The ability to separate sex from reproduction is something we often take for granted in modern life. But for women especially, this ability is a relatively recent phenomenon. Though much maligned in some circles, the oral contraceptive pill, it can be argued, contributed significantly to the advances women have achieved towards economic and political equality in the late 20th century. The Birth of the Pill, as compellingly told by Jonathan Eig, is a fascinating history full of mishap and high drama.
A writer for the New York Times, Eig neither apologizes nor romanticizes the protagonists in his story. The tale’s leading lady, Margaret Sanger, is, well, a complicated figure historically speaking. Feminist, sexual freedom crusader, and yes, some would argue racist and eugenicist, she was the visionary behind the pill. A founding member of Planned Parenthood, it was Sanger who brought together science with the financial backing and sheer force of will to bring The Pill to fruition. A free love advocate, she envisioned The Pill as a tool for women’s sexual liberation by removing the worry of pregnancy without permission or interference from their husbands. She understood, however, that widespread support for such an invention would require focus on its potential implications for family planning and population control.
The other players are no less compelling. Dr Gregory Pincus, a research pioneer in the field of hormones and human biology, was recruited by Sanger to the cause. A brilliant egomaniac dismissed by Harvard after his early experiments with in vitro fertilization, Pincus was an outsider in the scientific world. Pincus understood the societal impact The Pill would have, and pursued its development with a zeal that can only be described as Machiavellian. Motivated by money and notoriety, Pincus was unafraid to manipulate facts and massage the truth in the interest of achieving his goals.
Dr John Rock, a gynecologist in practice in Boston, was a much more sympathetic character, but not exactly unqualified hero material either. A Roman Catholic, he believed sincerely that contraception and church doctrine were not incompatible. Many of his patients were unwittingly recruited as early test subjects, believing they were taking a medication to improve their fertility. Their participation, willing or not, helped establish the safety of The Pill. Like Pincus, Rock took something of an end-justifies-the-means approach to his research, but he was less motivated by personal gain than a desire to alleviate the burden of unintended pregnancy he witnessed first-hand in his patients.
Perhaps the least well-known by history, Katherine McCormick, a wealthy philanthropist, was the fourth member of this “team” of misfits. A graduate of MIT and suffragist, McCormick was a true believer in the contraceptive cause as critical to women’s equality. McCormick famously smuggled diaphragms back from Europe sewn into clothing she purchased during her travels abroad and then distributed them to Sanger’s clinics in the US. Unhappily married to the schizophrenic heir to the International Harvester empire, she provided the lion’s share of the financial support for the enterprise.
A couple of things stand out to me as a gynecologist and history buff. The Pill, as we know it today, came about because of a confluence of historical opportunity and the collective will of Sanger et al. The book recounts the shocking (by today’s standards) methods used to obtain consent of subjects and the flawed, often dangerous, methodology employed by Pincus and Rock. As I mentioned before, establishing the safety of the pill depended in large part on the participation of Dr Rock’s patients; many of whom took it under false pretenses. However, much of the research to establish the effectiveness of the pill was conducted in Puerto Rico, where the burden of poverty, exacerbated by unwanted pregnancy, lessened the resistance of subjects to try an experimental medicine. Their vulnerability was, frankly, exploited.
I do wonder if the development of something so radical as The Pill would even be possible in 2015. Protections of study subjects in the modern age include, among other things, a strict informed consent process and institutional oversights that simply did not exist in Sanger and Pincus’ time. Don’t get me wrong: these protections are critical, but one does wonder how many people could be willingly persuaded to take an unproven medicine, not for the treatment or prevention of disease, but to stop a normal physiologic process.
The other thing that strikes me is how an invention that revolutionized sex a little more than half a century ago gets such a bad rap today. Part of the reason I chose my specialty is the impact we’ve made on women’s health and life expectations. A big portion of this providing contraception. Class action suits against manufacturers of oral contraceptives is a cottage industry among personal injury attorneys. These serve to fuel a lot of the suspicion surrounding the pill. Likewise, the lawyers are not worried about the very real dangers of the alternative to contraception for women who like having sex with men: unintended pregnancy. At least in the industrialized world, we’ve managed almost entirely to divorce ourselves from what life was like before contraception and safe pregnancy care were widely available. I’ve had more than a few patients decline medical contraception because they want what’s “natural”. They really don’t. What’s truly “natural”, and what the reality was for many women 60 years ago, was to have 6 or 8 or more children. That makes it tough to do other things, like get an education or hold a job or do anything else besides cook and change diapers.
Of course, we have many alternatives to the pill nowadays for those who desire safe, effective birth control. It can be argued, however, that the pill paved the way for the development of other contraceptives by uncovering the enormous unmet need fulfilled by the pill. As I’ve often said, when they come up with a completely safe, 100% effective, reversible contraceptive, my job will get a whole lot easier. For many, the pill remains the best, if an imperfect, choice for contraception. I’m a fan of The Pill, and I’m a fan of the book.
The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution. Jonathan Eig, 2014. W.W. Norton & Company, Inc.