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Sweetening the Pill

Hormonal birth control isn’t for everyone. But that doesn’t mean that it’s part of a patriarchal capitalist plot to force women to work while menstruating (WORK WHILE MENSTRUATING?!?! IMPOSSIBLE). Yet that’s the argument from a feminist writer in her new book Sweetening the Pill: or How We Got Hooked on Hormonal Birth Control. Lindsay Beyerstein handily addresses her arguments in Slate:

There’s no question that some women experience side effects on the pill. Perhaps the best known and most serious of these is an increased risk of blood clots. The pill approximately doubles a woman’s risk of a blood clot, but her absolute risk remains low. On the pill, a woman’s annual risk of developing a clot rises from about 1 to 5 women out of 10,000 to 3 to 9 in 10,000. Bayer’s controversial Yaz and Yasmin pills probably push the risk of blood clots even higher (10 to 22 in 10,000). Even so, the risk of a blood clot on the pill is a fraction of the risk of a blood clot during pregnancy or the postpartum period. Are these acceptable risks? As a pill taker, they are to me, but every woman has to make up her own mind.
You might assume that women take the birth control pill for, well, birth control, but Grigg-Spall thinks she sees a more sinister agenda. “Women do not choose … hormonal contraceptives because these things are necessary or convenient for them or because they consciously need or want to,” she asserts. Instead, according to the author, “Women are encouraged to suppress their monthly ovulatory cycle in order to not miss any days of work or so as they can remain sexually available or experience only one-note moods.”

Sweetening the Pill frames hormonal contraception as a societywide assault on ovulation and menstruation orchestrated by the capitalist system and its handmaidens in the medical establishment and feminism. Grigg-Spall ascribes the pill’s popularity to a misogynist culture that expresses its contempt for the female body by squelching its natural cycles with artificial hormones.

If capitalism, medicine, and feminism sound like strange bedfellows, that’s because they are. Grigg-Spall makes a series of seemingly contradictory claims about the capitalist-medical-feminist bloc that is supposedly bullying women into taking the pill: 1) The pill is popular because it turns women into emotionally stable and industrious workers who never miss a day of work or bleed on the shop floor and because the economy needs women’s “passivity, anxiety and emotionality.” 2) The pill is the modern-day equivalent of the 19th-century practice of “female castration,” which was used to desexualize women, and the pill is promoted as part of a feminist scheme to make women more alluring and available to men. 3) The pill kills female libido, and the pill fuels the supposed epidemic of sluttiness known as “raunch culture.”

Does the pill masculinize, ultrafeminize, or unsex women entirely? Grigg-Spall claims all of the above!

I am one of the many American women who took the Pill for a while, didn’t like some of the side effects (mood swings, lower sex drive), went off of it and never went back. I found other birth control options that worked — and they worked in large part because I’m not financially or socially dependent on my male partners, and I have quite a bit of sexual negotiating power. That’s far from universal for many women. And most of my friends who are on the Pill don’t have the same side effects that I had, and are perfectly happy relying on it as their primary means of contraception. Also, one friend feels like she gets in her best shape by running, another by doing Barre classes and Pilates, whereas I prefer yoga. Shocking news: People are different, and our bodies work differently! The Pill works really well for a lot of women. It works less well for others. It’s intolerable for some.

That it didn’t work for Holly Grigg-Spall is a real thing. But that does’t mean that the Pill is terrible for all women, or that none of us should go to work while menstruating (for the record, I work just fine while menstruating). Other commentators point out that doctors shouldn’t dissuade women from using the Pill, and that too many of us are encouraged to choose hormonal birth control over all other forms. While I’m sure it has happened that doctors direct women one way or the other, part of a doctor’s job is to ask questions about why a medication isn’t working for you, and give you medically accurate information about risks and benefits. Which is why I think this is bunk:

Just as we who hold pro-choice values don’t judge or hassle women for the reasons they choose to have abortions, we should not judge or hassle women for the reasons they choose not to use HBC, nor try to deter them. Yet anecdotal evidence abounds that women who want to quit the birth control pill, have their IUDs removed, or learn fertility awareness based methods (FABM) are often actively dissuaded from acting on their choices. It takes extreme self-assurance to do what one young university student told me she did when her doctor questioned why she didn’t want to use HBC. Her response: “My reasons are none of your business.” She said she knew the doctor would try to overcome her objections to the side effects she refused to incur.

I believe that pro-choice sexual health advocates and care providers can and must find a way to do their work effectively within this birth control dichotomy. We must acknowledge the right of women to choose HBC or NHBC depending on which best serves their health and contraceptive needs. And it’s our obligation to help them use their chosen method effectively and confidently, without persuasion or dissuasion.

If you’re going off of any medication, it is in fact your doctor’s job to ask why. And of course women should have the right to choose non-hormonal birth control. But doctors also need to discuss realistic risks and benefits. The truth is, statistically, an IUD or hormonal BC will make it less likely that you’ll get pregnant compared to relying on fertility awareness. That doesn’t mean that fertility awareness is a worse choice than hormonal birth control for all women everywhere; it does mean that doctors need to lay out the facts and allow patients to weigh them. That isn’t dissuasion. It’s responsible medical care.

What’s not responsible medical care (or advice) is deciding that because something didn’t work for you, it’s not only totally useless but an evil corporate plot to keep sisters down.


63 thoughts on Sweetening the Pill

    1. Yes, the fact that half of doctors are women does nothing to counter the point that all doctors are evil patriarchs! 9_9

  1. “Women are encouraged to suppress their monthly ovulatory cycle in order to not miss any days of work or so as they can remain sexually available or experience only one-note moods.”

    Yeah, because if you’re in such pain that you’re too incapacitated to work, that pain alone surely couldn’t be a motive to get rid of the cause (periods), could it?

    And no one could ever enjoy their work and not want to miss days of it for their own sake, either?

    And emotional stability! Man, why would a woman want that? I mean, most women I know just love having horrible mood swings during their period that leave them crying all day or lashing out at their families. Wait…

    The real question here is why Slate (and Feministe) are bothering to give this crackpot more media spotlight. There are so much more amusing bizarre, contradictory theories that people have self-pubbed* out there.

    (*Or used some no-name publisher with a serious lack of quality control)

    1. I wonder if her head would asplode if she met my doctors? I’m perimenopausal now and my periods are giving me merry hell again, like they did in my teens. Said doctors have NOT suggested going back onto the Pill, or HRT; in fact they’re saying to avoid them if possible.

      It’s almost like individual doctors can look at individual patients and have different ideas for treatment!

  2. This is conspiracy-theory crap at its finest. Just no.

    I did have a doctor who actively pushed hormonal birth control on me visit after visit even though each time I patiently explained why I didn’t want to go on it (and sometimes these visits were only two weeks apart). So I absolutely understand the desire to just tell a pushy doctor to shut it and just accept your decision. But since then, I’ve had good luck finding doctors/nurse-midwives who listen to me and respect my decisions.

  3. I think there’s a larger conversation to be had here: the way women are often treated by physicians in general, and OB/GYNs in particular.

    It never would have occurred to me to use the tactic of refusing to explain my reasons not to take the pill, and kudos to the woman you mention for figuring that out! Think about it, though – at what point do men have to justify their refusal to take a medication?

    I never took the pill for birth control; I used it to control a number of conditions (one of which happened to be menstruation so excruciating that I couldn’t work- a condition that I understand is hardly universal, but which does exist.) I also reacted horribly to it. I fired doctor after doctor of both genders (I still fear going to the OB/GYN for this reason) until I found someone who would LISTEN and not tut-tut over my complaints that the pill made me sick (did an end-run around gynecologists and went straight to the ER, who recommended a surgeon. Problem solved.)

    It’s hard not to see some pharmaceutical conspiracy when this experience was repeated over many, many doctors for 20 years – but I think it’s less the pharmacology and more that doctors are allowed to dismiss the complaints of women, even more so if they specialize in women.

    “Hysteria” lives, if not in reality, at least in the minds of many medical professionals. Kudos to you if you’ve found someone who doesn’t buy into it.

    1. Think about it, though – at what point do men have to justify their refusal to take a medication?

      When they discontinue a medication, same as everyone else… Everyone has the right to refuse treatment, but the medical provider still has the duty to prescribe and propose the best treatment they can.

    2. Think about it, though – at what point do men have to justify their refusal to take a medication?

      Every single time?

  4. Wait, I thought birth control was part of the evil feminist plot to destroy the ” traditional” family??

  5. It would have been nice to have my name (other commentators?) added to the quote (from this post http://www.hormonesmatter.com/can-pro-choice-community-embrace-birth-control-dichotomy/) used in this piece.

    I don’t get the pushback to the suggestion that the pro-choice sexual health community – to which I’ve belonged for 30 years – could be doing a better job of serving women who want to use non-hormonal birth control effectively and confidently. There is so much more our sexual health clinics and educational/advocacy organizations could be doing in support of this goal with programs, workshops, services and research. Why aren’t we doing this?

    The goal is to end the kinds of experiences that EG and mh recount here.

    1. I totally support urging the pro-choice health community to do a better job meeting the needs of women who want to use non-hormonal birth control effectively and confidently. I am one of the women who uses non-hormonal birth control. But issuing crank conspiracy theories, or demanding that health care providers not give their patients additional information or ask them questions, is not “support.”

      1. Where did I make such a “demand?” Suggesting that we honor women’s desire not to use HBC, and that “it’s our obligation to help them use their chosen method effectively and confidently, without persuasion or dissuasion?” That’s not a demand, that’s an opinion, which you are free to disagree with.

        Two commenters here have stated that they received no support – over and over again – from their doctors to make the choice not to use HBC. Suggesting that this should change is a demand for what? Respecting your patient’s right to participate in their health-care decision making?

        1. If by “honor” you mean “never discuss” a woman’s choice to not use HBC, then no, that’s not a reasonable option for doctors and other healthcare professionals to take.

  6. It’s really unfortunate that Grigg-Spall had to basically attack hormonal birth control itself, because it kills any chance for meaningful conversation. Hormonal birth control just doesn’t agree with some people (sometimes after years of problem-free use), and cultural expectations regarding responsibility for contraception can make it difficult for cis women, especially those in long term heterosexual relationships, to transition to barrier methods. This deserves discussion, but it does not somehow change the fact that hormonal birth control is empowering and even necessary for a lot of people. Her desire to tell people what to do with their bodies is basically preventing a conversation about how to better empower everyone to make their own choices more freely.

  7. Things I really hate:

    1) Psuedoscience
    2) The idea that there is a One True Way to be a women.

    Things I really like:

    1) The Slate article linked.

    Seriously, I am so fine with people using whatever form of BC they want, and I am so ready to get behind women whose health care providers have inappropriately pushed hormonal BC on them or not respected their desire to stop. I totally, totally believe that some physicians do that. But Grigg-Spall’s book…uhg, I don’t have words. The sheer number of factually incorrect statements and the “your women-ness exists in your uterus” attitude make me crazy.

  8. I think the book pretty dramatically glosses over the initial reasons why hormonal BC was demanded in the first place. It’s been pointed out elsewhere that the non-hormonal methods, especially barrier ones, seem to be far more susceptible to partner sabotage (poking holes in condoms, damaging diaphragms, etc). While hormonal BC isn’t beyond sabotage either (especially the Pill), she seems to overlook that part of hormonal BC’s appeal for many women is the privacy it can offer (especially the newer methods) and the inability of a partner to sabotage it. That isn’t true for all women, but it’s disingenuous, in a conversation about BC, to not address all the reasons why it’s useful. She seems to be presuming an awful lots about the motives of the women who use BC, and that’s where she really gets into trouble.

  9. “Women do not choose … hormonal contraceptives because these things are necessary or convenient for them or because they consciously need or want to,” she asserts. Instead, according to the author, “Women are encouraged to suppress their monthly ovulatory cycle in order to not miss any days of work or so as they can remain sexually available or experience only one-note moods.”

    Codswallop. I started on the Pill at seventeen, because I was going to RMIT and thought I might meet a boy I liked, and if sex was going to happen, I needed to be on it. Plus, my periods were sometimes absolute hell when I was a teenager, and controlling that was necessary and wanted even if I never did a day’s paid work in my life.

    Also bullshit about “one note moods” – like our only moods are happyhappyyesI’mupforsex or PMSrageweep.

    I wonder if she’s also against antidepressants? OH NOES MY MOODS ARE MORE STABLE MOTHER GAIA FORGIVE ME.

    Wow, these claims are stupid.

    1. What’s this about remaining “sexually available?” She is aware that for a lot of women, BC actually results in MORE periods. Some hormonal BC takes women who naturally might menstruate once every 2 months, or 3 months, or even further apart and creates an artificial monthly period. Jeez, it’s almost like she truly does not understand that not every woman gets a period every month. Or that there is any variance at all among individuals.

      1. Or that for some couples periods are not a stoplight and therefore have no effect on “availability,” just logistics.

  10. By the time I got to this quotation from the book, I wasn’t the least bit surprised:

    Sweetening the Pill offers an insultingly reductive account of what it means to be female: “If we shut down the essential biological center of femaleness, the primary sexual characteristics, then can we say that women on the pill are still ‘female’?” Grigg-Spall muses, casting ovulation as the sine qua non of femaleness. If so, postmenopausal women, pregnant women, girls, ovarian cancer survivors, and transwomen aren’t really female.

    “Female” = fertile, I guess. People who think this way are so depressingly predictable.

    1. I no longer have a uterus. Therefore I am no longer female? My “biological center of femaleness” is history, but, I am the same person that I was, minus the horribly long drawn out painfully bloody periods.

      Yeah, Grigg-Spall can take a long walk off a short pier.

    2. Hmm, does this also mean you’re not really a RealFemale™ if you haven’t had sex with a man that had the potential to get you pregnant? I’ve never touched an earthly man in my life, so I’d be counted out in that case.

      … Wonder if one can be a CatFemale or something instead …

  11. And this is even worse:


    Gray urges women to tailor their work schedules to match their menstrual cycles and not push themselves to excel at tasks that are at odds with their cycle. For example, she says women should take advantage of their preovulation phase to “understand complex ideas,” because that’s when our frail and inconstant lady brains are best suited to the task

    1. OK. I’ll just tell my university that I can only conduct scholarship during my pre-ovulation phase. For the rest of the month, I guess I’ll just have to sharpen pencils and play solitaire. That should work out nicely.

      Also, what’s with this “sexually available,” women as objects of male desire bullshit? Why wouldn’t women take the pill because, um, we want to have sex with hot dudes without getting pregnant? We have desires too!

      1. Criminy, I hate the term “sexually available.” As if woman will fling herself to the ground with her legs up in the air the moment some dude expresses an interest.

        I think the only time I was pressured to go on the pill (I used condoms exclusively) was when I was in college and I was going to get a pregnancy test every few months because my cycle was really irregular, and the test was free. But I’ve been fortunate enough to have a reproductive system that mostly minds its manners, so I haven’t had to hormonally prove to it that I am the one In Charge.

      2. She thinks that workers are allowed to plan their own schedules? She should try telling that to mostly female retail, fast food, and factory employees. If she’s been living on another planet, she should be running a travel agency and not writing uninformed arrant bullshit.

    2. Normally I’d be all in favor of any plan that gave me 10 days of vacation a month, but if she thinks I’m going to menstruate again just to get it, she can fuck right off.

    3. Really, why even try to understand complex ideas at all? Isn’t that best left to manly man-brains? I vote* that all uterus-owning people stay home and simply have babies 24/7.

      *I kid, of course; women shouldn’t vote either!

  12. I’m in a same-sex relationship. I’m on the pill because I developed an ovarian cyst and wished not to develop any more of them, and because my breasts started to become so tender before my period that so much as breathing on them caused me significant pain. And my reasons for choosing hormonal birth control were fairly mild, as these things go. This particular stream of biologically essentialist feminism–in addition to being transphobic and shot-through with cringe-worthy science denialism–is remarkably tone deaf to a good deal of suffering.

      1. Better yet, a lot of times you get told that the suffering you might be enduring is because you’re not living naturally enough. Menstrual cramps? Breast pain? Your diet must be wrong! Or you’re not in proper spiritual and mental harmony with your bodily rhythms!
        Yes, I grew up with a lot of this bunk. From my dad. Go figure. I’m now a thorough-going technophile.

      2. Nah, it’s actually part of God’s curse upon Eve for eating the fruit in the garden of Eden, that baby-related functions will cause pain. So you’re thwarting his will, or something.

  13. Unfortunately I think a lot of ob-gyns and associated folks (myself included) are fighting against abstinence-only education that teaches that all birth control pretty much doesn’t work so you’ll get pregnant anyway if you’re having penis-in-vagina sex and haven’t you heard about the icky side-effects?? Like those icky side-effects (weight gain, nausea, bloating, skin changes, mood changes, blood clots, etc.) aren’t heightened in pregnancy anyway. And it is being honest to tell patients that if their goal is not getting pregnant, at least in the immediate with the option of maybe doing so in the future (eliminating sterilization as an option) that hormonal methods are their best bet for that goal.* As it is, we trade some side-effects and potential problems for most of the higher efficacy methods, or a higher risk of pregnancy for less side-effects. I can understand when a provider perceives the goal of Less Pregnancy as more valuable than Less Side-Effects why they push hormonal methods, to the point of brushing away side-effect complaints. It is not patient-centered, no, and doesn’t make for a good client relationship. However, acting like all birth control methods are equally effective at pregnancy prevention doesn’t work either (and sorry, I see a lot of “but with PERFECT use and and and” stuff in regards to non-hormonal methods), only education about what is likely to be the most effective with accurate information about side-effects, costs, upkeep, etc. and letting patients make their own decisions about goals is best for the relationship.

    *exception for the copper IUD, which is a great long-term chemical free method that only recently (along with any IUDs) became recommended for nulliparous women due to the difficulty in insertion – so many providers stick to the old recommendations of IUDs only for people who’ve given birth, and subsequently less are getting the copper IUD because of it. Not to mention cost.

  14. It takes extreme self-assurance to do what one young university student told me she did when her doctor questioned why she didn’t want to use HBC. Her response: “My reasons are none of your business.” She said she knew the doctor would try to overcome her objections to the side effects she refused to incur.

    When I told my doctor I wanted to change my Asthma medication, he asked me why. I thought nothing of it at the time, but now I see he was a patriarch trying to control my breathing.

    Of course the doctor wants to know why a specific type of medication or a HBC doesn’t work for a patient. That way he can help not only this patient better, but he can tell the next patient that some people have a problem because reason and he can report side effects.

    1. I used to work in complaints.

      Every now and then, we’d get a customer calling in absolutely furious with us, convinced we were only interested in stealing their money and deeply disappointed in our service. And they would call in to the complaints department, and flatly REFUSE to provide their names, the details of the product they had an issue with or any details of the complaint whatsoever. And then get even angrier when I had to explain that, without that information, there wasn’t really much I could do to help them.

      Nice to know those sort of people are equally horrible to every service provider they encounter.

      Funnily enough, when my doctor asked me about my concerns with various contraceptive methods, and my reasons for wanting to switch from the method I was using at the time, I thought it was because he wanted to help me figure out the best match for my needs, eventually helping me to settle on a hormone-free copper IUD. But now I see his secret plan all along was to force me onto hormonal pills so I could work a full time job with regular hours and have sex with the people I want to have sex with. Quell Horreur.

    2. I thought nothing of it at the time, but now I see he was a patriarch trying to control my breathing.

      I’m seeing my (female) doctor about asthma meds this afternoon. I may be on the verge of uncovering a fifth-columnist for the patriarchy!

      1. Watch yourself around those breath-fascists, The Kitteh’s! I’ve heard doctors are even known to forcibly restart breathing in people with no respiration! Sceery!

      2. All’s well, Bagelsan! My doctor passed the Sekret UberFeminist Test by presribing what I asked her for. (Prolly didn’t hurt that I had the current inhaler with me.)

        Your restart-breathing joke’s kind of eerily well timed: I’m just filling in an Advance Care Plan and I keep writing “Do Not Rescusitate” in capital letters (and varied spelling ‘cos I’m too lazy to look it up) in different sections. 😛

    1. Hard to say. True, it’s hormone-free, but an IUD still requires you submit your fragile female person to carrying around a foreign, man-made object inside your Holy Uterus. Not to mention that the wonderful, hormone-free contraption might make your periods heavier and more painful – those are small prices to pay for the wonder of being free from the evil hormones of doom. So sayeth this book, anyway.

  15. This book sounds very problematic but it is true that fertility awareness methods 1) are equally method effective as hormonal bc, with no side effects, and more method effective than barriers 2) carry additional benefits such as achieving pregnancy when desired (which helped a friend avoid IVF her doctor had pushed) and pinpointing far more accurate due dates than doctor’s estimates based on memory of last period (which saved both me and another friend from unnecessary repeat C-sections) 3) unjustly withheld from women who are not married or engaged and straight by many teaching groups based on religious reasoning and 4) dismissed as ineffective religious propaganda by way too many doctors and other health care providers due to their ignorance as well as reflexive response to group 3.

    1. I’m not sure what you mean by “method effective,” but studies that show that FAM is as effective as oral contraceptives or barrier methods tend to have highly questionable methodology, like counting participants who get pregnant as achieving “desired pregnancy” whether they were trying to conceive or not.

      They also carry additional severe drawbacks, like being hard to follow.

  16. Jill,

    Re your comment:
    If by “honor” you mean “never discuss” a woman’s choice to not use HBC, then no, that’s not a reasonable option for doctors and other healthcare professionals to take.

    It seems Ann Friedmans’s piece in The Cut yesterday (http://nymag.com/thecut/2013/09/pill-no-prob-meet-the-pullout-generation.html?mid=twitter_nymag) provides yet another perspective on how women fed up with HBC are making sexual health care decisions. I’d be surprised if discussing their new BC methods with their doctors was part of the transition plan. If it was, I’d love to know how those conversations went. Can you imagine what their doctors might have had to say about it? Perhaps women are avoiding these conversations altogether because they have no intention of being “dissuaded” from ditching their pills or “persuaded” into getting an IUD. Just a thought.

    1. Because the “pull-out” method is so remarkably effective. Are we back in the 1950’s?

      I know there are a lot of women, in the comments to that piece, talking about how completely they trust their partners, not just to pull out in time but also to be monogamous. Perhaps I’m overly cynical, but I’ve heard too many stories, both from women and from men (back when I was a de facto spy in in the world of men) to think that that’s ever a good idea.

      1. I have to confess to having been part of this trend, though I am not young. For me, it was the result of having to use condoms that are prone to breaking anyway combined with being unable to get the contraception of my choice (copper IUD) due to financial constraints. It was not my first choice, but my only other options seemed to be HBC, which I wasn’t touching due to concerns I have around depression, and barrier methods, which I have used and loathed. I would not have done it had I not lived in a place and situation in which I knew I could get an abortion if need had been. If I’d had insurance that would’ve paid for my IUD up front, instead of needing me to lay out over $800, I wouldn’t have done it. But I didn’t have that to lay out.

        1. EG, please don’t think I was criticizing you in any way. You made the best decision for yourself that was possible under the circumstances you were in. And, knock on wood, it seems to have turned out OK. My concern is more with people who make that particular choice without being fully informed of the risks, when other choices are available to them.

        2. I know you weren’t criticizing me, Donna–I’m just a little defensive about it, because I know it’s not the ideal, most “responsible” decision I’ve ever made. I was reacting more to what’s in my head than to what you said; I’m sorry about that.

        3. No apologies whatsoever are necessary. Besides, as I said, it turned out OK — I think you would know by now if it hadn’t!

      2. I know there are a lot of women, in the comments to that piece, talking about how completely they trust their partners, not just to pull out in time but also to be monogamous.

        Probably saying something everyone here knows, but even if the bepenis’d person does manage to pull out “in time” every time, that’s no guarantee. Preejaculate can contain sperm too, so zir partner could end up pregnant anyway.

    2. Jill didn’t make that comment, I did, and I think the pull-out “method” is dubious at best, ridiculously lousy at worst. Welcome to a generation raised with crappy religious sex-ed.

      1. I stand corrected, Bagelsan. Apologies.

        My point is that because the SRH community often fails to present NHBC methods, especially FAM, as valid, effective and accessible, women wanting to quit HBC don’t seem to feel like they have many options. The growing popularity of period tracking apps has me wondering how they might become a “gateway” to certified FAM instruction.

        I appreciate that the pull-out trend is partly fall-out to what you call “crappy religious sex-ed.” In Canada we have more comprehensive sex-ed, but we are still not doing the best job providing info, support and services to use NHBC methods.

  17. It takes extreme self-assurance to do what one young university student told me she did when her doctor questioned why she didn’t want to use HBC. Her response: “My reasons are none of your business.”

    What? That’s not extreme, that’s like the most normal thing ever.

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