(Not so) happy birthday, contraceptive pill!

This week marked 65 years since the oral contraceptive pill was first introduced to married women in the United States. Today, few dispute its impact: for the first time, pregnancy didn't have to dictate the course of your life; you could choose when, or whether, to have children. It was the symbol of women's emancipation.

Six decades on, however, the pill is starting to feel less like a feminist tool of liberation and more like a frustrating reminder of medical complacency – of a system that can't be bothered to develop safer alternatives. And it shows: demand for the pill is stagnating, and "pill fatigue" is making headlines as women look for other options.

Disillusionment, not denial

Before I go on, it's important to stress that my views on the pill are shaped by personal experience. After all, so many women are happy with it, and it continues to bring about so many economic, political, cultural, and personal freedoms.

But especially amid the rise of wellness influencers and a conservative backlash under Trump, the conversations taking form around the pill have to be considered, yes, but with caution. The horror stories that circulating online remain individual accounts, amplified by algorithms or co-opted by those with reactionary agendas.

Still, we shouldn't entirely dismiss them: on the contrary, they are striking a nerve and should help us progress in terms of contraceptive research and women's health in general. I'm not arguing against the pill itself; I'm calling for one that doesn't come at such a significant physical and mental cost. Disillusionment doesn't always mean denial.

Is this the best we've got?

We've all seen that encyclopaedia of side effects folded into every pill box; the list is so notoriously long people jokingly use it as a blanket. Migraines, fatigue, irritability, reduced libido, nausea, breast tenderness, ... all the way over to blood clots, strokes, and cancer.

In recent years, psychologists have even proven lesser-known mental effects of oral contraception, from increased anxiety and depression to changes in sexual attraction, with some women reporting they no longer felt drawn to their partners after coming off the pill.

For medication that's been around for this long, spanning four generations and a million dosage tweaks, it baffles me that we're still dealing with the same symptoms as our mothers and grandmothers. And I can't help but trace this to a broader culture of medical complacency, rooted in patriarchal and capitalist thought.

Gendered healthcare gaps

While the gendered bias partly stems from the fact that most medical concepts are still based on male physiology, it also comes down to transparency and power. With contraception especially, you're often prescribed something without being properly educated of the risks or offered alternatives – ultimately stripping you of the ability to give informed consent.

When I was first prescribed the pill at 15, it was handed over as the obvious, if not the only, fix for my debilitating cramps. It wasn't until eight years later, when I started experiencing flash bleeding, high blood pressure, excess copper levels, and serious mood shifts, that I began questioning what this pill was actually doing to my body. Even then, showing up to doctor's appointments equipped with detailed symptom logs, my concerns were brushed off as "perfectly normal, just stress".

So many of my friends could tell a similar story. Study upon study shows that women's pain is consistently minimised in medicine: we're less likely to be believed when reporting symptoms, less likely to receive appropriate treatment, and more likely to have our issues dismissed as stress or hormones.

Meanwhile, multiple promising male contraceptives failed in clinical trials* because participants complained of acne, fatigue, mood swings – essentially the symptoms we've been facing for decades.

So in essence we're seeing a kind of complacency in the field that seems to rest on a deeply cynical assumption: that women simply will tolerate the discomfort, that the side effects are an acceptable cost of bodily autonomy. "Nothing to be done about it, take it or leave it."

Commodifying women's pain

Of course, contraceptive stagnation isn't just a reflection of medical sexism – there's always the money factor.

Contrary to the narrative that markets always drive innovation, I feel as though contraception proves the opposite. Why bother investing in safer, better alternatives when the existing pill, however flawed, continues to bring in stable profits? After all, the male contraceptive pilot projects are proving it's not a question of feasibility at this point.

The pharmaceutical industry sure doesn't have a real incentive to change when millions of women – or governments, in our case – continue to pay for mediocre products because the stakes are too high not to.

Beyond 'good enough'

All in all, I take issue with the pill precisely because of its potential. 65 years ago, it changed lives, redefining choice and autonomy. But six decades on, we're still living with the same health risks.

And here's where my birthday wish comes in, dear pill: do better. We deserve safer options, more transparency, and reliable male counterparts that would finally turn contraception into a shared responsibility, rather than a cultural weight that women are expected to carry alone.

*At the time of writing, a new male contraceptive pill had successfully undergone its early-stage human trials without causing any side effects.