Birth control pills

Evidence suggests long-term use of the birth control pill doesn’t harm fecundity.

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Anatomy of an alternative fact offered by top Trump health adviser

Shortly after then–President-elect Donald Trump announced on 5 January that he planned to appoint Katy French Talento to his Domestic Policy Council as his health care expert, the backlash began.

Talento, who has a master’s degree from the Harvard University School of Public Health in Boston, where she specialized in epidemiology and infectious diseases, was lambasted on several fronts. Some critics derided a column she had written for The Federalist, advising women concerned about the “Zika apocalypse” to have their husbands sleep on top of the covers, “offering himself as human sacrifice to the mosquitos.” She was slammed for her attempts while she worked as a U.S. Senate staffer in 2003 to derail federal HIV/AIDS research grants that focused on sex workers—which she alleged promoted Russian prostitution—and people who injected drugs. But Talento, a former nun who has spoken out for conservative values, took the most heat for her articles warning women that the birth control pill is “seriously risky” and leads to miscarriages and deforms the uterus.

None of the flood of stories (here, here, here, here, and here) criticizing Talento’s pill perspective took her seriously enough to examine the scientific rationales that led her to these conclusions. But articles she wrote for The Federalistwhich is published by Ben Domenech, a former speechwriter for former Secretary of Health and Human Services Tommy Thompson, who has a checkered journalistic past—offer a window into how she reads the scientific literature.

In “Miscarriage of Justice: Is Big Pharma Breaking Your Uterus,” Talento cites what she calls a “ground-breaking 2012 study” to bolster her argument that long-term use of birth control pills causes harm. Ladies, she asks, did your doctor “tell you that the longer you stay on the Pill, the more likely you are to ruin your uterus for baby-hosting altogether?”

This is an alternative fact.

The 2012 study that Talento refers to appeared in Obstetrics & Gynecology. It looked at 137 women trying to get pregnant with in vitro fertilization and frozen embryos. A research team led by Robert Casper, an obstetrician-gynecologist at the University of Toronto in Canada, reported that 30 of these women had a thinner endometrial lining of the uterus than the other 107, the control group. A thicker endometrial lining helps with implantation. The women with the thinner lining had used oral contraceptives for an average of 9.8 years versus 5.8 years in the control group. This difference held up when they made the threshold for use of the pill only 5 years.

Contrary to Talento’s suggestion, however, Casper and co-workers did not find that women with thinner linings had more miscarriages. Rather, seven of the 30 women who were told they had thinner lining opted not to do an embryo transfer during a specific cycle (compared with 4 out of 107 in the control group). In other words, they could not have miscarried because they never attempted to implant the embryos. And the authors took note of a 2002 study, published in Human Reproduction, that found the use of oral contraceptives for 5 years actually increased a woman’s chance of conceiving. That study, which prospectively followed more than 8000 women who were trying to get pregnant, concluded “that among fertile couples, prolonged use of oral contraception is associated with greater subsequent fecundity and the association is strongest after 5 years of usage.”

<p>Talento’s&nbsp;arguments in The Federalist diverge from data.</p>

Talento’s arguments in The Federalist diverge from data.

The Federalist

ScienceInsider contacted Casper, now the scientific director of TRIO Fertility in Toronto, to see what he thought of Talento’s interpretation of his group’s study. “I think the benefits of the birth control pill in preventing unwanted pregnancy or in treating painful menstrual periods far outweighs the rare possible case of thin endometrium,” wrote Casper in an email. “I believe this is a rare side effect of birth control pills. The only reason we discovered it is that we see infertile women for investigation and treatment so we end up finding these cases where they would not be noticed in a general practice where ultrasound measurement of the endometrium would not usually be done.”

Talento is not coy about the fact that she has extrascientific concerns about the pill.

“Our reproductive health isn’t the only thing broken by the Pill and other vehicles delivering hormonal contraception,” she writes in a second article in The Federalist, “Ladies: Is Birth Control The Mother Of All Medical Malpractice?” “There’s also economic and relational devastation that has left women and children abandoned by men who now feel entitled to consequence-free orgasms. As a result, fewer and fewer women, men and especially children enjoy the stability, prosperity, and human flourishing. After all, she could have been using birth control, so it’s not on you—right, bro?”

Here’s the bottom line from Casper, who, in addition to the study Talento used to back her argument, has published more than 100 other research articles on pregnancy: “There is no evidence that the birth control pill is ‘seriously risky’ in terms of future reproductive health.”

A request for comment from Talento had not been answered as this story went to press.