I knew that there we a number of things that I was not going to be able to readily find or get in Singapore. Even being here for a week has shown me just how many options we are used to having in the U.S. So fine, I can’t get my preferred brand of organic peanut butter, or, oh well, whatever, I will be switching brands of face wash because I am not willing to pay quadruple (!!!) what I pay for it in the U.S. But birth control…. now that is a whole different issue.
I believe that women should have complete control over their bodies, including their reproductive systems. Personally, I feel that birth control pills should be combined with Flinstone’s Vitamins. Well maybe not literally, but that one’s access to such pills should be as easy and as inexpensive as it is to get those yummy fruit-flavored vitamins. Such ease of access would mean that weightier decision in a female’s lifetime would be about when to stop or go off birth control rather than go on it. Birth control empowers women: the earlier on in life that a woman has access to birth control, the more economically stable she will be later on in life.
I am the first one to admit that I did not do my due diligence in researching whether or not I was really going to have access to Ortho Tri-Cyclen Lo in Singapore. Oh, something about being busy completing a dissertation, selling a house, getting married, etc. Still, I did a few searches on the expat forum and all posts seemed to point to yes. Two conversations with two different pharmacists in Singapore later and I find out that not only will I not be able to get my preferred brand of birth control, but one can’t even get tri-phasic birth control in this country. Oh how 1980s are we?!?!?!
Look, birth control pills aren’t like Aspirin or Tylenol. These are pills that are made up of synthetic hormones. These hormones are chemical messages that travel throughout the bloodstream, throughout the body. Yes, they have targeted receptors with which they bind, but they affect the whole body in a myriad of other ways as well. No two women respond to a single pill with its own concoction of synthetic estrogens and progesterones in quite the same way. Hormone changes are why we grow, why we go into puberty, why we menstruate, and why we eventually go into menopause. Hormone changes, either naturally as we age or artificially through various drugs (including birth control) aren’t minor things. They are a shock to the body’s system. They are a disruption. I am not saying that I would have refused to move to Singapore had I known that I would not be able to get Ortho Tri-Cyclen Lo here; what I am saying is that my control over my body should not be delimited arbitrary borders decided upon by pharmaceutical companies.
I am a loyal Ortho product supporter, and I guess, by extension a loyal supporter of Janssen Pharmaceuticals. And, I have been a loyal supporter for the entirety of my adult reproductive years, thankyouverymuch. I was on Ortho Tri-Cyclen for four years before switching to Ortho Tri-Cyclen Lo. That switch, even within brands – so still keeping to the same synthetic hormones just a different level – was awful. I felt like my head was detached from my body for three months. Seriously, it was one of the most horrible fogs I’ve ever been in.
The only reason I switched to the Lo was because I was teaching at a school affiliated with the NYC Catholic Diocese, and their health insurance plan would not cover birth control. Thankfully, my GYN took pity on me and supplied me with more than a year’s worth of birth control pills for free. Ortho had just come out with the new Lo pill, so that was the one they were pushing and she had plenty of free samples of it. Had it not been for the cost factor, I don’t think I would have switched from Ortho Tri Cyclen to Ortho Tri Cyclen Lo. Still, I switched, and after the horrible adjustment period, I’ve been happy with this pill for about a decade.
Trust me, I was grateful that all those many years ago my GYN at the time was able to provide me with the free samples of birth control, but I was also really pissed off that I had to go to those lengths and depend upon the generosity of my doctor. I was fresh out of college, teaching English at an all-boys Jesuit high school, being paid very little, and I was really pissed off that my employer and the Catholic Diocese could hold my body hostage in the way that they were.
When I was going through the whole my-head-does-not-feel-attached-to-my-body adjustment, the Principle of the school where I was teaching stopped me one day and asked if anything was wrong as I had seemed not as focused and sharp as I normally was. I really wanted to lay it all out for him right then and there. I really wanted to tell him that it was his fault that I was not able to be at my best in the class room, that it was his fault I felt like shit, and that it was his school’s medical insurance provider that was causing me to be a crap teacher for those few weeks. I thought better of it, responded, “no, no – everything is fine,” and walked on. I was in my first year of teaching at the school and fresh out of college. If I had had a bit more experience and a bit more job security, I would have gladly spoken my mind. At that point, however, I was just grateful I had figured out the birth control situation for myself without having to spend nearly $1000 a year our of pocket.
Back in the U.S., yes, I recognize that as a female who takes my reproductive rights seriously I am tied to the whims of my insurance providers. In graduate school we had a pharmacy benefit cap each academic year. Insurance coverage on prescription benefits just barely covered a year’s worth of birth control, and on occasion – say if I had required antibiotics at some other point during the academic year due to a nasty bacterial infection – I might have to pay out of pocked for birth control. Once or twice that happened. On a grad student stipend such out of pocket additional expenses weren’t welcome, but that seems to just be one of the added expenses of being a female who choses to assert this type of control over her reproductive health. The point is that at least back in the U.S. I had a choice and I had access.
There were various points in time that I considered getting an IUD. I though about how much money I would save over the course of five or ten years by going with an IUD rather than continuing to pay for Ortho Tri Cyclen Lo each month. Twice I seriously entertained it. Once, before I went off to grad school for my Ph.D., I even went through the consent process with my doctor and booked an appointment to have one inserted, but I just could not bring myself to make that kind of change. My body has done exceptionally well on this one pill. I had gone through the change of pills once before and it was hell. I did not want to take a chance with something more permanent like and IUD.
The second time I seriously entertained an IUD during grad school, my doctor there suggested I try the Nuva Ring for a few months to see how the more localized distribution of hormones would work for me. Four months later I was sick of being weepy and again feeling like my head was detached from my body. I called my doctor asked her to phone in a prescription for Ortho Tri Cyclen Lo to the Student Health pharmacy – that experiment was over.
Now that I am in Singapore, I don’t know what I will do. I have this amazing opportunity to explore the world and live in Asia for a few years, but how much of it will I miss out on if I am forced to change birth control pills and my body reacts poorly? Now that the dissertation is nearly complete and I can take my Ph.D. once it is in hand and find a job in Singapore, what if I am not able to perform my best because my head feels detached from my body? I don’t even want to think about how changing birth control pills could affect my relationship with my husband if some new brand and combination of synthetic hormones tanks my sex drive (sorry, Partner). I truly love Ortho products and I am a huge fan of Ortho Tri Cyclen Lo, but I am not okay with Janssen Pharmaceuticals, Inc. holding my body hostage, tying my body to a country I can’t be in right now, tying my body to a place where I no longer have health insurance.