by Laura Eldridge
With concerns about environmental contamination growing and Americans becoming increasingly aware of its dimensions, we are asking complicated questions about public and personal decisions. Contraceptives, both hormonal and non-hormonal, have entered this difficult, multi-faceted conversation, as it becomes clear that our methods of birth control have an impact on our environment.
Many people are coming to understand the unintended consequences of dumping chemicals into our natural environment, and realizing the massive scale on which this occurs. Since the Second World War, chemical production in the United states has gone up 20 times, and commercially registered chemicals have increased 30 percent in the last 32 years. Our waterways are full of the residues of drugs that have been taken by patients and peed out or simply dumped unused into the toilet. Our factories use chemicals to process and make products that find their way into our water through multiple means, and our farms use various compounds to fatten animals.
Substantial parts of this chemical soup are compounds known as endocrine disruptors. That means that they are structurally and chemically similar in some way to the hormones that bodies (both human and animal) produce, and can interfere with the control and precision those biological messengers normally have over bodily functions including reproduction.
While we still don’t know how serious the risks are to humans, we have seen distressing changes in animal communities. By the 1980s and 90s, scientists observed problems in the reproductive organs of birds in the Great Lakes region and in alligators in the everglades. Female songbirds in California began singing songs usually reserved for males. In 1995, Arizona scientists observed sexual changes in fish downstream from Las Vegas.
Fish With Medicine Cabinets
While scientists knew that something was very wrong in the natural world, they weren’t sure what. Tests conducted on the St. Lawrence River found a pharmacopoeia, including trace amounts of ibuprofen, antibiotics, epilepsy drugs, Alzheimer’s drugs, and even caffeine. While clearly hormonal mechanisms are at work in the fish, what isn’t clear is whether industrial chemicals, farming, or everyday human pill and product use are responsible. When asked what causes intersex fish, the U.S. Geological Survey’s Vicki S. Blazer says, “I feel comfortable saying human activity . . . the question is which human activity? And is it something we can do anything about?”
There are many types and sources of endocrine disruptors. Many are synthetic, compounds created in labs for pharmaceutical and agricultural uses. Natural estrogens –called phytoestrogens — are a second group, and often enter the environment through plants and foods (soy is one) that act like hormones in the body. Industrial byproducts are another category. Chemicals such as Bisphenol A, a compound added to plastic to make it harder, and phthalates, used to make plastic flexible, have been studied for their dangers to humans who come in contact with them.
Pharmaceutical estrogens are one of the most widespread contaminants (in that they are found in more places than many other compounds), and although they account for a tiny part of the “chemical soup” (while they are in lots of places, they occur in extremely small quantities) they may be more dangerous to wildlife than compounds found in higher concentrations, although this remains uncertain. A study out of Villanova University tested 21 streams in one Pennsylvania county and found that all contained synthetic hormones. Ten of those streams contained ethinyl estradiol (the particular compound used in most birth control pills) in quantities 30 times greater than those shown to damage some fish. The sheer volume of different chemicals, however, and the speed with which estrogen contamination dissipates, make it difficult to assess which (or which combination) of compounds are posing the biggest dangers.
| 30,252 condoms are picked up on beaches each year. |
This has made the question of the role of pharmaceutical estrogens – both those used for birth control and those taken for menopausal hormone replacement or as part of cancer treatment – difficult to asses, and has opened up hormonal contraceptives, always under intense scrutiny, to unjust criticism from those who are oppose birth control and adopt this argument as part of their political agenda.
Though they are not alone, the Vatican has been one voice promoting the association of oral contraceptives and pollution. Seizing on global interest in the environment, the Vatican newspaper L’Osservatore Romano reported in early 2009 that the Pill “has had devastating effects on the environment for some years by releasing tons of hormones into nature.” Accusing the drug of causing male infertility in the west, the Vatican called for people to give up pharmaceutical contraception. The church fathers failed to voice active concern for the multitude of other drugs found in waterways; there was no cry to give up Advil, for example, or antidepressants, or sun block, and no acknowledgement of the multitude of other endocrine disruptors – industrial and agricultural – that are also potentially a problem.
Responding to this attack, Jennifer Rodgers noted in a piece for RH Reality Check that to criticize the pill alone was selective and potentially misleading. Such a critique, she argues, “misses the larger picture – we need better water treatment systems to get rid of ALL the chemicals.”
Since, of course, simply giving up hormonal contraception is not an option at this point (the environmental impact of unchecked reproduction would be far, far more devastating ), and since pharmaceutical estrogens are only one piece of a bigger puzzle, what can be done to make our water safer?
Making Safe Drops to Drink
As Rodgers notes, one important step is to improve both water and sewage treatment systems. Our current sewage treatment systems aren’t designed to screen out hormones, and so are relatively ineffective at doing so. Some water treatment plants are responding to the demands of a chemical-infused world. Others balk at the high cost of testing water for such contaminants — around $1,000 per sample — and note that until the Environmental Protection Agency (EPA) requires such screening, it simply doesn’t make sense.
Another problem has been inaction on the part of the EPA, which was required by Congress in 1996 to begin screening various chemicals for their potential to act as endocrine disruptors. Fifteen years later, progress has been slow, although the past two years have shown increasing action. However, as Barbara Seaman explained in 2003 in The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth, the EPA and the National Institutes of Health “spent several years and several million dollars investigating natural and synthetic chemicals that mimic hormones. Shockingly, both these massive multimillion-dollar studies ignored the proverbial elephant in the room: the pharmaceutical and veterinary estrogens and other hormones that human and animals have been eating and depositing into the environment for years — hormones that have been proven to be linked to hormone-dependent breast, uterine, ovarian, and testicular cancers.”
Astoundingly, even as more was being demanded of EPA in the 1990s, less was being asked of drugmakers. In 1997, the Food and Drug Administration (FDA) slashed the number of drugs required to demonstrate environmental safety. By 2005, the FDA was finally reconsidering this stance, noting that the potential health hazards of various chemicals remain unknown.
While regulatory agencies struggle to catch up, some towns are taking steps to clean up their acts, creating drug collection programs where citizens turn in unused pills rather than flushing them. In one pilot program in Maine, amazed police watched as 52 people turned in 55,000 pills. Drug makers, while denying that their products are pollutants, have cautiously offered financial support for efforts to establish risks and develop methods to contain them.
Scientists at Sweden’s Goteborg University are worried that newer hormonal contraceptives — namely the contraceptive patch and the vaginal ring — may be especially potent polluters if not disposed of properly. When a woman throws away her monthly patches, each one still contains around 600 micrograms of ethinyl estradiol. If that patch is flushed down the toilet, it continues to release hormones into the environment at higher rates than they occur in urine as byproducts or because of discarded pills. The vaginal ring may be even worse: NuvaRing has around 2.4 milligrams of estrogen by the time it is thrown away, 33 percent more than three discarded patches and six times more than a full cycle of oral contraceptives. While we wait for better disposal solutions, users should be careful not to flush either patches or rings when they are finished with them. The patch should be folded in half and both wrapped in paper and thrown in the trash.
Bedside Manners
If a woman is particularly committed to reducing her environmental impact, she can opt against hormonal methods and try a different type of contraception. What makes a contraceptive appropriate is different for everyone and a change should always be considered in conversation with your doctor.
The copper IUD provides a non-hormonal option that is both environmentally friendly and highly effective (boasting a “typical use” efficacy that is higher than the Pill). Because of past problems with older IUDs, many women’s health experts still urge caution with this method, as some safety questions remain open, however most are optimistic that the new IUD provides a safe, reversible and green contraceptive. Another choice is a reusable barrier method, like a diaphragm or a cervical cap. These older contraceptives, while lacking the near-perfect efficacy of hormonal methods, still offer reliable pregnancy prevention when properly used, and the diaphragm in particular boasts a “typical use” efficacy that is better than the male condom.
| Environmental responsibility has moved into the bedroom. |
The Fertility Awareness Method is certainly a green option: this type of birth control requires a woman to monitor and chart her fertility signs and use alternate contraceptives or avoid sex during fertile times. While deserving of more respect that it has received in many reproductive health forums, fertility awareness requires rigorous adherence, and, unsurprisingly, suffers from a very high rate of failure based on user error.
Because condoms are the only effective method besides abstinence for preventing sexually transmitted infections, giving them up is absolutely not an option for anyone at risk of these problems. Environmental organizations, including the EPA, have worried about improper condom disposal. The Ocean Conservancy, a nonprofit group based in Washington, DC, estimates that 30,252 condoms are picked up on beaches each year, and the devices are among the many pollutants making up the growing amount of sea trash disrupting coral reefs and ocean ecosystems.
While this seems like a lot, Nina Shen Rastogi puts this in perspective, noting that approximately 437 million condoms are sold annually in the United States; condoms may account for approximately 1,365 tons of waste (no small sum), but this is a fraction of the 152 million tons of trash American’s produce each year. Given this, and given how irreplaceable condoms are for protecting sexual health, as well has providing contraception, what can an average user do to cut down on their environmental impact?
Most condoms are made of latex. Because this is a natural product, the condom will (in theory) biodegrade with time, but since a condom isn’t made entirely of latex (there are other chemicals and components involved), it does not happen very quickly. Polyurethane condoms, an important alternative for people with latex allergies, won’t break down because this material is a type of plastic. Female condoms are also made of polyurethane or the equally un-biodegradable synthetic rubber. Lambskin condoms, literally made from animal skin, are completely biodegradable, but they don’t offer protection against sexually transmitted infections.
There is currently no way to recycle condoms. The paper box that the prophylactics are packaged in can be put in the recycling bin, but the foil or plastic wrappers and the condoms themselves cannot be. Health educators at Columbia University note that because of this, the best thing to do is to wrap condoms in a biodegradable material — like tissues or a paper bag — and throw them into the trash can (wrapping in plastic and other indestructible materials can prevent the already slow breakdown of the latex). The worst thing is to flush them in the toilet: even rubber-based latex won’t biodegrade in water.
We have much to learn about the environmental impact of our contraceptive choices, but including birth control chemicals and devices in conversations about creating a greener world is a start. The effect of our choices on the natural world is a subject that touches on many intimate parts of our daily lives: it should come as no surprise that the massive project of environmental responsibility has moved into the bedroom.
Laura Eldridge is a women’s health writer and activist. She is the co-author (with Barbara Seaman) of The No-Nonsense Guide to Menopause (one of Publisher’s Weekly’s 10 best ‘Lifestyle’ books of 2008) and the co-editor of the women’s health anthology The Body Politic: Dispatches from the Women’s Health Revolution. Her most recent book, In Our Control: The Complete Guide to Contraceptive Choices for Women, was published in 2010. Ms. Magazine calls the book “women’s health activism at its finest.”
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