hi, i'm lisa fletcher, and you are in "the stream." birth control pills are taken by millions of women without a second thought. but are there new dangers along with the newer generations of the contraceptive? ♪ >> our digital producer, wajahat ali is here. he is bringing in all of your live feedback. waj so many people take these prescriptions sometimes for decades at a time and some don't bother to ask if there are

risks. >> yeah, a lot of tweets have been coming in . . . and the tweets have been coming in. lot of opinion on this. >> yeah. four out of five sexually active women have taken birth control pills at some point in their life. but a new wave of criticism claims women are under social pressure to take the pill

without fully understanding the effects it has on their health. some say it could even be life threatening, but is this criticism grounded in fact. we're joining by a professor from george washington university, and psychologist, senior legal analyst at rh reality check which offers news and analyst on sexual issues. thanks so all of you for being here. so doctor, i want to start with you. are the first control pills of today vastly different from those say from just a decade ago? >> they are.

when birth control pills became popular in the 60s and '70s, the dosing was really high. it's much higher than what we have today. we also have newer generations of progesterones which have varying effects of side effects bepenning on the person and what they would like to get out of the pill. and that's where some of the controversy arise. >> and are those like yaz, and yazmine which have all of the lawsuits pending? >> absolutely. what the lawsuits are about are increased occurrence of blood clots. birth control pills do increase your risk of having a blood clot. the question is how much?

and the absolute increased risk is not that high. we do know no matter what it is higher on any birth control pill, and with yaz, and yazmine the increased risk is a little bit higher. ultimately you have to chance that with the risk of a person's -- one there are alternatives, but two, pregnancy is a much higher risk of blood clots that a birth control pill ever would be. >> doctor i want you to jump in here. i know you have concerns. do yours focus more on the physiological health or the mental well-being of women who are on the pill? >> both in fact. >> for the most part women make birth control for one of two reasons. either they have a normal menstrual cycle and they want to

have unfettered sex, and we may be inducing pathology in these otherwise healthy women. and many women come to my office with complaints of low libido and foggy thinking that are relieved once we remove the birth control pill. and from my perspective and my training this is the equivalent of turning off the smoke alarm without putting out the fire. because there are many other ways to approach the imbalance that don't require synthetic hormones. >> our audience is really weighing in . . .

and i'm going to go to you with this question. not everyone is a doctor, do you think the average american women is aware of the potential consequences of the pill? >> i think it depends on the woman. i think that there is a really stark difference in access to health care between women of color and white women. and also low-income women, and middle and upper-class women. so when we talk about this debate, i think it's really important that we not fear monger, because people of color and communities of color have had a very complicated relationship with birth control, whether it be using birth

control methods to control their own reproduction so as not to bare more children that would be forced into slavery during slavery eras, whether it's fear that they would be forcibly sterilelized against their will. and this notion that they should be a little bit more -- they have an obligation to reduce the number of children that they have because those children will ultimately end up on welfare. so there are a host of issues that come into play when we're talking about contraception especially when it pertains to women of color. >> doctor let's get back to some of the physical aspects of this. a women's risk increase if she is on birth control pills, if she is overweight, if she smokes. how does that play into not just

your decision when you are prescribing, but do those factors play enough into a general physician's narrative? >> it absolutely does. i think that every time i have a patient that comes in for a contraceptive consultation, people don't necessarily -- they oftentimes will come in ways i want a birth control pill, but i think really it's my job to offer them all of the different options of birth control, because there's quite a few of them. taking in to account their personal history, family history, their body mass index, and taking into account those things, medications they are taking, certain medications don't work well with the birth control pill and then offering them all of the different options. i think one thing is i think you are right, there is some fallback to the birth control pill because it has been around for a long time and people are

used to it, but we probably should be moving more towards reversible contraception that may have less impact and used in more women. so taking into account their whole system and also what symptoms they have. do they have endometriosis, do they smoke, those kind of things? >> it sounds like i would want to have that consultation with my physician. but your profession has just suggested that the birth control pill be available over the counter. >> yeah. i think the reason they said that is we do think that birth control pills overall for the vast majority of healthy women are safe. however, there is that list of

things that we really shouldn't be -- patients that we shouldn't be prescribing oral contraceptions for. and they think there is a checklist of the different conditions that we can give patients and they can sort of self regulate and self decide am i a good candidate for these or not? now obviously that doesn't take into account the physician patient relationship and a lot of these things do currently need to be prescribed, but i think it would open up more access to a lot of women to good effective birth control. >> because the pill is so common, do you think women sometimes forget that they are actually taking a prescription drug for years or even decades at a time, and what is the consequence of that? >> absolutely. i think it's probably a combination of wide-spread, in my opinion often irresponsible

prescribing, and also direct to consumer advertising, which has a huge impact on perceptions on the part of women when it comes to safety. we have a pretty good understanding of mechanisms by which birth control may be changing bodily functions. they raise things called globulin. they change inflammatory markers, and deplete significant b vitamins which are important especially in a reproductive-age woman, and deplete antioxidants. while it is commendable that say there might be a way to consent, i don't think we have a good way of knowing who are these women who might be sensitive to those

biological changes. >> allison says . . . but a lot of our community saying they wish they had more knowledge. >> we used to write a tweet about access. does even talking about the risks of the most popular form of contraception threaten that? tweet us your thoughts we'll share them after the break. much-needed vacation. travel is a great cure-all. the framingham heart study

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welcome back. we're talking about the birth control pill, and more recent concerns about potential negative side effects. doctor people are concerned that having critical conversations about birth control pills can derail access to them. are you concerned about that? >> when people have conversations with me, one thing that is great about that is they have already made it through my door. also being able to prescribe these things and being able to offer all of the other types of contraception is so important. so having a lot of commercials and worry, and there's a lot of mystique and -- and bad ideas about the iud out still from back in the day. i think having all of that out there in the media and everything really puts fear for

people which does limit their access. and some of it is legitimate, but at the same time to be able to open up about the facts about it is so important. because there are a lot of forms of birth control out there that can really benefit a lot of women. so i'm lucky in that when they make it through my door i have a luxury, but i think sometimes the commercials and other fear about it, can impede that. >> this whole concept of access has really been responded to . . .

>> is criticism on on both sides. their natural femininity forces them to only have one access. >> i think it depends what you are criticizing about the pill. we can work very hard to make sure women have access to all of the safest forms of birth control. and we do know the birth control pill is very safe. we also should recognize how important it is for many, many women over the course of their reproductive lives to prevent segment nancy. there has been research that has shown us that something like 8% of women would when faced with

an unwanted pregnancy would equate that to feeling like they are dying. we're talking about women that it's extremely important to giving them control of their lives. as far as opening up to careers and the type of families they want to have, the partner they want to have, at the time they want to have, you can't minimize those opportunities, and if they don't have access to birth control, they don't have access to other things in their lives. >> you're not suggesting not having access. you are just talking about increasing the knowledge base? >> absolutely. and i think it's probably a little bit more nuance than that. because the consideration of effective alternatives that are non-hormonal should be amplified, i think. and also a lot of my concern centers around -- yeah, i would think a significant portion of the population who don't take

birth control for contraception, but instead as a treatment. and that's one of my big gripes. there are two parallel conversations. >> we have our community responding . . . >> respond to that last tweet. should the government help women obtain birth control? make it easier? >> i think they should. i think that access to birth control as has been said does allow women to better plan for their lives. it allows them to achieve economic parity with men. it allows them essentially

reproductive autonomy, something that has been denied to women across the board and particularly women of color for decades and decades and decades. so i think the government stepping in and acknowledging that birth control is health care, and acknowledging that when it comes to the employee, employer relationship, birth control is part of economic compensation for the labor that is being done. so i think it's really critical that we stop considering reproductive health care as something different than just wages or any other benefits that one would accrue when one is employed. >> you are shaking your head yes. >> yes, well said. i agree. >> who is responsible for shaping the narrative about the safety of birth control pills? >> i commend dr. marco for having this sort of discussion that she does with patients.

i think that is unusual. i practice in manhattan, and i would say most of my patients spend all of 30 seconds discussing all of the options with their physicians. so they need to educate themselves about all of the ramifications known and unknown, and the considerations of future outcomes that may not be desirable for the patient like ending up on a lifelong antidepressant which is very often what happens when patients develop these symptoms that are often a direct result of synthetic hormonal modification. >> our community is associating to the big money involved with this . . .

doctor, you have been hearing this i'm sure from patients. does big pharma impact the doctors in their decision to not offer alternatives to the pill here? >> i think that there is evidence that if you have interactions with pharmaceutical companies, it does impact -- and there's actually pretty good studies based -- that have looked at physician prescribing patterns and interactions with big pharma. i think one of the luxuries i have is i'm in academic medicine, and we have a policy that we don't interact with pharmaceutical companies. so i hope that gives me a better perspective. and i think a lot of these doctors aren't having these

conversations with their patients because i have countless patients who come to me and said they have never heard of iud's. so i think there is some impact of that. we know there's an impact of that. and it makes it challenging, you know, to -- to have a completely unbiased view even though we as doctors like to think we have an unbiased view, there has been evidence that shows that they do impact us in some ways. so i think it's important for us to go out and educate our providers too. there is no one size fits all birth control, and there are a lot of options that work for women. >> we want to take a closer look, are there unique challenges facing women in minority communities when it

comes to tackling birth control?

we are talking about the birth control pill which revolutionized women's life, but now some people are calling for

alternatives. and the community has not stopped tweeting. >> yeah, i just got a tweet from brenda . . . and here is a great video. >> those who don't have access to adequate information about birth control and how different forms of birth control can have effects on the body, i think that there are some communities who don't receive sufficient reproductive care, prenatal care things like that, and they aren't given information on how birth control is impacted by wait. and that is really important for

communities of color that have disproportionate levels of obesity. >> are alternative forms of birth control less accessible to minority communities? >> i think that health care access in general is a very big problem among communities of color. so when you are talking about a person going to the doctor just expecting she is going to go get the pill because she has seen advertisementments for it, she may be going into a an appoint with the preconceived notion of the birth control that she wants. and if the she is not getting a critical analysis of the various forms of birth control, i think then it becomes a problem, because then you see certain communities that are being

misinformed or mall informed, under informed about the types of contraception that are available to them. but women of color have a very complicated relationship with birth control because of the history of forced sterilization, targeting low income women, women of color with new types of contraception that haven't been well tested, for example. so i think it become really important to make sure we're getting accurate information, wide range of information, and that we're getting information that is catering to the needs of people of color. >> speaking of that, do women know enough about their own bodies, and take enough ownership of their well-being? this >> i think that's an excellent point. i took birth control for 12 years, and before i aimed to become pregnant, i had to learn

a lot about the natural menstrual cycle. and divorcing women from what their hormonal symphony actually looks like every month is a significant consideration, and that's what we're doing when we allow and permit women and condone the long-term prescription of birth control or even more deregulated access, so i think that's a relevant consideration. >> dr. marco do you want to wrap it up for us? >> i think really the birth control pill has been a great form of birth control for a lot of women but not without risks and controversy, and it's not for everyone, and there are so many great alternatives. and i would encourage people to try to get access and talk to doctors about the alternatives and not be scared of them. >> thanks. good night, everyone. ♪

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