The swinging 1960s will be remembered for hippies, sexual freedom, the women's liberation movement and a pill that changed women's lives. On the eve of the 50th anniversary of the Pill's approval for contraceptive use, coincidentally falling on Mother's Day, Cynthia Busuttil finds that the revolutionary tiny tablet has many health benefits too.

They are not sick but 100 million women around the world start their day by taking a small pill, which puts at rest any concerns of pregnancy. Considered to be almost completely effective when taken properly, the Pill has revolutionised women's lives since it was approved for contraceptive use 50 years ago.

"It gave women control. For the first time they had power over their own fertility," Anna Borg, from the University's Centre for Labour Studies, said.

A quick look at the advances made by women over the years confirms this. Pre-Pill generations saw women spending a good part of their fertile years pregnant, having multiple babies and staying at home to care for their large families. But, today, more women are attending University and focusing on their careers without worrying about an unwanted pregnancy. The Pill, together with better education of the reproductive system, has allowed women to decide whether and when to have children.

"There was a shift in mentality. We started with big families to ones with just one or two children. This was not brought about solely by the Pill but also due to better education," Ms Borg explained.

Before the Pill was approved for contraceptive use on May 9, 1960, women had to rely on rudimentary means of contraception, many of which depended on the male's compliance.

"The Pill gave women control, allowed them to be responsible for their fertility without having to rely on someone else," Ms Borg said.

Yet, some feminists argue women should not be pumping themselves with chemicals and messing with nature. "There is the argument that, since women get pregnant through the act of somebody else, why aren't they shifting the responsibility on the man? But, on the other hand, can somebody else always be trusted?"

Not just for contraception

The Pill might be highly associated with birth control but its use goes beyond not wanting to have babies. In fact, before it was approved for contraceptive use in 1960, America's Food and Drug Administration had approved Enovid 10mg for menstrual disorders.

Donald Felice, president of the Malta College of Obstetricians and Gynaecologists, said the Pill was a commonly used therapy by gynaecologists.

"There are several non-contraceptive reasons. The Pill prevents heavy and painful periods, regularises periods, prevents ovarian cysts and is used as treatment for endometriosis (bleeding outside the uterus)," he explained.

In fact, the majority of prescriptions for the Pill by gynaecologists tend to be for therapeutic rather than contraceptive reasons.

"This was a revolution for women, not solely from a contraception point of view but also for health reasons," Dr Felice said.

A 40-year study, published earlier this year in the British Medical Journal, found that women on the Pill could expect to live longer.

While there are some women who are at risk of thrombosis or suffer from liver disease who cannot take the Pill because it makes their conditions worse, this medication is considered safe for the vast majority.

"It is safe and effective and has a lot of non-contraceptive benefits. It can be used throughout the fertile years and there are no contraindications regarding age," he said.

Dr Felice said the biggest problem was lack of compliance, which could render the Pill ineffective. But if taken properly, it was more than 98 per cent effective.

Although the contraceptive effects of the Pill kick in after two weeks, Dr Felice said he still recommended women use other means of contraception during the first month, to be on the safe side. He urged women not to stop the Pill immediately when they felt nauseous or got headaches because these tended to disappear after some time.

A woman's experience

Alexandra*, 36, has been on the Pill for 17 years after her gynaecologist recommended it as treatment for erratic periods and acne.

"I was 19 at the time and I saw it as a godsend because, for once, I could get a grip on my monthly cycle and my acne was in control. Luckily, I never suffered any side-effects, which other girls complained of, such as putting on weight and mood swings," she said.

The only drawback was pigmentation, which is a known consequence of the Pill.

"I decided to give my body a break for six months but, although I managed to get rid of the pigmentation, my acne was back and my cycle went out of sync. So I went back on the Pill and have been on it for 17 years," she said.

She has changed several brands, the first time after about five years because the brand she had been taking ceased to be available. She only suffered severe mood swings on one of them, which she changed within a month and everything went back to normal.

Alexandra admits to have forever hounded her gynaecologist with questions whenever there was a report about the side-effects of the Pill.

"He was always telling me not to worry because all I was doing was 'freezing' my ovaries and, as long as I didn't smoke, the side-effects were minimal," she said.

The reasons why she remained on the Pill changed over the years, moving from therapeutic concerns to being more in control of her body. "As a woman who is focused on my career, it has helped me postpone having children to achieve my goals," she said.

However, she wonders whether when she decides to have children this might be too late. "When you have control over whether and when to procreate, there never seems to be a right time to have children... In that sense, the Pill has done nothing to eradicate women's battle with time and fertility but it has succeeded it giving women the freedom to pursue their goals in life," she said.

*The woman's name was changed to protect her identity.

Sexually-transmitted infections

Although it freed women from unwanted pregnancies, the Pill also gave rise to more casual sex.

"It could have contributed to an increase in sexually-transmitted infections," Philip Carabot, who runs the Genitourinary Clinic at Boffa Hospital, said.

He said women on the Pill were more likely to have unprotected sex because they did not have any fears of getting pregnant.

A quarter of the 1,132 females who visited the GU Clinic last year said they used some form of contraceptive on a regular basis, with the Pill being the most common, Dr Carabot said.

The local scenario

• According to the latest Health Interview Survey, carried out in 2008, there were about 6,300 women in Malta, aged between 15 and 54, on the Pill.

• The Pill is most common among 25- and 34-year-olds, with 8.5 per cent of women in this age group saying they take it.

• Another 7.8 per cent of those aged between 15 and 24 said they took the Pill.

• Only 3.7 per cent of 35 - 44-year-olds and 2.4 per cent of women aged between 45 and 54 take the Pill.

• The Pill's biggest users are women with post-secondary education (8.7 per cent), followed by those with tertiary education (7.7 per cent). Only 5.5 per cent of those with just a primary education and 4.1 per cent of those who reached secondary level use the Pill.

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