When an Emmy Award-winning television host and a veteran film producer decided to create a documentary on the birth control pill, it sent them on a six-year journey.

Executive producer Ricki Lake and director Abby Epstein said that what they learned in the making of “The Business of Birth Control” — which premiered Sunday at the Doc NYC film festival — is that there is a severe lack of awareness of how hormonal birth control affects people’s bodies and their mental health.

The film interviews dozens of medical experts and reproductive health advocates, as well as bereaved families, to get an in-depth look at the lack of research on these drugs, the industry’s racist history and controversial practices, and the potentially devastating side effects of hormonal birth control.

“My head exploded so many times during the making of this film,” Lake said, adding that the most surprising moment for her was learning that hormonal birth control can change how users perceive potential mates. In other words, as Lake put it, “it changes who you are attracted to.”

For Epstein, what took her most by surprise was the fact that so little research had been done to understand how these drugs affect mental health — but had been approved by the Food and Drug Administration in the 1960s anyway.

Lake and Epstein have been making films together for years, many of them related to women’s health. So when they came across Holly Grigg-Spall’s book, “Sweetening the Pill,” which charts women’s side effects of birth control, they immediately knew they had found their next project. They landed an investor in a day, according to the pair, and were able to start filming in 2014.

Now, as the film becomes available to stream in the coming months, the filmmakers are bracing for one particular criticism: that they are trying to scare people off their birth control. But Lake and Epstein insist that the film’s message is not anti-birth control.

“We are not saying that hormonal birth control should never have existed,” Lake said. “We want this option to continue to be available to everyone and have it for free. But we also want there to be more development [of hormonal birth control] that will make them safer and have less side effects.”

It starts with a lack of understanding

According to the Centers for Disease Control and Prevention, nearly 47 million women ages 15 to 49 in the United States were using a method of birth control from 2015 to 2017. Of these women, 12.6 percent were using oral contraception; 3.2 percent were using Depo-Provera, the vaginal ring or the patch; and 10.3 percent were using long-acting reversible contraceptives, which include IUDs.

In recent years, there has been a cultural shift toward awareness of what people are putting into their bodies, which has led many to seek out more holistic approaches to their own health care. But despite this shift, Lake and Epstein believe there is still so much that is unknown about the effects of hormonal birth control. Making the film helped them understand what’s keeping people from knowing more about these popular drugs, they said.

Through their own research for the film, it became clear that the real problem was the lack of research on reproductive health more broadly. Without fully understanding how female bodies work, Lake and Epstein say, it’s not possible to understand how these drugs affect people or for the industry to create safer hormonal contraception options.

“Doctors think these drugs are safe, because they believe the drug companies’ information about their products,” Epstein said. But there are relatively few large-scale studies about people’s lived experiences using hormonal birth control, she added.

Of the studies that have been done, one of the most notable ones was a 2016 study that included more than 1 million women living in Denmark. It found an increased rate of antidepressant use among women using hormonal contraception. Several other studies have found that extended use of oral contraception increases the risks of developing breast or cervical cancer but decreases risks for endometrial and ovarian cancer.

If researchers and health-care providers don’t fully understand female bodies, then patients are fundamentally less able to advocate for better care, the filmmakers said. Epstein put it like this: “It’s easy not to understand how your pill works if you were never properly taught how your menstrual cycle worked.”

The importance of informed consent

The film also focuses on emphasizing the importance of informed consent between doctors and their patients. Informed consent is something that Lake is particularly passionate about because of her own negative health-care experiences during the birth of her son; it’s a major topic of Lake and Epstein’s 2008 film, “The Business of Being Born.”

Lake’s experience with hormonal contraception was no different, she said. She felt as if her doctor pushed her to take the pill without any discussion of its risks or side effects. As a result, she said, the medication aggravated her hair loss.

The American Cancer Society says you should expect to be part of a shared decision-making process based on your doctor’s recommendations and your preferences. This can include, the society says, ensuring you are provided with the name of the treatment your doctor recommends, as well as the risks and benefits of that treatment and other alternative treatments. Some forms of hormonal birth control may increase your risks of hypertension, blood clots, heart attack and stroke, so you’ll want to review your medical history and risk factors with your doctor to ensure they are matching you with contraception that is the best fit for your health.

It was in exploring the topic of informed consent, Lake and Epstein said, that they learned their most impactful lesson: In the worst-case scenario, the absence of informed consent can have an enormous emotional toll that extends far beyond just the people who use hormonal contraception.

The Langhart family is one of four families highlighted in “The Business of Birth Control.” Their daughter, Erika, was 24 when she died in 2011 of a double pulmonary embolism caused by the NuvaRing. Although the Langhart family was aware that Erika was using the NuvaRing, they didn’t know a pulmonary embolism was a possible side effect of the device. They say Erika didn’t, either. In 2016, after becoming a prominent activist to raise awareness about the effects of birth control, Karen Langhart, Erika’s mother, was reportedly no longer able to bear the loss of her daughter and died by suicide.

Karen Langhart’s death, combined with the experience of getting to know these grieving families, made it clear to Lake and Epstein that so much suffering could have been prevented if these women had known about the risks of these medications. The filmmakers hope “The Business of Birth Control” starts a national conversation that empowers people with uteri to make more informed choices about their contraception and demand more patient-centered care.

“We deserve better options,” Epstein said. “We need safer options and new technology to change this for future generations.”

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