Now, at last, I understand my mother. Or at least one tiny part of her. Well, two words of her. Those words were: “Relative risk! Relative risk!” She was a gynaecologist and adviser and distributor of pre- and post-coital contraception to three generations of sexually active women in south-east London over a 40-year career, she could be heard bellowing the phrase at the radio whenever a pill scare story hit the headlines, as they did every few years.
In The Contraceptive Pill: How Safe Is It? (BBC Two) general practitioner Zoe Williams pulled off the rare feat of explaining basic chemistry and basic statistics to an audience full of people like me, who got lost with the former somewhere around acids and alkalis and never even got started on the latter. Williams did so in a manner that looked effortless and didn’t make you feel like an eejit for never having fully grasped how the pill women pop almost every day of the month actually works. Essentially, it overrides the natural hormonal cycle and replaces it with one dictated by the synthetic alternative you’re ingesting from the pack, suppressing your ability to ovulate until such time as you’d like to have a crack at gestating something.
Given science’s ability to work even when you don’t understand it, comprehending the mechanics of the 1960s’ most useful and revolutionary invention is actually less important than understanding the figures – about possible links with cancer, blood clots, mental health issues and so on that science generates about it elsewhere. Because that can lead, and has led, to confusion, alarm, mistakes and – given the nature of the thing – great spikes in unwanted pregnancies and terminations.
Take, for example, as Williams does, the headlines that attended a report last year on the pill’s effect. Most went with some minor variation on the theme that taking the pill increased the risk of breast cancer by 20%. The average human brain translates this roughly as: “I am a large number more likely to get a bad thing! I have just moved a fifth closer to death! I must stop doing the thing that is almost certain to kill me!” The average doctor’s brain translates it roughly as: “Christ, I’d better go in to work early tomorrow.” And the average statistician’s brain translates it as: “But the background risk – the number of women who will get breast cancer anyway – is 55 cases per 100,000. And 20% of that small number is also, by definition, a small number! The relative risk is tiny!” Such a brain, housed in the body of one Prof Philip Hannaford of the University of Aberdeen, then followed on by comparing it with the much higher risk associated with various commonplace lifestyle choices as well as the protection the pill offered against other cancers, and generally added if not to the gaiety of an underinformed nation, then at least to its sense of perspective.
Other forms of missing information and ignorance were touched on, such as why women don’t know they can try other forms of pill if one is affecting them adversely; why particular adverse effects, such as a lowering of libido, don’t seem to register as important in the general medical community; and why we take a pill on a 21-days-on, seven-days-off cycle at all. There is no medical reason for it – it was felt by the (male) inventor that women would still like a monthly bleed and that it might fool the pope into approving of the pill. In one of these things he was demonstrably incorrect and if anyone ever gets round to asking women what they think of the other, I suspect he could be two for two. Especially given the gathering evidence, laid out for us by expert in the field Prof John Guillebaud (of University College London), that allowing ovaries to semi-rouse themselves from their stupor once a month and then sending them back to sleep is much more deleterious to health than allowing them to sleep for longer.
The interplay of a historically male-dominated medical profession and women’s health provides fuel enough for a thousand programmes. But last night’s did a huge amount, thanks to well-chosen experts and a presenter with the gift of engaging without getting in the way, in a perfectly pitched hour to explain issues, instil knowledge and empower viewers. I would like to keep taking this tablet.
