Morgan researched many different types of birth control and ultimately decided on getting an IUD. She believes that the MCPS health curriculum doesn’t teach enough about the different types of birth control since she had to teach herself about the process, she said. 

“I don’t think there’s enough information about sex in general,” Morgan said. “I feel like it’s very shameful.”

Health teacher Nikki Marafatsos believes that the curriculum covers all methods of birth control equally: She gives students a comparison chart of the more common and less common forms of birth control to allow them to compare on their own. She thinks that if the curriculum allotted more time to birth control, she could teach each type in more detail. 

 During her time in high school, Marafatsos believed there was more of a taboo around birth control and doesn’t remember her peers really discussing it. Today, she has seen the conversation shift about birth control in her own classroom.

“I have students who are very open about sharing information about their experiences, even talking about their own experiences among classmates and opening up to the whole class,” Marafatsos said. “We’re at a point where people are more educated about it and more willing to discuss it, which I think is good.”

Although taboos around birth control have eased some for young women, many teenagers still struggle with accessing birth control either because of their socially conservative parents shielding them from access or because of stigmas within their family’s culture that limit their options, Ota said. Although her parents are open to talking about birth control with her, the conversation within her parents’ families when they were growing up in Japan was much different.  

“I know it’s harder for Japanese families because there’s such a conservative ideology usually in their family,” Ota said. 

Although Clark recognizes that in many cultures parents avoid conversations with their children about sex, she believes that the conversation in America has shifted into a newer, healthier form. Now, Americans are more open to talking about sex, birth control, and especially the prevention of STIs, since the AIDS crisis. 

In addition to reduced stigma, birth control coverage has expanded in the last decade, as the Affordable Care Act mandates that insurance companies cover all FDA approved contraceptives at no cost to insured patients, Snyder said.

“There are many women around that world that have no access to any of that and have no control over their reproductive [health],” Snyder said. “I always tell my patients that they need to appreciate that they have this.”