America and the Pill: A History of Promise, Peril, and Liberation (2 page)

But the pill also empowered women to make demands on their physicians—initially by asking for prescriptions and later by insisting on more information and safer oral contraceptives. Within a few years of its FDA approval, as side effects and dan- gers became apparent, women came to realize that although the pill might solve some of their problems, it could also create many more. As the feminist movement gained momentum, women’s

health advocates protested pharmaceutical companies’ indif- ference to their well-being and demanded government action. Women were not the only ones affected by the pill. For every woman taking or contemplating the pill, there was at least one man involved. Men responded to the pill primarily through media spokesmen, who took up the social, sexual, and moral implications of oral contraceptives. Although some men found it liberating to be free of the possibility of impregnating their partners, others found the power and autonomy it gave to women threatening to their masculine egos. Meanwhile, re- searchers tried to develop a pill for men—an effort that con-

tinues to this day.

As it turned out, the pill did not solve all the problems of the world. It did not eradicate poverty, nor did it eliminate un- wanted pregnancies or guarantee happy marriages. But it be- came a major player in many of the most dramatic and contentious issues of the last half of the twentieth century: the quest for reproductive rights; challenges to the authority of medical, pharmaceutical, religious, and political institutions; changing sexual mores and behaviors; reevaluation of foreign policy and foreign aid; and women’s emancipation. The pill did not cause any of these developments or determine their out- come, but it was a hot-button issue for debate amid the social and cultural upheaval of the time. Eventually, the pill took its place not as the miracle drug that would save the world, but as an important tool in women’s efforts to achieve control over their lives.

Although the developers of the pill came from many differ- ent countries and its impact was felt globally, in many ways the

story of the pill is an American story. Two American women, Margaret Sanger and Katharine McCormick, succeeded in getting the pill developed; it was mostly American researchers and physicians who created and tested it, primarily American pharmaceutical companies that initially marketed it, and Amer- ican women, overwhelmingly, who consumed it.

Millions of women have their own personal stories about the pill, and some of them are contained in the pages that fol- low. Through an Internet survey, I received e-mails from hun- dreds of women and a few men. Respondents of all ages, backgrounds, religions, and sexual orientations told me their stories. They wrote of the impact of the pill not only on their bodies and their fertility, but also on their lives. They help pro- vide the personal dimension to the history of the pill during its first half century.
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I too have a story. The pill has special resonance
for me because my parents were involved in its early develop- ment and distribution. I was twelve years old in 1960, when the pill came on the market. I probably knew more about oral contraceptives than most girls my age. Dinner-table conversa- tion often revolved around my father’s work as a clinical re- searcher testing the pill in his private practice, or my mother’s efforts to establish birth control clinics in Los Angeles where the pill was offered free of charge and my father served as medical director. I remember the press swarming around my father’s office, and I watched when he was interviewed. Would the pill make women promiscuous? No, he insisted. Like most of the pill’s advocates, he disapproved of premarital sex and

believed that single women who engaged in sex would do so with or without the pill. But he hoped the pill would prevent unwanted pregnancy.

I tagged along to medical meetings where the pill was a hot topic. I remember debates and controversies about side effects and risks, and my father’s frustration at the lack of a perfect control group to compare the health of pill-taking and non- pill-taking women over a long period of time. People I knew as my father’s friends and colleagues I would later read about as birth control pill pioneers.

I was also a “human guinea pig” for the pill. In the early 1970s, after I was married, I asked my father what pill I should take. He suggested that I join the clinical trial of a low-dose pill being tested at the time. I dutifully showed up for the fre- quent medical checkups and lab tests required of study partic- ipants. My medical records are among the thousands used to document the safety and effectiveness of the low-dose pill.

Although I knew my father was involved in research on the pill, until I began working on this book I had no idea that he played a key role in the FDA approval process. As I read recent work by scholars in the field of medical history, I discovered that my father’s caution and uncertainty about the safety of the pill delayed its approval, to the annoyance and consternation of the oral contraceptive pioneers John Rock and Gregory Pin- cus. The FDA refused to approve the pill for market until my father gave the green light. Prompted to write this book be- cause the fiftieth anniversary of the pill’s approval was ap- proaching, I was astonished to find my father at the center of that momentous event.
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So while my interest in the pill predates my life as a histo- rian, I now understand the events that swirled around me in a new way. This study of the pill also dovetails with my long in- terest in women’s history, particularly the relationship between private life and public policies. Questions of politics, gender, sexuality, fertility, and reproduction have all been central to my work—and are all central to the history of the pill. As the fifti- eth anniversary of the pill’s FDA approval approached, I de- cided to investigate its impact on our lives and our world.

I wish I had been able to interview my parents for this proj- ect, to gain their wisdom and insights, hear their stories, and have them read and comment on my drafts. But they are no longer with us, so the best I can do is to dedicate this book to their memory, with gratitude for the work they did on behalf of women’s reproductive freedom.

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Mothers of Invention

You wined me and dined me When I was your girl Promised if I’d be your wife You’d show me the world

But all I’ve seen of this old world Is a bed and a doctor bill

I’m tearin’ down your brooder house ’Cause now I’ve got the pill

All these years I’ve stayed at home While you had all your fun

And every year that’s gone by Another baby’s come

There’s a-gonna be some changes made Right here on nursery hill

You’ve set this chicken your last time ’Cause now I’ve got the pill

This old maternity dress I’ve got Is goin’ in the garbage

The clothes I’m wearin’ from now on

Won’t take up so much yardage

Miniskirts, hot pants, and a few little fancy frills Yeah I’m makin’ up for all those years

Since I’ve got the pill

I’m tired of all your crowin’ How you and your hens play

While holdin’ a couple in my arms Another’s on the way

This chicken’s done tore up her nest And I’m ready to make a deal

And ya can’t afford to turn it down ’Cause you know I’ve got the pill This incubator is overused

Because you’ve kept it filled The feelin’ good comes easy now Since I’ve got the pill

It’s gettin’ dark it’s roostin’ time Tonight’s too good to be real

Oh but daddy don’t you worry none ’Cause mama’s got the pill

Oh daddy don’t you worry none ’Cause mama’s got the pill

The Pill
, 1975
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ountry singer Loretta Lynn’s rebellious anthem, the first popular tribute to the pill in music, tells the story of a woman whose dreams of marital bliss and adventure have been

thwarted by constant childbearing. Resentful of her husband whose prenuptial promises went unfulfilled as she stayed home to tend to their brood, she declares her independence with sexy clothes and good times, thanks to the pill. But she does not abandon her mate. The last verse of the song hints at one of the pill’s initial promises: satisfying marital sex. She tells her man that without worries about pregnancy “the feelin’ good comes easy now” and invites him to a night of pleasure. She lets him know that the pill has positive benefits for him as well as for her: “Oh daddy don’t you worry none / ’Cause mama’s got the pill.”

Loretta Lynn’s song articulates the hopes for liberation the pill promised to women. She sang to and for women who saw the pill as providing freedom from the fear of pregnancy and offering the opportunity to enjoy their sexuality with their chosen mates. Like the vast majority of women who took the pill, the song’s protagonist was married, and her dreams had been displaced by the birth of one baby after an- other. The pill offered her a chance once again to reach for her dreams.

By the time Loretta Lynn belted out her hit song in 1975, the pill had been on the market for fifteen years and millions of women were taking oral contraceptives every day. As Lynn’s lyrics suggest, the story of the pill is a story about women. That fact may seem obvious to twenty-first-century readers. But when the pill first came on the market in 1960, few people imagined how powerful a force for women’s emancipation it would become. The scientists and medical researchers involved in the pill’s development hailed it as a miracle drug that would

solve the global problem of overpopulation, thereby reducing poverty and human misery, especially in the developing world. They also saw the pill as the key to family planning, allowing couples to space their children, enjoy marital sex, and achieve domestic harmony. But women had other hopes for the pill, and it was their dreams that brought the pill to fruition and made it a powerful tool for change.

The story of the pill is shrouded in myths and misconcep- tions, particularly as regards the central role women played in its development. The names most closely associated with the pill’s arrival are Carl Djerassi, who first discovered how to synthesize the hormone progesterone from Mexican yams; Gregory Pincus, the scientist who discovered how to use this synthetic progesterone, known as progestin, to inhibit ovula- tion; and John Rock, the physician who first tested the pill on human subjects and became its most visible champion. But these men did not initially set out to develop an oral contra- ceptive. Many of the developers of the pill were trying to find a cure for infertility, an effort that led them to contraceptive research.

In spite of competing claims of paternity, there was no “Fa- ther of the Pill.” In fact, the pill had two mothers: birth control pioneer Margaret Sanger and the wealthy women’s rights ac- tivist Katharine McCormick. Both were in their seventies at the time they began their collaboration. As lifelong feminists, they had participated in decades of activism on behalf of women’s rights. They knew that women could not achieve full equality unless they had control over their reproductive lives. Although the two would never benefit from the pill them-

selves, it was Sanger and McCormick’s tireless efforts that made the pill possible.

The work of Sanger and McCormick built upon
centuries of women’s efforts to control their fertility. In the United States, by the nineteenth century contraceptive practices were widespread and reasonably effective, resulting in a dramatic decline in the birthrate. In 1800, American women had an aver- age of eight children. By 1900 that number had declined by half. Nineteenth-century women controlled their fertility through several different means: late marriage or no marriage, sexual re- straint, coitus interruptus, barrier methods such as the condom, pessaries (suppositories inserted in the vagina to kill sperm or block its entry into the uterus), and abortion. Abortion was common and generally accepted until “quickening,” the point at which a woman can start to feel the movement of the fetus, which usually occurs about four months into a pregnancy.
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Among the experiments in fertility control were those adopted by utopian and religious communities that sought to alter sex, gender, and family arrangements as well as reproduc- tive practices. The Shakers did away with sex altogether; Mor- mons established polygyny; and the Oneida Perfectionists turned to “group marriage” in which the community’s leader gave certain couples, selected according to eugenic principles, permission to procreate, and everyone else was allowed to have sex with whomever they wished as long as they practiced “male continence”—intercourse without ejaculation. Women’s rights leaders also called for new approaches to sex, marriage, and reproduction. They promoted “voluntary motherhood,” which

would give women the right to decide if and when to have children. Some radical activists went further. “Free love” advo- cates like Victoria Woodhull and anarchists like Emma Gold- man sought to liberate women from the shackles of marriage altogether.
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It was not until the late nineteenth century that policies limiting access to birth control and abortion began to develop, promoted largely by the emerging medical profession, whose mostly male practitioners sought to take control over the process of pregnancy and birth from midwives and lay healers. At that time, zealous campaigners against all forms of behav- ior they considered to be immoral took aim at contraception, calling it a “vice.” The most aggressive was Anthony Com- stock, a United States Postal Inspector and longtime vice cru- sader who began a campaign against all forms of birth control. In 1873 a federal law named for Comstock equated birth con- trol with pornography and prohibited all contraceptive infor- mation and devices from being sent via the U.S. mail. The Comstock Law restricted access, but it did not prevent women from obtaining birth control. Women shared information with each other by word of mouth and found ways to transport de- vices without using the mail system. They also mounted chal- lenges to the law that eroded its prohibitions. Advertisements for contraceptives used euphemisms such as “effective for fe- male disorders,” or contained warnings that “special care should be taken not to use the remedy after certain exposure has taken place, as its use would almost certainly prevent con- ception.” In spite of such efforts to get around the Comstock Law, it remained in effect for more than half a century.
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