When you say, “The Pill” there is no debate about what pill you are talking about. Birth control pills have been a tool of the women’s liberation movement for over 60 years.
Birth control in general is as ubiquitous in our society as aspirin – and seems as harmless. But what do we really know about how hormonal contraception works and impacts our bodies? Today’s guests, Ricki Lake and Abby Epstein, have a new documentary, “The Business of Birth Control,” which examines the complex relationship between hormonal birth control and women’s health and liberation.
Weaving together the stories of bereaved parents, body literacy activists, and femtech innovators, the film reveals a new generation seeking holistic and ecological alternatives to the pill while redefining the meaning of reproductive justice.
Abby Epstein started her career as a theatre director with her own production company, Roadworks Productions, which is based in Chicago. Roadworks Productions was founded in 1992, and the company had seen much success in the mid 1990s. After directing a few productions in Chicago, Abby moved to New York to be an assistant director on the production of Rent. She then worked on The Vagina Monologues with Eve Ensler. Epstein directed her first documentary Until the Violence Stops, a film about the impact of The Vagina Monologues on a global scale. Five years later, Abby Epstein released The Business of Being Born in 2008. Much of Abby Epstein’s film career deals with birth and sex. Her film Until the Violence Stops premiered at the Sundance Film Festival in 2004 and won an Emmy after its screening on Lifetime. The Business of Being Born debuted at the Tribeca Film Festival in 2007 and was released theatrically in 2008. In October 2018, Epstein released Weed the People, a documentary buoyed by hopeful experiences with medical marijuana, that she worked on for 6 years with Ricki Lake as an executive producer.
Pop culture icon Ricki Lake has built an extraordinary career.
The world first met Ricki in 1988 as Tracy Turnblad in John Waters’ beloved film Hairspray. Ricki went on to appear in other films such as Cry-Baby, Cecil B. Demented, Serial Mom, and Gemini. She also starred on television in China Beach and King of Queens.
At the impressive age of twenty-four, Ricki became the youngest talk show host in history. For 11 years, her long-running show was met with unprecedented success and changed daytime television forever. She went on to win an Emmy for Best Talk Show Host for her work on the reboot of The Ricki Lake Show.
In her intimate book, “Never Say Never: Finding a Life That Fits,” Ricki took readers behind the scenes of her troubled childhood—filled with food issues, abuse, and an unabashed yearning for a better life outside of her suburban home. She pulled back the curtain on her talk show and her early days as a “fat actress.”
Lake’s legacy and perhaps her greatest love, is her role as independent filmmaker. Her award-winning, critically acclaimed documentary, The Business Of Being Born, debuted at the Tribeca Film Festival in 2007 and changed the way women across America give birth. The film has become a national platform and tool for childbirth education. Lake and her producing partner Abby Epstein continued with two related projects: first, the book Your Best Birth designed to educate expectant parents about their birthing options; and second, More Business of Being Born, a DVD series featuring celebrities such as Cindy Crawford, Gisele Bundchen and Alyson Hannigan sharing their birth stories, as well as in-depth discussions of every step of the birth process. Lake has become an integral figure in the birthing community, serving on the board of Choices in Childbirth, a nonprofit organization that strives to improve maternity care all over the world. Lake and Epstein also teamed up to premiere their documentary film Weed the People, which examines the use of cannabis as medicine and its status as a Schedule I prohibited drug in the United States. Next up was The Business of Being Born, which premiered at Doc NYC.
Ricki lives in Malibu with her fiancé and rescue pup. She lives each day believing that happiness is a choice, each day is a gift, and we all have the power to create our own destiny.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.
To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Calling into the show today, we have Ricki Lake and Abby Epstein. Ms. Epstein is an Emmy award winning documentarian who directed and produced several well-known documentaries. Ms. Lake is a pop culture icon and Emmy Award winner who, at the tender age of 24, hosted The Ricki Lake Show. Together, they released the documentary The Business of Birth Control, which features the stories of activists, doctors and scientists who are blowing the whistle on how hormonal birth control affects the mind and body. Ms. Epstein, Ms. Lake, welcome to the show.
Ricki Lake: Thank you.
Abby Epstein: Thank you so much for having us.
Gabe Howard: I want to disclose to the audience that my only firsthand experience with this type of birth control is the tiny amount of involvement I’ve had with my sexual partners, and that is largely them informing me of what they chose and us making the decision together to stop using condoms as an example. In researching this show, I quickly realized that birth control is entirely framed as a women’s issue. Moreover, it’s entirely framed as a woman’s responsibility. From a psychological standpoint that just seems like an incredible amount of pressure. Why is this never framed as being an issue for men or an issue that impacts both men and women?
Ricki Lake: Yeah. I mean, they raise a really good question, and it’s really interesting that women can really only get pregnant a handful of days out of the month, yet men can impregnate a woman every single minute of every waking hour, probably sleeping hour as well. So yeah, it does seem to be unfair in a lot of ways.
Gabe Howard: Following along that theme, it seems very detrimental to be told that you are entirely responsible for something. Yet the tools at your disposal are largely controlled by male involvement, and I’m talking about, you know, the laws that we have, or insurance panels covering it or payer sources. Men are heavily involved in what’s available to women. Yet men very clearly state that it’s not their responsibility, it’s none of their business, and it’s all up to her.
Abby Epstein: Oh, yeah, I mean, but I think that’s just the history of medicine. From the beginning of time, medicine has always been extremely patriarchal, misogynistic. Our first documentary, The Business of Being Born, talked about how the midwifery profession that was like a woman’s domain was helping other women deliver babies was completely smeared by the obstetrics field, and midwives were really shut out. There’s always been this history of male control and then this sort of gaslighting of women, which is huge in birth control. Their complaints are discarded and they’re not taken seriously when they have complaints.
Gabe Howard: In your documentary, The Business of Birth Control, you cover a lot. Can you talk about the goals of the documentary and what you learned along the path?
Ricki Lake: The film was loosely based on a book by Holly Grigg-Spall called “Sweetening the Pill,” and it, you know, looks at the history of these drugs, and it’s a really kind of complex thing to take on because we’re challenging something that, thank God has been available for women for the past 60 years. We are grateful to have had this technology that have helped women control their reproductive life, and there has to be a way to have a conversation, to really look at these drugs and what they are doing to women. You know, these side effects that personally, I didn’t really consider when I was on the pill at an early age. I was on hormonal birth control for more than two decades, and I now know that it causes hair loss. It can cause significant hair loss in women, and that was my main issue that I dealt with over the years. I never attributed it to the birth control pill until the making of this film. So there’s so much to consider, the history of these drugs and the side effects. We talk about depression and all these things that can happen to a woman and also the extreme pulmonary embolism that can actually kill a healthy woman. The history of racism with these medicines and eugenics. You know, it’s just a complicated issue that no one really has been spending the time talking about. So we’re hoping to start a conversation that really will create a mass movement for women to want better. To know that they should have better birth control, at this point. With all the technology and all the advances we’ve made medically, there should be more than just our grandmothers’ pill from 60 years ago.
Abby Epstein: Yeah, I think it’s such a huge topic when you start to lift the veil. People are just absolutely blown away by what they didn’t know. And what’s unique about contraceptive and hormonal medication is that we have so little understanding of women’s hormones. And women themselves have so little understanding, that we have so little body literacy. Most women don’t really understand how their reproductive cycle works until they’re actually trying to get pregnant. People don’t understand that when you’re taking a contraceptive drug, right? You are essentially shutting down your own endogenous hormonal production. So the hormones that your body, which come from your ovaries and your hypothalamus, it’s a whole interconnected dance between your brain and your ovaries, that gets shut down. And the chemicals in the pill or the patch or the NuvaRing or whatever you’re taking, replace your endogenous hormones.
Abby Epstein: And there’s very interesting book called This is Your Brain on Birth Control by Dr. Sarah Hill, who’s in the movie, and she’s really done a deep dive on this. That was one of the things that’s really just basic to this. Who tells a 14 or 15 year old girl who, let’s say, is going on the pill because of period cramps or acne? Or there’s a million reasons to get put on the pill now, way beyond birth control, right? Who sits down with that 15 year old girl and says, you know, you might feel like some mood swings or if you feel some depression or, there’s no warning about any of these subtle changes that can happen and you’ll hear this all the time from women. It’s like they didn’t realize what the pill was doing to them until they got off of it. And then all of a sudden, they got off of it and they were like, Whoa, I feel so great now. There’s something about these drugs, yes, they’re so pervasive, and they’ve been described as like, so innocuous, and you can get it over the counter now. But nobody really understands what they’re actually doing and how they work.
Gabe Howard: There’s a concept in philosophy and psychology, for that matter, no good deed goes unpunished, and I just have to wonder because reproductive rights are constantly under attack. Is there any concern that misogynists? I mean, let’s just be honest, that misogynists will use your film to further stigmatize birth control or use it to restrict access to birth control?
Ricki Lake: You mean conservatives, right?
Gabe Howard: Yeah, I’m trying to be polite, but I mean, yes, we see this.
Abby Epstein: Oh, OK, so the.
Ricki Lake: You’re saying, yeah, the pro-life movement, you’re saying it.
Gabe Howard: Yeah.
Ricki Lake: I mean, I don’t know if there’s like a fear of, I mean, I just, I am coming from a place of wanting to really start this conversation and go deep. And yes, it’s complicated because it is challenging something that has made so many advances for women, like we want the pill to be on the market and available, but we want women to have the information to understand what exactly it’s doing to their bodies to really be able to baseline their own emotional and mental health while on these drugs. It’s really about an education, and that’s the same thing with our previous film, The Business of Being Born. It’s about empowering women with the information to make an informed choice because really, there is no informed consent today.
Abby Epstein: And what we’re saying, Gabe, is it’s next wave feminism. It’s the opposite of conservative. We’re saying yes, women need access to all these reproductive health options, options to manage their fertility, better menstrual cycle health. We’re saying we want more and better where I think that if a more conservative or an anti-birth control, anti-access group tried to, like, hijack our message, they really can’t because they’re just against contraceptive access. I mean, they’re just against any kind of choice and we’re the opposite. We’re saying, not only do we, we want more birth control, we just want better birth control, we just want birth control that women can actually take or maybe even men can take. Let’s get crazy. You know? That doesn’t have this four page pamphlet of side effects. It’s time for some innovation now, and women are just not heard. They’re just not heard on how frustrated most women have been throughout their lives, trying to find the right kind of contraception.
Gabe Howard: I so appreciate you saying that the goal isn’t to remove anything or restrict anything, but to provide education for what is already out there and push forward research into getting even better. I mean, none of us are using the same cell phones that we used even five years ago. Yet I believe you made the point. We’re using the same birth control from 60 years ago. One of the very interesting things that I learned from the two of you is that there was a study talking about how adolescents who take the pill are at an 80 percent increased risk of depression. That’s very alarming, especially with what we know about the suicide rate in adolescents. Listen, I’m a mental health advocate. I’m the host of the show. This is my entire job. I did not know that. I was completely unaware of a risk for young women in the field of which I profess to be an expert. That is startling to me.
Ricki Lake: Wow. Wow.
Gabe Howard: What can we do to get this out there? Because again, I’m well-intentioned, but clearly, clearly, I am ill-informed.
Abby Epstein: You’re not the only one, I mean, my mother has been a practicing clinical psychologist for 40 years and only since we made the movie is she now connecting certain patients that put in an IUD and then started to have anxiety and mood disorder increase. And now she is screening for that. I mean, I think the whole field of psychology, we really hope this movie gets screened at psychology conventions. Hope that all psychologists read Dr. Hill’s book, “This Is Your Brain on Birth Control,” because it’s shocking, right? Like how? How could you not know that? And how could the women who are taking the pills themselves not understand the risk of depression and just so you know, Dr. Lidegaard, the Danish doctor who did that study that you’re referring to, he also did a study on suicide that showed a similar link between certain types of oral contraceptives and suicide. And these are very good studies because when Danish studies, they track everybody through their health system. So this is looking at over a million women and tracking prescriptions and tracking prescriptions for the pill, prescriptions for antidepressants, hospitalizations for suicide attempts. It’s pretty clinical. It’s very shocking in this day and age, and especially with people waking up to mental health issues in general, that this is not more front and center. But I think that even when that study came out, there was a bit of pushback from the medical establishment on the study.
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Gabe Howard: And we’re back with Ricki Lake and Abby Epstein discussing their documentary, The Business of Birth Control. Interestingly enough, I asked a few women in my life who are, in fact, on birth control if they were aware of this and they both said no, they didn’t think that there was any link whatsoever. That all their contraceptive was doing was ensuring that they did not get pregnant, and the side effects were no connection whatsoever to mental health.
Ricki Lake: Right, you just do not get the time with your care provider for all of the reasons. There’s just not enough hours in the day to really sit down and go through the pros and cons and make an informed choice when it comes to this. For me, I remember going to my gyno for my pap smear once a year and there’d be a stack of free pills they’d offer to me because the latest drug or the latest patent, they’d just be giving them away. And it looks like candy. It seems so easy and, like Abby said, innocuous. But if you knew that this could have the potential to make you feel this way, it really might change someone’s mind. And there are options that might be more amenable if they just knew. That’s what we’re hoping to accomplish with this film is just education.
Abby Epstein: Unfortunately, Gabe, we have a lot of conditions right now like endometriosis that affects one in 10 women, PCOS, polycystic ovary syndrome, fibroids, we have a lot of issues that affect millions of women for which there is no cure and no treatment and no research. For those women, going on hormonal birth control is a life saver. It is like literally the only thing that gets them out of their pain. Although ultimately, what we explained in the film is that it’s just a symptom suppression, right? So the second you go off, your PCOS, your endometriosis, I mean, it is back, back with a vengeance, unfortunately. Like Ricki’s saying, it’s kind of like there’s two kinds of patients here, right? There’s somebody who might say, You know what? I’m willing to take the risk of having depression or low libido or a migraine. I’m willing to take that risk because I really need these drugs. This is essential for my functioning and my reproductive health because my endometriosis is so bad. But then there’s the other, the healthy patient who doesn’t have these issues, who is just looking for contraception. That’s where it’s not about only having like five minutes with your ob-gyn, it’s really about the fact that they don’t actually believe you see it. There’s no studies. If you talked and say, Well, I think this pill’s made me gain weight or I actually think that I feel off, they will counter that. They will say, Well, studies show the pill does not cause weight gain. And you know why? Because there’s never been a double-blind, placebo-controlled study because you can’t do them. All they can basically say is, Oh, OK, well, that one doesn’t suit you. Let’s try a different brand. There’s hundreds of pills on the market. We’ll find one that works with your body. That’s typically the kind of answer you would get. There’s also a big disconnect in women’s health. What are the actual side effects?
Gabe Howard: And from a psychological standpoint, this is your doctor, you say all they can do is prescribe a different pill and there’s hundreds of pills. The they in that statement is your trusted physician who is taking care of you, making you healthy. It’s very, very reasonable to believe what they say. Doesn’t that complicate the issue dramatically? Because somebody watching the documentary is going to think, OK, you’re making sense and then they talk to their doctor, and I’m not trying to throw doctors under the bus, I’m really, really not. But these one-on-one conversations are quick, and they say, No, no, no, I’ll just give you another one. And then the person has to decide if they want to listen to the documentary or their doctor. That has to make your role as an advocate extraordinarily challenging.
Ricki Lake: The bottom line is each woman has to advocate for herself. I went on it without even questioning. It’s my doctor telling me what I should do. Ok, I’m going to do it.
Abby Epstein: Gabe, you know, Ricki and I’ve been up against this before, right? Because our first movie together, The Business of Being Born, was a little bit of the same thing. We were going against in some ways, we were questioning. We were pushing back on the way childbirth is managed in America. And I think that, like Ricki said, this is the age we’re at. We are in an age where you have to advocate and you have to do your own research. And I don’t think that this kind of, you know, I will call it a sort of a patriarchal relationship with the physician. They have all the power and whatever they say is the bottom line. And you just listen and you just do as you’re told, and you trust every word out of their mouth, that doesn’t work anymore, especially in women’s health, because the research just isn’t there. Women’s health is in a dismal, dismal state in this country. If you look at childbirth statistics, if you look at birth control, if you look at menopause, if you look at the hysterectomies that we do in this country. Especially when it comes to women’s health, women, you need to do your research. You need to look for alternatives. Now there’s functional medicine. It feels to me like we are just in a new age. We do not have a magic cure. This is the new birth control. No, we don’t. And the reason we don’t is because we haven’t asked for it. We haven’t expressed our discontent with the menu of options that is currently available.
Gabe Howard: Ms. Epstein, I love that. I live with bipolar disorder and I’m a mental health advocate, I’m in the mental health space and I’m constantly telling people, you have to advocate for yourself. You can’t just take the first offer, you know yourself, especially, especially in mental health, because there’s no blood test, there’s no urine sample, there’s no. The diagnosis is largely an agreement, for lack of a better word, between patient and doctors. So if you’re just lying back in the mental health field and doing whatever your doctor says, you’re probably not going to get a good outcome. It’s really starting to sound like women are sort of in the same boat. They’re just walking in, giving their doctor some information. Their doctor is giving them something. And historically, that’s the end of the conversation. And you’re really trying to generate education, foundation and information that women need to push back. Patients need to push back to make sure that they’re getting appropriate care.
Ricki Lake: Yes, that’s the thing. It’s like we as women need to know what we’re up against and again, I want to like, we are not bashing the pill. We want the pill to be available. And for many women, it works. It works seamlessly. And I think for me, it worked well for me until it was after the fact with the hair loss that I was like, looking back on that. But really, we want there to be more options.
Gabe Howard: I completely understand how, unfortunately, the medical establishment does often fail people with serious and persistent mental illness. And we’ve got to do better. It sounds like you’re on the front lines of making the medical establishment understand that we have to do better. Now, your focus is reproductive health, but it’s going to wave out, right? I mean, if we start taking reproductive health more seriously.
Ricki Lake: Yeah, it overlaps. You know, the ties to depression and all these other mental health issues to these drugs. You do better when you know better.
Gabe Howard: Ms. Lake, Ms. Epstein, I want to thank you both so much for being here. Before we go, I would be remiss if I didn’t ask What can men do? What is important information that they have that if they were like me, they weren’t taught anything about this. Because my sex ed was segregated. I learned about sex ed with all males in the room and all the young ladies went off someplace else. Illuminate us so that we understand birth control better or at least know what to ask.
Ricki Lake: I think they should see the film.
Abby Epstein: I agree. Yes, I think seeing the film, we have the same thing with The Business of Being Born, the same feedback with so many men, so many fathers, just so happy to have this tool. And I think this is the same thing because I think that men, they don’t know how to step forward, right? And if they check in with their partner, their partner might say, Yeah, you know, I actually feel pretty crappy on this birth control stuff. And I think that if men were able to step forward, if they understood the impacts on their partner’s sex drive, the potential impact to their partner’s mental health, then they might be able to come forward and say, Hey, let’s take this off your shoulders. Maybe I can just get a vasectomy. Maybe we can do a fertility awareness class together. Maybe we can look at different barrier methods. I think it’s just taking it on and educating, and I think the film is the perfect gateway to do that.
Gabe Howard: Thank you. Thank you both so much for being here. The documentary is called The Business of Birth Control. It is out now. Where can folks find more information about you and the documentary?
Abby Epstein: Everyone can go to our website, TheBusinessOfBirthControl.com. And you can get information on how you can see the film. You can also follow us on Instagram and Facebook. We are @businessofbirthcontrol.
Gabe Howard: Ms. Lake, Ms. Epstein, thank you both so much for not only doing this, but for taking the time to educate me and the listeners, it’s very, very appreciated.
Ricki Lake: Thank you, thank you for your time. Pleasure talking to you.
Abby Epstein: Yeah, pleasure. Thank you.
Gabe Howard: Well, you are very, very welcome. And to all of our listeners, thank you so much. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” as well as an award-winning public speaker who is available for your next event. My book is on Amazon, or you can get a signed copy with free show swag or learn more about me over at gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It’s absolutely free. And hey, recommend the show to your friends or colleagues. Whether it’s on social media, text messages or good old word of mouth, I would consider it a personal favor. I will see everybody next Thursday here on Inside Mental Health.
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