The Best Contraceptive Is the Word 'No'

Birth control at Harvard is subtle. There are no fancy clinics with tote boards advertising how many are using what methods with such-and-such percentages of success. There are no pamphlets with male and female symbols crossing over pictures of unwanted, crying babies. And the only attempt the University makes to contact students about birth control comes freshman year, when the Yale Guide to Sex on Campus is passed out door-to-door.

Instead, like everything else at Harvard, birth control is quietly decentralized. Out of the basement of Stoughton in Room 13, students give tips on the latest birth control methods or refer people to favorite doctors at the University Health Service. On the third floor of UHS, a social worker passes on information about the morning-after pill or abortion. On the main floor the internists--the closest thing that Harvard has to birth control clinicians--scurry around prescribing the birth control methods to students seeking contraception from UHS. And, up on the fourth floor, gynecologists see patients with particular problems about birth control, or fit interuterine devices--something the internists don't handle.

The object of a good birth-control program, says Dr. Warren E.C. Wacker, director of UHS, is to see to it that those women who do not want to get pregnant, don't. Harvard's low-keyed decentralized program which offers the information without blitzing students with its presence, suits Wacker fine, because, he says, for the most part UHS accomplishes the objective. "Yale has a very active program of sex-counseling on campus; ours is not as vigorous," Wacker says. "But there is no higher rate of unwanted pregnancy, though, here."

Despite the piecemeal nature of the program, it is still possible to discern how the University insures that women don't have unwanted pregnancies, and at the same discover some of the trends in birth control practice that are emerging in this the sixth year of Harvard's birth-control-to-all policy.

If there is one point that everyone involved with Harvard's birth control program agrees on, it's that there is no method available today that will satisfy all. "Contraception at present means a choice among a number of inadequate methods," says Wacker. The chief birth control couselor, Ann Bisbee '62, assistant to the director, says the service at UHS "is integrated into a woman's medical care. What we try to tell them is that there are no perfect methods. We try to tell them the facts."

The "facts," however, don't seem to be all that objective from the student point of view. Most women interviewed last week who have used UHS birth control facilities, said they detected a preference, conscious or otherwise on the part of UHS doctors to prescribe the pill over all other methods--especially if couples are living together. Students who staff Room 13, Harvard's most informal dispensory of birth control information, contend that getting the "facts" all depends on which of the 15 internists a student happens to see. They say that the methods favored vary with each doctor.

But the internists themselves maintain that they present a standard and balanced repertoire and don't push any particular methods. Wacker, for instance, sizes up the pill to prospective users by first admitting that it has side-effects, but they are all fairly well-known. Since the estrogen levels of the pill have been reduced, "you don't find any increasing toxity," Wacker says, adding that the pill has now been used safely for the past 15 to 16 years. Bisbee advises: "What we say is that there is no connection between the pill and cancer." As for the diaphragm, Harvard's other most popular method, Wacker says, when used properly it is "good" but that "you still run the risk of a .5 per cent chance of getting pregnant."

Regardless of the pitch, the doctors who do most of the prescribing are positive that within the past few years, women are leaving the pill in increasing numbers for the diaphragm. Dr. Pengwynne Blevins, who perhaps sees more students about birth control than any other internist, says she can't give a percentage, but she thinks people are "turning away from the pill. Women are changing their views. The diaphragm is gaining acceptance," she says. Louis C. Brown, another internist, concurs, saying "there is an increasing move away from the pill" to the diaphragm and other methods.

"It's true that a lot of people are switching away from the pill to the diaphragm," Wacker says. However, he adds, because of UHS's decentralized structure there is no sure way of telling how many women are making the change. He says he often sees a pattern where women arrive at Harvard on the pill and then switch to the diaphragm after a few years here, Blevins says that lately she has been fitting a number of women for the diaphragm before they have ever tried the pill.

Bisbee explains the switch by saying, "Some women don't want to put chemicals in their bodies. They would rather trade a small chance of getting pregnant for no chance of illness" in later life. Dr. Paul Winig '62, a gynecologist in the UHS, who treats students, faculty and other University employees, hazards that only a little more than 50 per cent of the women he sees are still using the pill.

"It's no hassle to get the pill or the diaphragm at UHS," Blevins says. Fitting a diaphragm "is something that takes more than just a minute," however, and is much better done on an appointment basis, perhaps with some previous information available, she says. For the pill, Brown says "most anyone at Harvard can get it by asking for it. We don't question the propriety or the morality."

Despite earlier revelations about the pill and cancer, and the growth of the women's liberation movement of the 1960's and 70's, doctors at UHS say that very few men come in to ask about male contraceptive methods. In fact, there is only a very slight increase in the Harvard male's responsibility for birth control at all, they say.

Brown acknowledges that he sees very few couples in a given year--"far less than the number of women I see alone." Blevins says she sees only about two or three couples a year, a figure she seems disappointed with. "Women still tend to think it (birth control) is their hassle, although that is probably less true here than in some other places," she adds. Blevins says she tries "to foster feeling that is should be a joint thing. But women really don't even want to talk about it with their partners. They don't feel secure enough to do it," she says.

Brown says he sees men come in most often when it is too late--when they accompany the woman to request a morning-after pill. UHS doctors administer the morning-after pill on request--perhaps even too freely some students' claim--within 72 hours of unprotected intercourse. Because of the pill's side-effects, such as nausea, the doctors require that the potential user fill out a questionnaire and take a pregnancy test.

Students seem most at odds with the UHS birth control policy, ironically, just where the UHS doctors seem to differ strongest among themselves--over the use and effectiveness of the interuterine device. IUDs are the exclusive province of the fourth floor--where the University's two male gynecologists/obstetricians work. Only the gynecologists put in IUDs because, as gynecologist Winig says: "Putting in an IUD is a skilled procedure. If you don't know how, it is impossible. It's not that hard to push an IUD through somebody's uterus."

Winig says he offers advice to those unsure about birth control after what he calls the "front-line"--the internists and Bisbee--talk to the patients. Winig says he recommends IUDs as good alternatives to the pill or the diaphragm, and finds that two-thirds of the women to whom he has given IUDs are happy with them. Only one-third have asked for them to be removed, he says. The removal is a far easier process than insertion; the UHS emergency room can remove them if necessary, Winig says.

But regardless of Winig's endorsement, the doctors downstairs don't encourage women to ask for IUDs, especially if the woman has not had childbirth. "I'm not very fond of the IUD," says Blevins. "I don't think women tolerate their IUDs very well. I could learn to put them in, but I won't."

Wacker says the IUD is way down on his list of recommended birth control methods. The IUD peaked two years ago in popularity, he says. In women who have not given birth, the IUD tends to have some side-effects--including severe cramps, especially during menstruation, Wacker says. The UHS, however, does offer a smaller IUD for women who have not had children.

The UHS's policy of inserting IUDs only when women are menstruating makes it even more difficult to procure IUDs. It hurts too much to put them in when the cervix isn't dilated, Winig says. Because women can schedule appointments only one time during four-week periods, and because the gynecologists must frequently cancel appointments to deliver babies--about 30 per month--women can wait for months before they finally see a gynecologist. Winig, however, says he was unaware that many women have had difficulty procuring IUDs until interviewed, and says he may bring the problem up at a UHS board meeting this week.

Unwanted pregnancies at Harvard, Wacker says, are fairly rare--resulting usually because the user's birth control method has failed, and not because the couples were unprotected. Students who forget to take the pill regularly, or those who inserted their diaphragm poorly, are the cause for many of the unwanted pregnancies, Wacker says.

UHS policy toward those couples who face unwanted pregnancies is "to expedite whatever is the reasonable choice," according to Wacker. If the woman wants an abortion, the UHS will not handle it, but can make the arrangements. The UHS works on an "ad hoc" basis for a couple of which only one member is Harvard-affiliated, Wacker says. For most women who want abortions, the University recommends that they go to small clinics such as the Crittenden Clinic in Boston.

If there is any flaw in the logic of the decentralized system, it may be in the doctors' confidence that there is enough birth control education on campus. Room 13 staffers, who average one to two late night telephone requests for birth control information, have already had to tell a couple of callers that the morning-after pill must not be taken as soon as the sun rises the next day. Wacker says the people he sees seem well-educated about birth control. But what he may be overlooking with a system as subtle at Harvard's birth control program is that his patients may be self-selecting. "The people in the UHS think that the students they see are well-educated in birth control," says one Room 13 staffer, "but in reality students have to be educated just to know to go in there."