America and the Pill: A History of Promise, Peril, and Liberation (20 page)

mega-transformations in our social, cultural, or personal lives. It was, however, central to some of the most profound develop- ments in both public and private life over the last half century.

Although the pill was not responsible for the emancipation of women, it did provide an important tool for millions of women to effectively control their fertility, freeing them from fears of pregnancy and constant childbearing and enabling them to take advantage of expanding opportunities for educa- tion, employment, and participation in public life. The femi- nist movement made it possible for women to use the pill to improve their lives and to use their collective power to improve the pill as well.

Today’s pill has little in common with its 1960 original. Containing only a small fraction of the amount of hormones in the original dose, it is “not your mother’s birth control pill,” as the
New York Times
noted. The new formulas reflect improve- ments resulting from half a century of extensive research and more studies of its safety than any pharmaceutical product in history. A 1999 study reporting on twenty-five years of follow- up with more than 45,000 women demonstrated that the oral contraceptive pill is safe and effective.
2

Contraceptive use has also changed. Today, 98 percent of all women who have ever had heterosexual intercourse have used some form of contraception; 82 percent have used oral contra- ceptives. The pill remains the leading method of birth control in the United States. Since 1982 the pill and female steriliza- tion have been the two most widely used forms of contracep- tion. The percentage of women who used birth control at their first sexual encounter has also increased dramatically, from

43 percent in the 1970s to 79 percent today; although the method was most often condoms, the use of the pill also increased.
3

For all its improvements and its widespread use, the pill is still not the ideal contraceptive. Some risks and side effects re- main. Although it offers excellent protection against preg- nancy when taken properly, the pill is less reliable than other methods, especially the IUD, the patch, and the implant, which have lower failure rates because they do not require that the woman remember to take a pill every day. But pregnancy is no longer the most dreaded outcome of unprotected sex, espe- cially now that both abortion and emergency contraception are legal. More frightening and more dangerous are sexually trans- mitted diseases (STDs), especially HIV/AIDS. Hormonal contraceptives provide no protection against STDs, which can be incurable and even deadly. As one young woman lamented, “I think there was probably the perception once upon a time that the birth control pill took away the consequences of sex, but HIV/AIDS has been around for my entire life.”
4
For that reason, many women prefer to use barrier methods that protect against STDs, sometimes in addition to taking the pill.
5
The oral contraceptive is among a cornucopia of contraceptive products available—IUDs, patches, implants, rings, drugs that reduce the number of menstrual cycles or eliminate them altogether— yet none of them is perfect. There is still a demand for better contraceptives that offer protection against both pregnancy and STDs, without risks or side effects.

The story of the pill is not over. Although hormonal con- traceptives are now widely available in many forms, obstacles of cost and availability still make it difficult for some women

to get it when they need it. Access is still compromised by laws and policies that shift with the political winds. Yet it is clear that the birth control pill has come of age. It is safe and effec- tive for most women. Its developers and marketers listened to women who demanded safer contraceptives, easier access, more information, and further research. The feminist movement not only empowered women to make demands on the medical and pharmaceutical establishments, it also opened the doors for women to join men in these previously male-dominated enterprises. As increasing numbers of women entered the fields of science and medicine, the developers and providers of contraceptive products were also likely to be the consumers of those products.
6

From beginning to end, women were largely responsible for the pill’s success. The oral contraceptive was promoted and de- veloped because of the passion, commitment, and energy of Margaret Sanger and Katharine McCormick. Hundreds of women volunteered for risky clinical trials to help bring it to market, and then millions of women quickly made it the most popular form of birth control in the country and one of the best-selling drugs in U.S. history.
7

The pill contributed to the empowerment of women not only by allowing them to control their fertility, but also by changing the relationships between women and their doctors and by mobilizing women to take on large pharmaceutical companies, the Catholic Church, and the government. In their personal lives, women found that the pill opened up conversa- tions and contributed to increased intimacy not only with their male partners but with their female friends and relatives. For

many women, the process of deciding whether or not to take the pill led them to greater awareness of their bodies, their sex- uality, and their reproductive choices. Some women found their way to feminism through their experiences with the pill. Others discovered the extent to which their personal values re- flected or diverged from those of their peers and parents.

Without the political and cultural upheavals of the last fifty years, particularly those brought about by the feminist move- ment, the pill would have been just one more contraceptive— more effective and convenient than those that came before, but not revolutionary. Instead, it became a flash point for major so- cial transformation. The pill played a key role in the movement for reproductive rights, the achievement of standards of in- formed consent in medical research, and the requirement that pharmaceutical companies provide consumers with informa- tion about risks and side effects. It served to highlight the need for new male contraceptives. It was at the center of policy de- bates over foreign aid and family planning. It ignited skir- mishes in the culture wars. Most important, women used it as a powerful tool not only to control their fertility, but to change their lives.

ACKNOWLEDGMENTS

I would like to thank several people for their help with this proj- ect. Courtney Martin provided invaluable advice and assistance with the Internet survey and helped to organize and interpret the responses. Jeff Manuel, Matthew Schneider-Meyerson, and Jason Stahl provided outstanding research assistance. I am ex- tremely grateful to Sara Evans, Susan Faludi, Lary May, and Riv-Ellen Prell, who read the entire manuscript and gave me thoughtful comments and suggestions. Thanks also to all those at Basic Books who helped with the production, including Whitney Casser, Susanne Caulfield, Laura Esterman, Lara Heimert, and Amanda Moon, and to Elizabeth Bell for her ex- cellent copyediting. My agent, Sandra Dijkstra, was a wonderful shepherd for the book from beginning to end.

NOTES

INTRODUCTION

1. John Rock, quoted in Lara Marks,
   Sexual Chemistry: A History of the Contraceptive Pill
   (New Haven, CT: Yale University Press, 2001), p. 13.
   

2. Elizabeth Siegel Watkins,
   On the Pill: A Social History of Oral Contraceptives, 1950–1970
   (Baltimore: Johns Hopkins University Press, 1998), pp. 39–40.
   

3. Andrea Tone,
   Devices and Desires: A History of Contraceptives in America
   (New York: Hill and Wang, 2001), pp. 203, 227–228, 233–
   

236. There is no data available on the number of unmarried women who took the pill in its first decade on the market. See Chapter 4 in this book.

1. Throughout the book, respondents to the Internet survey are identified by first name and last initial. In the endnotes I have in- cluded any information about the respondents that they provided, such as age, religion, occupation, marital status, sexual orientation, and racial or ethnic background.
   

2. For this revelation I am indebted to Margaret Marsh and Wanda Ronner, whose outstanding biography of John Rock contains the story. See Margaret Marsh and Wanda Ronner,
   The Fertility Doctor: John Rock and the Reproductive Revolution
   (Baltimore: Johns Hopkins University Press, 2008), pp. 215–221. The detailed account of the FDA approval process is in Suzanne White Junod and Lara
   

Marks, “Women’s Trials: The Approval of the First Oral Contracep- tive Pill in the United States and Great Britain,”
Journal of the His- tory of Medicine,
vol. 57 (April 2002), pp. 117–160. I have drawn on these works to recount the story at the end of Chapter 1 in this book.

CHAPTER 1

1. “(Since I’ve Got) The Pill,” writers Don McHan, Loretta Lynn,
   

   T. D. Bayless, © Copyright 1973, Renewed 2001. Guaranty Music/ BMI/Coal Miners Music, Inc./BMI (admin. By EverGreen Copy- rights). All rights reserved. Used by permission.
   

2. For an excellent history of abortion before 1973, see Leslie J. Reagan,
   When Abortion Was a Crime
   (Berkeley: University of Califor- nia Press, 1997). See also James Reed,
   The Birth Control Movement and American Society: From Private Vice to Public Virtue
   (Princeton, NJ: Princeton University Press, 1984).
   

3. Elaine Tyler May,
   Barren in the Promised Land: Childless Americans and the Pursuit of Happiness
   (New York: Basic Books, 1995), pp. 46–54.
   

4. Linda Gordon,
   The Moral Property of Women: A History of Birth Control Politics in America
   (Urbana: University of Illinois Press, 2002 edition). Quote on page 34. For an outstanding discussion of this history, see John D’Emilio and Estelle B. Freedman,
   Intimate Mat- ters: A History of Sexuality in America
   (Chicago: University of Chicago Press, 1988, 1997), especially Parts II and III.
   

5. Gordon,
   Moral Property,
   p. 138.
   

6. Quoted in Gordon,
   Moral Property
   , p. 150; see also p. 157.
   

7. See Gordon,
   Moral Property
   , Chapter 8.
   

8. Lara V. Marks,
   Sexual Chemistry: A History of the Contraceptive Pill
   (New Haven, CT: Yale University Press, 2001), pp. 51–52.
   

9. Gordon,
   Moral Property,
   p. 157.
   

10. No byline, “Disorder in Court as Sanger Is Fined,”
    New York Times
    , September 11, 1915, unpaginated pdf file, New York Times online, accessed 8/11/08.
    

    NOTES CHAPTER 1
    

11. Quoted in Gordon,
    Moral Property
    , p. 221.
    

12. See Gordon,
    Moral Property
    , Chapter 11.
    

13. Quoted in Andrea Tone,
    Devices and Desires: A History of Con- traceptives in America
    (New York: Hill and Wang, 2001), p. 207; and Bernard Asbell,
    The Pill: A Biography of the Drug that Changed the World
    (New York: Random House, 1995), p. 9.
    

14. Tone,
    Devices and Desires
    , pp. 204–205.
    

15. Marks,
    Sexual Chemistry
    , pp. 53–54.
    

16. Quoted in Tone,
    Devices and Desires
    , p. 214; and Asbell,
    The Pill,
    p. 234.
    

17. Elizabeth Siegel Watkins,
    On the Pill: A Social History of Oral Contraceptives, 1950–1970
    (Baltimore: Johns Hopkins University Press, 1998), pp. 25–26.
    

18. Sheldon J. Segal,
    Under the Banyan Tree
    (New York: Oxford University Press, 2003), p. 71.
    

19. Tone,
    Devices and Desires
    , pp. 209–214.
    

20. There are several excellent accounts of the development of the pill. These include Marks,
    Sexual Chemistry
    ; Tone,
    Devices and Desires
    ; Asbell,
    The Pill,
    Book 1; Watkins,
    On the Pill
    , Chapter 1; and the PBS documentary
    The Pill,
    produced for the
    American Experience
    , along with its Web site www.pbs.org/wgbh/amex/pill/filmmore/index.html.
    

21. Sanger and Pincus quoted in Marks,
    Sexual Chemistry
    , p. 37.
    

22. Carl Djerassi,
    This Man’s Pill
    (New York: Oxford University Press, 2001).
    

23. The author remembers her father, Edward T. Tyler, M.D., giv- ing this explanation many times when asked about his research on both infertility and contraception.
    

24. Margaret Marsh and Wanda Ronner,
    The Fertility Doctor: John Rock and the Reproductive Revolution
    (Baltimore: Johns Hopkins University Press, 2008), Chapter 1.
    

25. Quoted in Tone,
    Devices and Desires
    , p. 217. For an in-depth account of John Rock’s life, work, research, and Catholicism, see Marsh and Ronner,
    The Fertility Doctor
    ; Loretta McLaughlin,
    The
    

    Pill, John Rock, and the Church: The Biography of a Revolution
    (Boston: Little, Brown and Co., 1982); and John Rock,
    The Time Has Come: A Catholic Doctor’s Proposals to End the Battle Over Birth Control
    (New York: Alfred A. Knopf, 1963).
    

26. See Marsh and Ronner,
    The Fertility Doctor
    .
    

27. Tone,
    Devices and Desires
    , pp. 216–219, quote is on p. 219.
    

28. Tone,
    Devices and Desires
    , pp. 219–220.
    

29. Marks,
    Sexual Chemistry,
    Chapter 4. The discussion of the clinical trials here is largely drawn from Marks’s study.
    

30. Quoted in Marks,
    Sexual Chemistry
    , p. 98.
    

31. Tone,
    Devices and Desires
    , pp. 220–221. See also Chapter 9 for an excellent discussion of the development of the pill.
    

32. Quotes are from Tone,
    Devices and Desires
    , p. 223–224.
    

33. Tone,
    Devices and Desires,
    pp. 223–224.
    

34. Marks,
    Sexual Chemistry
    , p. 114.
    

35. Suzanne White Junod and Lara Marks, “Women’s Trials: The Approval of the First Oral Contraceptive Pill in the United States and Great Britain,”
    Journal of the History of Medicine
    , vol. 57 (April 2002), pp. 117–160.
    

36. Quoted in Junod and Marks, “Women’s Trials,” p. 130, foot- note 33.
    

37. Tone,
    Devices and Desires
    , p. 231; for a detailed study of the ap- proval process of the pill, and Edward Tyler’s role in it, see Junod and Marks, “Women’s Trials,” especially pp. 131–133; see also Marsh and Ronner,
    The Fertility Doctor
    , pp. 219–221.