America and the Pill: A History of Promise, Peril, and Liberation (16 page)

But in Seaman’s effort to marshal all experts she could find to support her case against the pill, she unwittingly collabo- rated with some who had their own agendas. The worst of- fender in this regard was Hugh Davis, a researcher eager to denounce the pill and promote his own invention, the Dalkon Shield intrauterine device (IUD). Later, when the infamous Dalkon Shield caused thousands of women to suffer severe harm and even death, Davis’s true motives became evident. He owned a one-third share in the company that marketed the Dalkon Shield, and he had falsified data from his studies of the device. But when Barbara Seaman wrote her book, none of this had come to light. In fact, Davis wrote the introduction to Seaman’s book. He warned against the dangers of the pill and promoted the Dalkon Shield, but neither he nor Seaman ques- tioned the safety of his IUD, from which he stood to profit handsomely.
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The Doctors’ Case Against the Pill
failed to avert the Dalkon Shield catastrophe and very likely contributed to it. Davis used the platform provided by Barbara Seaman to promote his

flawed product. From 1971 until 1974, when its manufacturer,

A.H. Robins, withdrew it from the market because of com- plaints about its safety, 2.2 million women had been fitted with the Dalkon Shield—more than all other IUDs combined. At least 18 women died as a result of the device, and more than 200,000 women suffered infections, hysterectomies, miscar- riages, and other serious problems or had children with birth defects. More than 325,000 claims were filed against A.H. Robins. The company went bankrupt in 1985.
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At the time Seaman published her book, however, the pill was the focus of attention. Among the readers who found her book persuasive was Senator Gaylord Nelson, long a critic of big business and the pharmaceutical industry in particular. Nelson called for hearings on the oral contraceptive, which began in January 1970. Several of Seaman’s sources testified, beginning with Hugh Davis, who condemned the pill as un- safe and touted the safety and efficacy of his IUD. He deceived the committee about his financial interest in the Dalkon Shield, insisting he had none.
Time
reported that among the witnesses called to testify, critics of the pill outnumbered de- fenders by seven to one.
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The hearings gained huge publicity. Although women’s health advocates were gratified that the Senate was consider- ing the safety of the pill, they were enraged that no women were called to testify. Not even Barbara Seaman testified. Infu- riated, the feminist group D.C. Women’s Liberation disrupted the hearings with protests that were captured by news cameras and broadcast across the nation. But none of the women were given an opportunity to speak at the hearings, even though it

was women who had prompted the investigation, and their outrage at being excluded from the proceedings gained them additional coverage in the press. Although barred from testify- ing, women had a considerable impact on the outcome.

By 1970, the FDA ordered manufacturers to include in every packet of the pills an information sheet detailing the side effects and health risks. The hearings also affected women’s behavior: 18 percent of women who had been on the pill stopped taking it in the aftermath of the hearings and the at- tendant media coverage. Within a few months, the percentage of pill takers returned to its previous level, but women contin- ued to pressure doctors and drug companies to improve it.
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In response to complaints that the initial package inserts were in- complete and difficult for non-physicians to decipher, eventu- ally drug companies provided more user-friendly information materials.

In spite of improvements in dosage and packaging, ques- tions persisted about the pill’s safety, and feminists kept up the pressure. In 1977, for example, a televised debate on the
David Susskind Show
brought together a group of physicians and sci- entists to debate the safety and efficacy of the pill. Barbara Seaman was the sole woman on the panel. All the men with one exception defended the pill’s safety record, while Seaman, struggling to get a word in edgewise, raised objections. The scientists on the panel described the thorough research that had been conducted on the pill, its new and safer lower dose, and its record of success. The doctors said they would not hes- itate to prescribe the pill to the women in their families and in- deed had done so. Nevertheless, David Susskind, moderating

the debate, turned to the studio audience for comments by those who had suffered harm while taking the pill, including a man whose wife had died from a blood clot. Susskind said he would never want anyone in his family to take the pill, and he asked the men on the panel, “Why the hell would you recom- mend the pill?”

After the panelists confronted Susskind, he backed away from his condemnation of the pill and instead encouraged view- ers to consult their doctors before making a decision on what contraceptive was best for them. In spite of Susskind’s final concession and the reassuring words of most of the scientists on the panel, the emotional weight of the program was on the side of Seaman and the pill’s other critics, who brought their powerful personal stories of suffering to the broadcast.
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Seaman was among the founders of the broad-based women’s health movement. In Boston, a group of women began meeting informally to learn about women’s health care issues and to teach a course in the local community. The group became the Boston Women’s Health Book Collective (BWHBC), the most visible and influential voice of the women’s health movement. The group’s signature accomplishment was its 1973 publication of
Our Bodies, Ourselves
, which sold nearly 4 million copies and was translated into twelve languages.
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Like Margaret Sanger and Katharine McCormick, the members of the BWHBC were activists intensely concerned about women’s reproductive rights. But that is where the simi- larities ended. Had the two early pioneers lived into the 1970s, they might have been dismayed to see so many of their basic principles abandoned by the next feminist generation. While

Sanger and McCormick wanted a pill that would be totally in the control of women, the BWHBC called for continued re- search into a male pill. While Sanger and McCormick insisted on prescriptions for contraceptives and frequent medical exam- inations, the BWHBC distrusted doctors and encouraged women to examine themselves. Sanger and McCormick urged pharmaceutical companies to develop and market contracep- tives to meet women’s needs, but the BWHBC saw the phar- maceutical industry as interested only in making money, often at the expense of women’s health. The BWHBC claimed that capitalist medicine was “no more dedicated to improving the people’s health than . . . General Motors [is] to improving peo- ple’s public transportation.”
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Over time, the women’s health movement shifted its posi- tion on the pill. The first edition of
Our Bodies, Ourselves
took a neutral position, noting that the pill was dangerous for some women but that many used it with no problems at all. The au- thors urged their readers to make an informed decision about whether or not the pill was right for them.
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In later editions of the book, the BWHBC became less confident about the pill. In 1976, the authors advised caution, noting that after only fif- teen years on the market its long-term effects had not yet been demonstrated. By 1984, the authors were even skeptical of the pill’s effectiveness: “Some of us choose to take whatever risks are involved because we
falsely
believe we are getting 100 per- cent effectiveness and absolutely don’t want to become preg- nant. What price do we pay for this
alleged
perfect protection?”
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The 1998 edition no longer supported the pill and instead rec- ommended the diaphragm, cervical cap, or foam and condom,

with abortion as a backup in case of failure. “We must try to change the attitudes and prejudices that have kept us from using these methods in the past.”
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Sanger and McCormick might have been rolling in their graves at these pronouncements.

By 2005, however, the movement’s perspective had come full circle to a resounding endorsement of the pill. The authors of
Our Bodies, Ourselves: A New Edition for a New Era
noted that the pill now contained a mere fraction of the hormones that in larger doses had caused so many risks and side effects. They cautioned readers to reject “alarming stories from friends, trusted adults, or the media. . . . These stories may be based on half-truths, isolated cases, or old information.” Encouraging their readers to base their decisions on accurate information, they hailed the benefits of oral contraceptives: “The advent of the Pill, probably more than any other event, has enabled women the world over to prevent or delay pregnancy and, in doing so, to complete our educations, choose our careers, and create more egalitarian relationships. . . . The birth control pill is considered the most intensely researched medication in his- tory. . . . Despite problems associated with early pill formula- tions, researchers now maintain that the low-dose birth control pills on the market today are safe for most women.”
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Sanger and McCormick could rest in peace.

While the turmoil surrounding the pill subsided
in the waning years of the twentieth century, new controversies emerged with the next generation of hormonal contraceptives, particularly Norplant, a long-acting compound implanted in the upper arm, and Depo Provera, an injectable contraceptive

that prevented pregnancy for three to six months. Norplant gained FDA approval in 1990 and Depo Provera in 1992. Both of these methods had the advantage of protection against preg- nancy without the need to remember to take a pill every day.

Hailed as the first new contraceptive in three decades and touted as more effective and easier to use than the pill, Nor- plant consisted of six flexible, silicone-based capsules, each containing 36 milligrams of continually released hormones, preventing pregnancy for up to five years. It was first devel- oped in the late 1960s, and within a decade the Population Council was testing it in developing countries, prior to its ap- proval for use in the United States. More than 50,000 women in forty-four countries took part in studies that yielded hun- dreds of articles in medical journals. The World Health Or- ganization followed 8,000 users for five years, comparing them to women who used the IUD or sterilization, and found that Norplant users had fewer problems. Finland and Sweden ap- proved Norplant in the 1980s. By the time the FDA approved Norplant for use in the United States, nearly 5 million women around the world had used it. The main drawback to Norplant was the fact that it required a physician to remove it. Women couldn’t remove it themselves. For that reason, providers of Norplant had an ethical responsibility to make sure that women had access to trained medical personnel who could re- move the device on demand.
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The inability of women to insert or remove the device themselves left open the possibility of coercive use, especially in the 1990s when the political climate grew hostile to welfare and some taxpayers complained about public support for the

children of women on public assistance. When the FDA ap- proved Norplant for use in the United States, almost immedi- ately the new device generated a storm of controversy. The
Philadelphia Inquirer
set off a firestorm with an editorial that promoted Norplant as a means to “reduce the underclass” and urged financial incentives for inner-city black women on wel- fare. The public outcry was intense.
Inquirer
columnist Steve Lopez fumed at his colleague’s suggestion that “black people should be paid to stop having so many damn kids,” and the paper printed an apology.
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Nevertheless, the idea took hold. Policymakers and pundits across the country saw Norplant as a means to curb the fertil- ity of poor women, particularly those on welfare. Numerous legislative proposals attempted to require Norplant for women who used drugs, or who had more than a certain number of children on public assistance. Dr. Sheldon Segal, one of the scientists who developed Norplant, was enraged. He con- demned these proposals, asserting that Norplant “was devel- oped to improve reproductive freedom, not to restrict it.”
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A Republican congressman from Florida, however, sug- gested a federal program linking welfare to the use of Nor- plant. A state judge in California offered a woman convicted of child abuse the choice of Norplant or prison. Advocates for such programs included black as well as white policymakers. Marion Barry, an African American who was mayor of Wash- ington, D.C., supported the idea: “You can have as many ba- bies as you want,” he said. “But when you start asking the government to take care of them, the government now ought to have some control over you.”
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No state ever passed a bill that mandated the use of Nor- plant or offered financial incentives for using it. But many poor women and teenage girls found that it was easier and cheaper to acquire than other forms of birth control. Although Nor- plant was expensive when administered through private doc- tors, it was offered for free through subsidized clinics and in predominantly black public schools. There is no question that Norplant was more effective than the pill for preventing preg- nancy among teens. One study found that only 2 percent of adolescents became pregnant while using Norplant, compared to 38 percent who used the pill. But the practice of distribut- ing Norplant to teenagers remained controversial.
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By the late 1990s, Norplant fell out of favor as a result of several class-action suits against the manufacturers. In 1997, out of 1 million American women using Norplant, 25,000 of them—one in a thousand—had signed on to 200 lawsuits claiming that they had been injured by the product. Most claimed that they had permanent scarring from the insertion or removal of the implant. Fifty of these were class-action suits, some generated by lawyers who placed ads with toll-free numbers offering money to women using Norplant. Ironically, the manufacturers of Norplant had developed a biodegradable form of the implant that would not need to be removed. But women’s health groups vigorously opposed the biodegradable product because it could not be removed if a woman decided she no longer wanted the implant.
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