Liz Talks Podcast, Episode 29: Abby Epstein talks the Business of Birth Control

Abby Epstein, alongside Ricki Lake, is the filmmaker behind The Business Of Birth Control as well as The Business Of Being Born and More Business of Being Born. She’s a fierce advocate for informed consent and for bringing nuance and truth to the cultural conversation around birth control.

Liz Talks Episode 29

  • Introducing Abby Epstein [8:33]
  • The process of starting Business of Birth Control [15:33]
  • Reclaiming the divine feminine [30:00]
  • The “hyperaccommodating state” [36:44]
  • Starting the conversation at home [43:01]
  • Birth control as an endocrine disruptor [48:45]
  • Master Class More Business of Birth Control [59:17]

TRANSCRIPT

Welcome to Liz Talks. I’m Liz, and I’m a nutritional therapy practitioner and best-selling author; but here, I’m 0% professional and 100% mom, spouse, friend, and over-analyzer. We’re going to talk food, beauty, family, fitness, mental health, friendship, marriage, and everything in between in this season of Liz Talks, and I’m so glad you’re along for the ride.

Remember; this is a podcast about thoughts, feelings, and opinions. And I definitely do not give individual, personal, or medical advice. 

This is episode 29, topic: Liz Talks to filmmaker Abby Epstein about the business of birth control. 

In case you missed it, last weeks’ episode 28 was about my new obsession, the Vibrant Body Company’s safe, clean, underwire free bras that still look amazing, an interview with CEO Ali Schwebel. Plus, you can listen and be witness to a blossoming friendship in real time!  

Before I begin, I want to quickly thank Arrowhead Mills for their generous support of this podcast. It really is a big deal when a company like that is willing to take a leap of faith with someone like me, who is not advocating anything extreme. Rather, advocating balance. And it really means a lot that they’ve been here for me at the beginning of this show, before it was even a proven thing. I mean; we’re less than 30 episodes in. So it really is a wonderful thing.

So, the next time you go to the store, I’d love to have you support this company which supports me and look for Arrowhead Mills products. You can also find them on Vitacost.com. 

So today’s interview is a real dream come true for me. I got to interview Abby Epstein, who I have followed since her documentary with Ricki Lake, the Business of Being Born, came out, almost 15 years ago. And I just couldn’t be more thrilled to have the chance to chat with her. She’s an amazing person, amazing film director, producer, activist, truth teller. 

And I do want to be very clear. We talk about quite a few things today, including death and loss and pharmaceutical industry corruption, and gender. We’re all over the map. So if you’re wanting to start these conversations with your loved ones in your own way, versus having them listen to my conversation with Abby, just feel free to pop in some headphones and enjoy this interview that way. 

But note that nothing that we talk about here is for the sake of politics or political commentary. Some of what we discuss might feel triggering or polarized, but I invite you to detach entirely from politics and simply just ponder the substance of the conversation. I know I came away with a lot of things that I want to take the time to ponder. So hopefully you will, too.

Now, Abby’s stats are impressive. She made her film directing debut at the 2004 Sundance Film Festival with the documentary V-Day, Until the Violence Stops. And that featured Jane Fonda, Salma Hayek, and Rosie Perez. I love Rosie Perez. And that film won the audience award at Vancouver’s Amnesty International Film Festival. And it premiered on Lifetime television, and received both an Emmy and a Gracie Allen award. 

In 2007, she teamed up with Ricki Lake for their widely acclaimed documentary that I just mentioned, The Business of Being Born. And that premiered at the Tribeca Film Festival, and it was released by New Line Cinema and Netflix, and it was broadcast on Showtime. So a lot of us are familiar with that one. And that film’s success led to their follow up series, More Business of Being Born. Which featured Cindy Crawford, Alanis Morrisette, Giselle Bundchen, Christy Turlington, plus there was a book. It was called Your Best Birth, and that was published by Hatchet. 

And then after that, Ricki and Abby teamed up for Weed the People, which premiered at 2018 South by Southwest Film Festival. And that won the audience award at the Nashville Film Festival. And then it was acquired by Netflix for distribution; which is huge. So, under their company, BOBB films; Business of Being Born, Business of Birth Control. Abby and Ricki produced the documentaries Breastmilk and the Mama Sherpas; which I also highly recommend you check out. You can find all of them at the Businessof.life. And most recently, what we’re here to talk about today, the Business of Birth Control. 

So prior to even all of that, Abby directed Broadway theater. She held national tours and international productions of Rent and the Vagina Monologues. So just all of that. Just, whoa. And as far as my impressions of the Business of Birth Control, this film; it just does so much. And I talk about this with Abby; from tracing the racist roots of contraception that actually led pretty directly to the founding of Planned Parenthood, which I did not know. To the role of the feminist health movement in raising awareness about the side effects of the pill.

For a long time, I thought; gosh. The birth control pill was this huge victory of feminism, but also this tragic element to feminism. Because of all of the problems it really did usher in for women. But what I didn’t know was that classical feminists were sounding the alarm about side effects very early on. And several of them are featured in the film. And heartbreakingly, the film also shares personal stories of people who have suffered and lost loved ones as a direct result of birth control use. And this is having such an impact on me, and how I conceptualized an ongoing and developing and evolving conversation that I want to have with my daughter, who is 7 now, who I hope will never have to go on birth control. That we can have a conversation that’s productive enough to ensure that she knows all of her options when it comes to reproductive health, and she will be able to choose with all of the information. 

So, overall this film exists to do a lot of things. And one of those things is to promote body literacy. And to that end, I want to highlight the Business of Birth Control master class, as well, which we talk about a bit at the end of this episode. The master class is a 9 episode video series that features over 50 hormonal health experts aimed to help you make informed choices about your reproductive health. 

And as you watch the documentary, as you watch the Business of Birth Control, if you follow me and we have similar lists of people that we follow, you’ll recognize Dr. Aviva Romm, Dr. Jolene Brighten, and several others that I’ve been following for many years who are also featured in this film. So if that helps give you an idea of how in tune with the nuance and the conversation that needs to be had around these things, where it’s not black or white. It’s not zero-one. It’s not binary. If that gives you an idea of what a good job they did really bringing this conversation to the forefront. I think you’ll really enjoy. And I’m very, very excited about the master class. 

And I also wanted to share, before I get started with the interview, that you can stream this film for 50% off with code LIZ50, all caps. Capital L capital I capital Z 50. A film like this is so vital, yet it is so difficult to get distribution for it; for many reasons. Not the least of which is the slightly conspiratorial, yet no less true take that the pharmaceutical industry owns literally everything and everyone. 

So please post at least once about this documentary on your social media. Tell at least one other person. Spread the word. Because this information is so, so important. And this is the only way it’s going to continue to spread.

And, if you listen to this podcast episode between Wednesday June 22 and Sunday June 26, you can actually stream it completely free. So no code needed. And if you do this, please, again, commit to sharing with your whole network. And if you’re outside that free streaming window, please share my code LIZ50, all caps. Let’s push this out to as many people as we possibly can. 

Alright, here is my interview with Abby.

  • Introducing Abby Epstein [8:33]

Liz Wolfe: Ok, so this is just probably; I mean this is a get of a lifetime. Because I have been following you since the Business of Being Born. And what is it like? We’ll go all over the place with this, if that’s ok with you. But what is it like being so important? You, individually. Abby. You being so important to a generation of women who didn’t realize that there were other options in birth, and who watched you and the documentary and learned so much from you. How is your head not like this big? 

Abby Epstein: {laughs} It’s so weird. It’s so funny Liz, because it’s like; Ricki and I will sometimes; it doesn’t really hit us until it does. Because one of the things that I found; that movie came out 14 years ago. And I’ve been working in women’s empowerment space, and I directed the Vagina Monologues. I’ve been around a lot of really seminal art. And plays, and documentaries that have impacted culture. And I find that it’s so ignored. Like, the work is so completely ignored by mainstream. By prizes, and awards, and New York Times reviews. Vanity Fair features. We don’t get any of that for this work. 

I mean; if you think about it; the Business of Being Born is probably one of the most influential documentaries ever made. And we won not one award. Not one. I mean; maybe an audience award at some film festival. But honestly. It’s like; interesting. So there hasn’t been a lot of ability to really, I guess, contextualize the impact. Now things are starting to get written and published. So for us it’s kind of more of this. And you know, I think right after the film came out, because I’m in the movie, I would get stopped a lot. I mean; I would be sitting on an airplane and the flight attendant would come over on her hands and knees, tears in her eyes. “I know who you are, I just need to tell you your film changed my life.” 

You know? And it would kind of shock you. I mean Ricki, because she’s a famous celebrity, she probably got it a lot more than I did, just in person. So it’s strange. I feel like that movie kind of came through us, in a way. It was just like an act of service of a divine feminine. It was so much of just channeled through us, that movie. And we honestly had no idea there would be so much interest in it, or that it would still be this impactful. It’s just crazy. It really is. 

It’s funny because now I think the movie is going to be 15 years old in 2023. We finally got the rights back, so we’re going to re-release it. 

Liz Wolfe: Oh, amazing! 

Abby Epstein: Yeah. But again, we’re almost like fighting for it to be seen. Do you know what I mean? It’s like, we’re still having to talk to distributors or funders or whatever we need. Because that movie; not only did we never make a dime. We didn’t even break even on that movie. Can you believe it? 15 years didn’t even break even on the money we raised. 

So it’s kind of like, we’re now having to almost prove to people. And you have to do it in some ways through celebrity, which is crazy. You have to say; well, look. This celebrity was on the cover of Vogue, and she talked about the movie, and she talked about the movie. We’re kind of fighting for it to have it’s place in history. 

Liz Wolfe: Mm-hmm. You know, it’s so interesting you say the divine feminine. I have that exact phrase written down in my notes for this interview. Maybe we’ll come back to it, maybe we won’t. But it’s such an important theme. And I hate to call it a theme, but what you all have done for me with your work is to teach me that I should be empowered to own my body, my experience, and my divine feminine. And I’m cisgender woman, so I come with a certain set of perspectives, which is what I will be operating from during this interview. Because that’s my experience; that’s what I know. 

But, this idea that you just don’t know any different. That the outsourcing of our agency. Our, when I’m saying our I’m saying, you know, women like me. The outsourcing of our agency from such a young age. It’s educated into us from very, very early. 

When I was watching the Business of Birth Control, I was thinking about how we kind of even end up captured in this way. And I was thinking about, to what you were just saying, it’s kind of a full circle moment. The people that were interviewed; Aviva Romm, Dr. Jolene Brighten; all of these amazing doctors who have also done a really great job with social media and being able to reach people that way. So cool to see them there.

But one of the things that just; gosh, just resonated with me over and over and over was; these practitioners have broken free. And I was thinking back to fifth grade when Always sponsored our menstrual education for all of the girls in the fifth grade class. So I’m thinking; not about, wow. This is how my body works. This is this amazing thing. It’s; this thing that is going to happen to me when I’m 12, and these are the products I use to take care of it. It evolves into; you are, however old you are. You’re thinking about becoming sexually active. Or you have painful periods. Or you have acne. Whatever it might be; it evolves into; here’s the thing that you can take to Band-Aid that. Or to deal with that. Or whatever it is. And there was never any embracing of my femininity; that legacy. That privilege that I have as a woman to know my body and to know my hormones.

And truly, truly, truly Business of Being Born was that first step for me. And all of your work, up until now with the Business of Birth Control. I mean; epiphany after epiphany after epiphany. And I thought; I kind of had it all figured out. I thought you gave me all the information already. But there were things in Business of Birth Control that absolutely blew my mind. For example, towards the very end when you talked about birth control as an endocrine disruptor. Like; {pew} holy moly! 

  • The process of starting Business of Birth Control [15:33]

So all of that said. Why the Business of Birth Control, and why now? After your experience, of course, with Business of Being Born. Which, by the way, I ended up going for a home birth and I ended up with a hospital birth, like you. So I always felt very connected to you in that way. But tell me what the process was that brought you to this place right now? 

Abby Epstein: It’s so interesting. I don’t think; when we did the Business of Being Born, we did do a series of follow-ups, called More Business of Being Born. And they’re widely available. But we kind of dipped into issues like VBAC; vaginal birth after cesarean. Things that we just couldn’t get into in the movie. So we did those follow ups. And there was really no thought of doing any kind of continuation or sequel. 

I guess it was like 2015 or 2016, and we were working on a documentary that’s on Netflix now called Weed the People. It is about medical cannabis. And it was a little bit out of our wheelhouse. But it’s a beautiful movie. And we were in the middle of working on that when Holly Grigg-Spall sent me the galley of her book, which is called Sweetening the Pill.

So Holly I guess was interested in making a documentary about the book, and knew our work, and sent me an early galley copy. And I just read this book on the flight between New York and LA. And I got off the plane, and I went straight to Ricki’s. And I was like Ricki; this book, I just can’t even explain to you. I think this is our next movie. I just read this book on the plane, and I just connected so many dots for myself, with my experiences on the birth control pill. So many dots, you know. 

I was really angry. And really shocked. In the same way, I think, that I was shocked when I started to make the Business of Being Born with Ricki, and I thought I was this lightened empowered feminist. And I was like; ugh! I’ve been doing the Vagina Monologues for five years; and then I’m reading Ana May Gaskin, and I’m thinking; holy crap. I really know nothing about empowered birth, or the intersection between feminism and childbirth. 

And it was the same thing here. It was like; I didn’t really truly fully understand what was going on. So I read the book. And I just; you know, had that feeling where I was like; Ricki. I just know this is information that people don’t have. And I know this is like a movie nobody wants to make. Nobody wants to make this movie. Because there is this bizarre kind of diplomatic immunity that has been giving to the birth control pill. You cannot criticize it. You cannot tell any; if you talk about side effects, you are fear-mongering. You know? 

There is no way to have a rational conversation around the downsides of hormonal contraceptive. So I knew; we’re going to get attacked. {laughs} And it was very clear; because we put out a one-page press release that just said we were optioning Holly’s book, and that it was going to inspire a movie exploring these themes. Oh my god. I mean, you know, a lot of the liberal media press, they just went right after us. You know? 

So I could see from the beginning that it was going to be tough. But I think it was just one of those films where I was like; I don’t know, this is probably going to be difficult. But it has to be made. And I feel like we’re the people who can do it. We can sort of ride that line. We can take a little bit of the slings and arrows. We have the Business of Being Born, that sort of established position. 

Which; by the way. We did a double feature for the premier in New York. So we screened them back to back; the Business of Birth Control and then the Business of Being Born after it. I have to tell you; not only does the Business of Being Born hold up, 100%, 14 years later. But it’s way more radical and way more button pushing and way more controversial than the Business of Birth Control. I feel like the Business of Birth Control is very diplomatic and gentle. 

So I think in a way; I mean, you know. There has definitely been some pushback against the movie, which we expected. But I think the movie; like you saying; oh my god, I didn’t know the pill was an endocrine disruptor. Well, ok most people don’t know that the World Health Organization classifies the pill as a class 1 carcinogen. So that’s something; we didn’t even put that in the movie. Do you know what I mean? We stayed away from certain angles that would just kind of; again, be scary or fear mongering or be information that is like; what is someone supposed to do with that information? That it’s a class 1 carcinogen? What does that mean, if you don’t dive really deeply into all the stats and research around cancer. Which is way more than we could do in a 90-minute movie. 

And I feel like the timing; I have to tell you, Liz. Aside from the Roe vs. Wade overturn, which is complicated, I do think the timing is perfect. Because even two years ago, I don’t think people were ready for this film. And I think that because of the opioid epidemic, and because people are now really awake to the fact that pharmaceutical companies cherry-pick data and lie and bury data and understand that people are being harmed and killed and keep marketing and lying their drugs in the most evil way imaginable. 

I literally think since that’s all been laid out now with the opioid epidemic, it’s easier for people to see. And I also think that there’s been more of a movement in women’s health, around reproductive health. And I think there’s been a lot of attention given to gaslighting recently. Underfunded research. The really awful, awful state of women’s health in this country. So it’s a little bit now more, I think, respected or I would say acceptable. You know? 

Liz Wolfe: Yeah. It does feel like the right moment. One of the things; you do so much with this movie. One of the things; I was trying to kind of box it up in my brain {laughs} trying to think. Ok. What are the main take home? And there are multiple. But what you’ve done for me is really what I think the holy grail is of a film like this. I know nothing, but for me if I were to speak completely uninformed on what a film like this should do, it made me want to go look into 7 different things. 

It made me want to look into the history Planned Parenthood and Margaret Sanger. That was a very interesting thread that you all put in there. I was a little bit familiar; I read a book called Medical Apartheid fairly recently, which was phenomenal. And the history of birth control in relationship to communities of color was absolutely fascinating. And also, the individual stories. I mean, I get chills even thinking about these parents who lost children because of venous thromboembolisms, blood clots, confirmed due to these different types of birth control.

And it does feel like the right moment, now that these conversations are happening. And what I think is really, really neat. And so compelling. Is that you all were actually brave enough to bring nuance to the conversation, to really try and highlight that context. And you allude to it, I think, in one part where; in something that you just said. To acknowledge, for example, that the left has trouble tolerating this conversation is not to say that you’re an agent of the right. It’s bringing a nuance to the entire conversation. And maybe we can say two things are true at the same time. Where these things can be so damaging. And there is so much evil. There is a medical cartel behind them. And at the same time, perhaps they played an important role in the progression of feminism. Maybe that was a detour; I don’t know. But all of these ideas kind of wrapped up together in your documentary. And I think you did just such a fabulous job of shining light on so many different things. 

Abby Epstein: Thank you. We shoved a lot in there. I mean way more…

Liz Wolfe: {laughing} 

Abby Epstein: We should have probably covered in a 90-minute documentary. But I just kind of felt like; it’s very hard to, you know; you could make an entire documentary on just on, I would say, the mental health side of this. 

Liz Wolfe: Yes. Yes. 

Abby Epstein: It could be it’s own film. 

Liz Wolfe: Absolutely.

Abby Epstein: And we were trying to look at mental health side effects and other externalities along with physical side effects, with racist history. You know; I mean, we really put a lot in there. And I think what’s interesting is; there are so many things. Again, the film was shot a long time ago. Because we had it sort of on ice for the pandemic. So it’s like; the film was actually finished in 2018 or 2019.

So what I think is interesting is; when people say, oh you can’t talk about these blood clots and these deaths because it’s just fear mongering, and it’s out of context, and it’s so, so rare. Meanwhile; let’s look at they just pulled the J&J vaccine.

Liz Wolfe: Right.

Abby Epstein: Off the market for a blood clot risk that is a fraction. 

Liz Wolfe: Yes. Infinitesimal. 

Abby Epstein: A fraction of the blood clot risk of these hormonal birth control products. Give me a break. I mean, that would have been perfect to put in the film, if that was in there. Because it backfired so badly when they tried to say; oh, don’t worry about this vaccine. It’s much safer than the birth control pill. You know?

Liz Wolfe: Oh my gosh. 

Abby Epstein: All these women all around the world were just outraged. Like; oh I get it. It’s ok for us to die. You know? 

Liz Wolfe: Acceptable risk is delineated by gender apparently? 

Abby Epstein: By gender, and also I think by stigma. Right? Because birth control is, let’s be real. It’s sort of affiliated in some way with women’s sexual freedom and sexual promiscuity. It’s completely disregarded; one of the women in our movie, which we say in the movie, who died from the NuvaRing, she was prescribed the NuvaRing for an ovarian cyst. 

Liz Wolfe: Mmm. Which are self-limiting and generally resolve on their own. Right? I remember that’s from the movie. 

Abby Epstein: Exactly. But it’s like; so people are forgetting A) that this is prescribed as medicine in so many cases. But it’s just; I think when you try to conflate kind of talking about risk, and products, whether it’s vaccine risk or whatever. Here, and this is another thing. Let’s say looking at something like the J&J vaccine and trying to compare risks to a birth control product; you are talking about a healthy population. You are talking about optional elective medicine. Drugs that people are taking electively to manage their fertility, for the most part. We’re not talking about something that’s going to be slowing down a deadly pandemic. You can’t compare one or two.

So that’s one of the other things that I think got so lost in the way that birth control has just become so ubiquitous and such a rite of passage. And now I think especially with all the mail order services and the delivery to your home. Which, by the way, I support. Again, with a nuanced conversation. Right? I fully support access. Easy access with informed consent. I mean, that’s really the conversation. But I think now it just feels like you’re ordering a supplement or something. It just kind of feels really benign and we absolutely lose sight of this medication. 

And I think some of the things that; we have actually a master class that we’re launching after the movie. And I was just editing that the other day, and listening to some of the sound bites. It’s just; when you think about it, it’s like, when you take those synthetic hormones. When you take that synthetic estrogen, and the synthetic progesterone, or whatever, and you put that in your body and lower or erase your level of endogenous hormone, you’re impacting every single system.

Liz Wolfe: Yes. It’s not a closed loop. Every system. 

Abby Epstein: You know? I just think it’s the same thing that I think really happens with our planet, Liz. I think there’s such hubris around the ecosystem of the body, and what we can suppress. And that suppressing menstrual cycles, and suppressing the endogenous hormones of a 15-year-old girl for decades on end, is going to have no impact. It’s like, exactly what we’re doing to the earth. I think it’s completely connected. 

  • Reclaiming the divine feminine [30:00]

Liz Wolfe: I do too. And I think that what you mentioned about; let’s see, I guess the book I have is Wild Feminine. But the divine feminine; I really believe. And this is going to be ugly. However I say this, it’s going to be ugly. It’s going to be not a well-formed thought, so I hope people can be forgiving of me. But what the world needs is more of this divine feminine connection. I don’t really understand what that means, but this idea that we can limit the ego and the hubris. Which is something that we think of as maybe traditionally masculine or maybe an outlandish manifestation of the masculine that maybe can become toxic if not appropriately balanced with femininity and what that maybe means as a quality. Not necessarily; I’m not talking about having a vagina. I’m not talking about that. I’m talking about the qualities of femininity that are nurturing, that are connected to both yourself and the world and the people around you. All of that feels like a really important shift in the vernacular and the way we experience our culture that I feel like would have such great benefits for, like what you’re saying, the world. The environment. The ecosystems that we live in. The ecosystems of our bodies. 

Abby Epstein: Mm-hmm. Yeah. 

Liz Wolfe: It feels important. 

Abby Epstein: Yeah, I agree. And I think in both of the films, it really speaks to that. And I agree with you. I think that’s a lot of the healing that needs to happen right now in the planet. And that is why I think birth activists really talk about; if you want to see how a culture, if you want to judge or evaluate a culture or a society, look how they treat birth, look how they treat new families around the childbirth experience, and look at how they treat women. Because it is. 

And I think; what’s sad to me is that there’s a lot of pushback or gaslighting around this kind of; oh, that’s sort of woo-woo and anti-science and whatever they push back on. Or natural; oh, this natural as a negative kind of natural. And I think that we’ve got to get over that. Because there isn’t anything woo-woo about this documentary. Every single thing we talk about is completely backed by science, and we were extremely careful in vetting all the experts who speak on camera. And we didn’t include people who kind of fell into more murky categories, or were out there with other messages that would kind of confuse. We definitely; everybody is like a PhD, an MD. You know? Really, really backed in science. There isn’t anything woo-woo about it.

And yet, at the same time, I do think that, and I love the work of Dr. Sarah Hill, who wrote This is Your Brain on Birth Control, she’s in the movie. But I love that she sort of took this idea of women being a different version of themselves on the pill, and sort of backed it up in a completely scientific way. Do you know what I mean? And I think it’s true. It’s like; you are disconnected from your biology and from who you are. And I think that hormones; again, and this is not woo-woo. This is science, right? {laughs} Your hormones. These chemical little messengers that are emailing messages, right? All over your body all the time. I mean, your hormones interact with your environment to literally create your brain. They create who your brain thinks you are. 

So when you mess with those; which is exactly what you’re doing when you go on hormonal birth control. When you mess with those, you are totally changing who you are. It may not be perceptible to you. It may be slow and insidious. But I think a lot of the women we interviewed, and I can speak to this personally. When you come off of hormonal birth control, that’s mostly when you can realize it. It’s more of a retroactive. It’s hard to figure it out when you’re on it. But then we hear a lot of this; oh, I went off birth control and all of a sudden; my life was sort of in two dimensions and all of a sudden my life became 3D again. And became colorful. I all of a sudden started listening to music again. Or started wearing makeup again.

There’s kind of this idea of a veil being lifted, we’ve heard, time and time again. But I think that to me is a really, really, I think, crucial piece of this. Because I think that without that knowledge. Without understanding that. And because of the age that a lot of people are starting contraception, which is usually in teen years or maybe in university. They are usually times of great sort of upheaval and life change. It’s not like a midlife thing that you start birth control. That is very concerning to me. Because I’ve now just heard too many stories of too many young women that are just; you know, really I would say traumatized by side effects that they were unable to connect. And were never connected back to their birth control. And that’s terrifying. 

Especially in this age of information. I do see it trending now on Tik Tok. I mean, I do see; on Tik Tok there was a whole trend about mental side effects. But it’s got to go further than just saying; oh, I feel a bit crazy on the pill. Or I feel a bit more hormonal. It’s like; no. Because crazy implies that it’s you. {laughs} And it’s not you.

Liz Wolfe: It’s not you. 

Abby Epstein: Yeah.

  • The “hyperaccommodating state” [36:44]

Liz Wolfe: You know; I still wonder. I actually do have some longstanding side effects from the pill. I mean, this has been a very long time. But I actually feel somewhat fortunate that this is all that stuck with me, because of my experience with that. But I ended up sprouting chin hairs. Literally whiskers. You know, I’m doing electrolysis now. And I’m grateful that this is kind of the lasting legacy and not something else. Because some of what happened to some of these women in the documentary; it’s just so unbelievably tragic. 

But I also think sometimes I wonder this; there’s a quote, and it might have been Dr. Hill. But she talks about the “hyperaccommodating state” that young women are in. 

Abby Epstein: Dr. Collins.

Liz Wolfe: OK. That’s who it was. She mentions anti-depressants and birth control. And that really got me thinking. I was kind of journaling around this a little bit. And what I wrote was; “my behavior during the time I was on birth control did not fulfill me. I regret it from start to finish. Pill or no pill, I did not value myself or hold my physiology sacred in any way. For me, the pill was another way to make the men in my life satisfied with absolutely no benefit to myself; none.” 

And when I was thinking about that, I was also thinking about my daughter. Who is 7. And the fact that I want to have a very open conversation with her around this stuff, because I think that’s one of the answers that you all talk about in the film, that conversation. And bringing all of the different options. Not just the options around birth control but also getting to know our cycles. You talk about the fertility awareness method. All of that.

But there is still this sort of resonance of shame around sexual choices; sort of on the one side, and then birth control on the other that I still see young women getting on birth control without their parents even knowing. So a lot of these conversations aren’t happening in the home. So hopefully that can change.

But bringing this conversation to, hopefully, medical providers and to resources in the birth community so our daughters, who may feel too afraid to talk to us about something like this. Because if it’s not for acne, or for controlling cramps, it’s; oh my gosh, I want to have sex and I can’t tell my parents. Hopefully, we can still have this conversation happening somewhere. So what happened to me doesn’t end up happening to my daughter.

Abby Epstein: Yes. And I do think that a lot of this conversation is happening among peers. And I think that it’s kind of crazy, but I think that for a lot of women’s reproductive health issues, women are learning more from Facebook group and friends than they’re learning from their providers. Or they never had this conversation at home. 

And I think as far as what you said, Liz, that you were really taking birth control to sort of accommodate men. I hear that a lot, especially from college students who will say; yeah, all the guys just expect you to be on the pill. They’re kind of annoyed if you’re not on the pill. Well; you know, in support of men, I just want to say that I also think that if they were more educated. We just did a premier in Austin, Texas, and the actor, Adrian Grenier was there. The actor from Entourage. And Adrian posted on his social media account last week.

Liz Wolfe: I saw that. 

Abby Epstein: Yeah. That was the first time after seeing this movie that he even understood that there were ANY side effects with hormonal birth control. I mean, not even the burden of how bad the side effects can be. But he didn’t even understand that there were any. So I also think that there are other cultures. There are some other cultures in Asia that really, where almost for men it’s a sign of respect to wear a condom. It’s actually a sign of respect and protection for your partner, because they don’t want their partners taking birth control medication. 

So I love this idea of kind of; I mean, I love the idea of the paradigm and the conversation shifting, first of all, around contraception, to be talking about hormonal versus non-hormonal. Instead of the conversation usually being around which hormonal product I might tolerate. But then also, I think this idea about equity. We’re trying to start kind of a fraternity tour or college campaign around the movie. And we’re teaming up with a company that’s developing a really interesting male birth control procedure that is like a 10-minute, pain-free, hormone-free, temporary procedure that will block their fertility. And basically, when you’re ready to undo it, you just go. They kind of blast some baking soda and water. 

Liz Wolfe: {laughing} 

Abby Epstein: They blast out the blockage and you’re ready to go. You know? 

Liz Wolfe: Wow. Fascinating. 

Abby Epstein: Fascinating, right? But thinking about having something like that out there. And then it shifts, right? Because then it’s kind of like; not something I think; you know, I have two boys. And that’s something I would probably do for a young teenage boy. Because if you’re worried about contraception, that’s probably more of your problem. {laughs} 

  • Starting the conversation at home [43:01]

Liz Wolfe: Right. So you have two boys? I don’t know what age they are, but they know what you do. Right? 

Abby Epstein: Yeah.

Liz Wolfe: What’s the conversation; what type of conversations do you all have around this? 

Abby Epstein: Well they’re 12 and 15. And I made them sit through both movies. 

Liz Wolfe: {laughs} Wonderful.

Abby Epstein: {laughs} And I think that we’re; I mean, it’s hard because they’re still young. So nobody is sexually active. They hear everything and we talk about things. But they know what I do, they understand what I do. It was interesting; I was talking to my 15-year-old the other day and he, I guess at his high school some of the seniors or juniors presented an honors project. So an in-depth study they did, and they presented it to the whole upper school. And he was like; mom, I was thinking maybe I would do mine on birth control. He said; wouldn’t that be really interesting? 

Liz Wolfe: Wow. 

Abby Epstein: And I was like; yeah. 

Liz Wolfe: {laughs} Yes it would! 

Abby Epstein: I was like; you should think about that. You know; so I think because they’ve been around this. They’re still watching the Business of Being Born going; ew, gross! 

Liz Wolfe: {laughs} 

Abby Epstein: Blood, and you know. But I think that those; it’s having those conversations. I think in some ways, too, it’s not siloing, I would say. Sexual education and body literacy among genders. And I think as we’re moving towards a more gender fluid society; and I think gender is super interesting. I mean, when we started the Business of Birth Control; so this would have been like 2015, right? I remember we had maybe just an announcement about it. And immediately we got an email talking about gendered language. And that there are people who don’t identify as female who also take the pill. And I remember in 2015 being like; what?! {laughs} You know what I mean? It sort of hit me so out of the blue. I was like, what are they talking about? What do you mean? We have to accommodate gender? But we’re talking about the pill.

And now; look where we are. Just 7 years later. And I think that some of that freedom, in a way; even I love this. I love this; some of my kids they’ll have friends that will go by certain pronouns. The pronouns don’t necessarily mean they’re queer identified, or that they sleep with the same sex. They just prefer to be non-binary. And it’s really interesting when you think about it. But I think it’s quite freeing in a way.

Liz Wolfe: Well it’s interesting how it all comes back; these conversations kind of; they start out as pretty ugly, I think. Not necessarily as people being mean to each other. But just stumbling through these conversations around where everybody falls in this continuum of reproductive justice. We all have some capacity to reproduce, and whether that’s something that informs our lives or feels important or not, we’re talking about equipment that everybody has, one way or another. And how we express ourselves, and whether it’s from a platform of; I have this anatomy so I identify this way, or I have this anatomy that I do not identify with. This entire conversation around just getting people the care that they need. It’s like; that’s just universal. It’s completely universal. And that hopefully continues to be a conversation that opens up.

And like I said before; I am cisgender, suburban mom. I’m very typical. And I can embrace that. I can recognize that. And there are people just like me who also need this message. I don’t know; the work, it can be messy and it can be ugly but it’s happening. 

Abby Epstein: It is happening, but I think that sort of, that more free, that more open conversation around the fact that my 10 or 11-year-old can come home from school and say, Oh, Juliette is non-binary. Or whatever. To me, just how that impacts looking 10 years down the road, that generation approaching. I mean, the pill is going to seem; my god, ancient.

Liz Wolfe: It’s like; yeah, we already did that. We know. 

Abby Epstein: It’s going to feel also like this gender burden. That sort of cisgendered women have to take on the entire burden of birth control. I think hopefully a lot of that will dissipate, you know? It will seem more like an antiquated idea. Like, our grandmother’s idea of life. Oh, the woman has to be on something. You know.

Liz Wolfe: Yeah. Yeah. I’m totally picking up what you’re saying, and it’s not something I thought of before. But how we drill down on something often involves an expanded conversation that maybe is unexpected to us. 

Abby Epstein: Yeah. 

  • Birth control as an endocrine disruptor [48:45]

Liz Wolfe: But it’s exactly what we need. Man. Well I’m excited to devote some more thought time; some more journaling time to that idea. Because it’s really not something that I had thought of before. 

One of the things I wanted to circle back to, this idea of birth control as an endocrine disruptor. I mean. I have been aware of the problems with birth control for a long time. I follow Dr. Jolene Brighten; I follow Aviva Romm. I mean, it was delightful to see how many of the women that I have been following also being highlighted in your documentary. 

But for some reason, that just didn’t click until I saw this film. Where it’s not just into our exogenous hormones. It’s not just hormone disruptive. It’s not just synthetic hormones. It’s literally disrupting your own hormone balance. And there’s no real way around that. And I know many people get very upset; maybe because they take it personally. Because they’ve been on birth control; maybe for acne or for cramps. Or maybe because it was the only thing that kept them safe in the environment they were in, from unwanted pregnancy or whatever it may be.

But again, this is that place where I come to where two things can be true at the same time. Or more than two things. Where this is of benefit to some people, but you cannot deny the fact that it is an endocrine disruptor, no matter who you are or why you’re taking it. And I think that’s really tough for people to accept sometimes. 

So what was your experience around that idea in creating this film? 

Abby Epstein: Yeah. I think, you know, it’s funny you bring that up, Liz. Because to me it’s almost like; that idea again is one of the great hypocrisies around what I call this diplomatic immunity around the pill. It’s sort of like; yeah, but don’t look over there. Don’t look over there. Just keep looking over here. Because you know what they’ll counter that with, Liz? What they’ll counter that with is; well, then you’ll be pregnant. 

Liz Wolfe: Ahh! 

Abby Epstein: You know what I mean? 

Liz Wolfe: Yeah. That’s a nonstarter. 

Abby Epstein: That’s what it will be. “Well pregnancy is even more risks. You have a higher risk of a blood clot. You have a higher risk of…” You know.

Liz Wolfe: Ugh.

Abby Epstein: It’s like they’re only using this drop of pregnancy as the counterfactual in the statistics, which is ridiculous. Was invented by really good pharmaceutical marketing people, and has been picked up by doctors repeating that ad nauseum. So it’s like that’s why a lot; because to me, ok. This is a whole generation avoiding endocrine disruptors. Everybody is trying to not eat plastic. 

Liz Wolfe: Microplastics! 

Abby Epstein: Microplastics.

Liz Wolfe: BPA. 

Abby Epstein: Right! BPA and hormones and everyone is really conscious of this; we’ve seen what’s going on right now with puberty starting younger and younger. This is absolutely now a huge concern for endocrinologists and for doctors; this idea of puberty starting now at like 9 or much, much younger. So I think that to me it’s like a non-starter. It’s sort of like; well that shouldn’t even be an option for people.

But I think that; again, there’s this very strange kind of thinking around birth control. Which, again, I think comes from pharmaceutical marketing. And Dr. Romm talks about this really well in the movie. But I remember one of the first conversations I had. So I was starting to make the documentary. And I had met one or two of the families whose daughters had died from the DVTs and pulmonary embolisms. I guess I was so naïve and so shocked; I ended up calling this very powerful woman in women’s health. She’s very powerful OB/GYN. She’s on a lot of boards. And counsels. And somebody recommended I talk to her. 

So I called her up, and I was really very earnestly saying to her; I said, I just don’t understand. Because to me, it’s like; if one girl died, that would be enough to pull the product off the market! I just can’t imagine that you’d have a product that healthy 22-year-old men were consuming and they would be dying from embolisms and strokes and that product would stay on the market. How did even one girl die? And you know what this doctor said to me? She said; have you ever seen anybody die in childbirth? Because I have.

Liz Wolfe: Oh. God. 

Abby Epstein: That was her comeback. Her comeback was basically telling me these deaths are A) collateral damage. B) acceptable. And C) again, she’s using this counterfactual that the result of not being on the NuvaRing is being pregnant and then having a chance of dying in childbirth.

Liz Wolfe: Oh my gosh. That’s horrifying. 

Abby Epstein: Liz; I almost dropped the phone.

Liz Wolfe: Yeah.

Abby Epstein: I was shaking. I was so shocked. I was like; I can’t believe this is this big women’s health guru, that all these other doctors I respect were telling me that I had to speak to her, and she was this authority. You know; that’s when I could really feel the way patriarchy and misogyny has sort of seeped in, you know? And Dr. Romm, again, talks about this very eloquently. But it really is so; our medical system it doesn’t matter if you’re trained, what gender you are as a physician. It’s like; it’s in there. It’s indoctrinated. It’s in the systems, right? 

And I just; I mean, the way she answered me. And the rage underneath her voice, do you know what I mean? The rage that I was going to question these products, you know? These medicines. It was a huge wakeup call. And I was really stunned and I was scared. Because I was like; my god. No one is watching the hen house. Nobody is looking. It’s all on us. It is all on us. 

Liz Wolfe: I think Dr. Aviva said something like 65% of the pharmaceutical company’s budget is on advertising. And that’s likely not just direct to consumer. It’s probably also advertising to doctors just like this. 

Abby Epstein: That’s right. And I think if you look; what I’ve noticed is some of the stories we covered in Europe. There was a young woman who had a stroke at a young age on Yasmin, Yaz, in France. And we cover her story in the Master Class. But she went on quite a crusade, she and her mother. And they were able to get that pill taken off the market in France. 

Liz Wolfe: Wow.

Abby Epstein: As deemed too dangerous. So it’s interesting where you see; and I guess you see this in the food industry, too. Where in Europe they’ll ban certain dyes or certain chemicals. 

Liz Wolfe: Yeah, cosmetics too.

Abby Epstein: Yeah. That we seem to be ok with tolerating here. And it’s the same with birth control. So I think there’s a very; look, it’s hard to swallow. I’m a really optimistic person. And I’m not a conspiracy theorist. But man, I will tell you. The lack of regard for human life and the lack of; I mean, it’s so dark. We can’t even get into that deeply in the movie. But in the Master Class we have a link to Marie Brenner’s article in Vanity Fair called Danger in the Ring, and in that article, some of the families in our film are in that article. But in that article, Marie really goes deep into the NuvaRing, and she really traces the whole history of how the studies were done. 

I’m telling you; it is no different than the pill trials in Puerto Rico that we show in the movie. It is no different! They just throw out the data that doesn’t fit. They just cherry-pick it. And they finance studies that work for them. That show the drugs effectiveness. And I think it’s criminal.

Look; I think, it’s happened with opioids. It’s happened and happening with birth control products. I think whenever you have a market that the stakes are so high. It’s like the stakes are so, so high. Because if suddenly we came out and said; birth control is an endocrine disruptor. Nobody take birth control. It’s broken. It’s been deemed unhealthy and no healthy young women should ever take this again; where the f*ck would our society be? Our whole society honestly? {laughs} It’s like, that’s how we are managing fertility. And by the way; we are managing it badly. Right? 50% of pregnancies are unplanned in this country. 

Liz Wolfe: Yeah. It’s not working.

Abby Epstein: It’s not working. But there are such high stakes around it. It’s so threatening to even consider the fact that birth control isn’t 100% solved. 

  • Master Class More Business of Birth Control [59:17]

Liz Wolfe: Ok, I want to hear more about the Master Class. I know we’re coming to the end of our time together. But you’ve talked about the Master Class a little bit. And we wanted to make sure to schedule this podcast around the launch of the Master Class so we can get people in that pipeline. I’m really excited about it. But I would love to hear just your elevator pitch. 

Abby Epstein: Sure. Me too. I mean, basically the Master Class; if you think about for a movie like this. If we interviewed, I don’t know, over 50 probably of these incredible hormonal health experts and doctors and everybody was interviewed for 60 to 90 minutes. And then you can see in the movie; only a fraction of the people end up in the movie. And then of those people, maybe only a minute or two or a couple of seconds, right, of their entire conversation.

So what we’ve done with the Master Class is we’ve basically broken it down into 9 episodes that cover all these different topics from how the pill affects your brain to side effects and risks that you need to know. Benefits of your menstrual cycle. Transitioning off of hormonal birth control. How to talk to your doctor. We’ve broken it down into episodes, and then we basically curated sort of the pearls; all the knowledge bombs from all of these different experts into each course. Each episode of the class. 

And then within that, you have videos, but you also have excerpts from books and you have links and you have supporting material. So, I don’t know, to me it’s almost like it’s getting a little bachelor’s degree in body literacy. To me it’s like; if you go through all these 9 episodes, you will really have an incredible. I mean, something like I would say people should buy for their daughters and insist that they really watch the whole thing. 

Because again, there is so much; just looking, let’s say, at the side effects and risks alone. You might have noticed in the movie, we don’t get into autoimmune. Right? That’s really a big topic with birth control. There is significant increases to risks, especially things like Crohn’s and IBS. Significant risk increases. Things like that. We don’t talk about inflammation. We don’t talk much in the movie about IUDs or the Mirena crash. We don’t talk much about certain conditions like Factor V Leiden, or MTHFR. Certain blood clotting disorders that really can affect how birth control interacts with your body. 

So this is like; the class that drops in. You know? And really goes deeper on kind of so many aspects of it. So yeah, we’ve got, I think four episodes out now. We’re dropping a new episode every couple of weeks. And then we’re building almost like a community around the Master Class. So when you opt in, it’s not just like; ok, now you have access to all these great classes or whatever. But then we have a community around it so we have, I think, 35 hours of recorded webinars with all of these experts. So you have access to this whole library. And then we’re going to have live webinars and conversations that you can join throughout the year to get answers. 

because, you know, I just find a lot of times if Ricki and I will do one of these clubhouse or one of these kind of apps conversations or even a webinar, I mostly find that a lot of women just really want to tell their story {laughs}. They really want specific advice to their story. And usually, their story is pretty typical across the board, or similar to thousands of other women’s stories. So we wanted to also set up sort of a forum where if people are dealing with a certain thing, whether that’s rebound acne going off the pill. How can I go off the pill because my acne is worse than it was when I went on? So we tackle those things in different topics or webinars with the experts of the Master Class. 

So that’s really what we’re doing. And mostly, Liz, it’s because when we came out with the Business of Being Born, we just didn’t understand. 

Liz Wolfe: {laughing} 

Abby Epstein: We weren’t set up and we were just inundated with so many women emailing us. How do I find a doula or a midwife? 

Liz Wolfe: Yes. What’s the difference? I didn’t know! {laughs} 

Abby Epstein: We couldn’t catch it all. We just weren’t set up. So this time we were like; ok. We know this film is a conversation starter. It probably raises more questions than it answers. We want to have that set up for people. We want to have the people who see the movie and are like; ok, wow. My mind is blown. But I have a million more questions. Now you can come into this community, watch this Master Class, connect more personally with the experts. So we just wanted to offer that level of support and community. 

Liz Wolfe: Well, I think it’s so phenomenal. Not only that you’ve put together this framework for people, but also the theme behind it. What I’ve just really sensed over and over again is that you are putting all of this together so that we can save ourselves. {laughs} You know; it’s not a matter, you have these amazing doctors and contributors in the film. And yet, at the same time, this isn’t going to be a top-down change. We’re not going to all of a sudden; our OB/GYNs aren’t going to start acting right. You know? We have to save ourselves with the knowledge that we share with one another. 

And it’s such a perfect manifestation of that connection that we all share to each other, but platformed for the digital age. You know? We have to be able to find each other. We have to talk to each other. And I feel like that’s what you’re doing. 

Abby Epstein: I agree. And I think that also we need to stop trivializing our experiences. Because I think so many of us have had really negative experiences experimenting with different forms of birth control. And I think as women, it’s so easy for us to kind of disconnect from that outrage. It’s just like childbirth; you can have an abusive birth experience where you were really mistreated. But you’ve got that baby, and you’re like; I’m not going to complain because I’ve got this baby and the baby is healthy. It’s sort of similar. I think we all are like; yeah, well, you know. I felt super depressed for 2 years and almost dropped out of college. Then I went off my birth control and figured that out.

Oh my god, but what about those two years when you almost dropped out of college because your moods were so dysregulated? Don’t trivialize that. We have a right. We have a right to body sovereignty. But we also have a right just beyond to having the right to abortion and the right to birth control. We have just a right to feel good in our bodies and not feel pressured or feel like we don’t have any options and that we have to take a medication that makes us depressed or makes us anxious or gives us blood clots. Whatever it is. That’s, I think a big part of it. Just claiming that space and that health. 

And that’s what I love about this space, Liz. I love that so many women are just forming their own fem-tech companies, and they’re just like; well, nobody could treat my UTIs so I’m developing something. And this is what I’m hiring the scientists and I’m going to figure this out for myself. And I see that all over in this space. And I think it’s amazing.

Liz Wolfe: Well, I think you’re amazing. And I’m so grateful for all the time today and for all of the amazing work that you’ve put into everything, but in particular, right now, the Business of Birth Control and of course the Business of Being Born, and all the work that you’ve done around that. So thank you so much for coming on, and for sharing so much of yourself, and for what you’re doing in the world. 

Abby Epstein: My pleasure, Liz. Thank you for everything you’re doing, too. Thank you for amplifying the message, and bringing it to your audience. Because we’re really finding that’s what; we don’t have a distributor on the movie. We don’t have money. We don’t have a marketing team. Nothing! No Facebook ads. It’s all word of mouth, so it’s really helpful for us. For you to also put this on your platform and share it. 

Liz Wolfe: Well, it’s an honor. 

That’s it for episode 29 and my interview with the wonderful Abby Epstein of the Business of Birth Control. You can find more information and stream the film at www.TheBusinessof.life and don’t forget to use the code LIZ50, all caps, for 50% off streaming. And you can also access the Master Class, More Business of Birth Control from there. 

A huge thank you to Arrowhead Mills for making this episode possible. And remember, you can ask me anything by sending me a DM @RealFoodLiz on Instagram. But the best way to ask is to go to www.RealFoodLiz.com/askLiz that way messages don’t get lost in my inbox. 

I appreciate you all! I’ll see you next week. 

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