America and the Pill: A History of Promise, Peril, and Liberation (5 page)

A dissenting opinion came from Dr. Edward Tyler, head of the Planned Parenthood Clinic in Los Angeles and a clinical researcher who had treated nearly two hundred patients for menstrual problems and infertility using Enovid as well as other hormonal compounds. Tyler had serious reservations about the pill’s safety. While John Rock was satisfied that the pill was safe and Gregory Pincus dismissed the side effects as mere nuisances, Tyler found that a significant number of his patients experienced abnormal bleeding, weight gain, swelling from fluid retention, and other problems. In 1958, he reported

those concerns at a medical meeting and caught the attention of an FDA official in attendance. Because he had no vested in- terest in any particular formulation of the oral contraceptive, the FDA considered Tyler to be more neutral than Pincus or Rock, who had both tested and promoted Enovid.

Tyler’s concerns slowed down the approval process, causing Rock and Pincus considerable annoyance and frustration. But the FDA would not grant approval as long as Tyler had misgiv- ings. After carefully reviewing the responses to the question- naire, an FDA official interviewed Tyler as a final step in the process. Tyler assured the official that his earlier concerns had been addressed, and that he was now convinced that Enovid was safe. Finally, on May 9, 1960, the FDA announced provi- sional approval of the pill and, on June 23, officially approved the 10-milligram dose of Enovid for daily use as a contraceptive. Because there were still concerns about its long-term safety, the FDA limited use of the pill to two consecutive years.
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Of course, John Rock, Gregory Pincus, Edward Tyler, and the scores of researchers involved in developing the oral contraceptive could not have brought the pill to market without the women who participated in its testing. Margaret Sanger and Katharine McCormick lived to see the fruits of their efforts. By the time they died—Margaret Sanger in 1966 at the age of eighty-six, Katharine McCormick the following year at age ninety-two— millions of women were “on the pill.” Yet with the exception of Sanger and McCormick, the pill’s most ardent advocates saw its potential not in terms of women’s emancipation but rather as a miracle drug that would solve the problems of the world.

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The Population Bomb

Today the population bomb threatens to create an explosion as disruptive and dangerous as the ex- plosion of the atom, and with as much influence on prospects for progress or disaster, war or peace.

The Population Bomb
, 1954
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hen the oral contraceptive arrived on the market, its champions claimed that the tiny pill promised to end human misery and eradicate the causes of war by controlling population. In meetings and conferences across the globe, ex- perts met to address the “population bomb.” At one such meeting, in the summer of 1965, hundreds of medical experts gathered in Bombay (now Mumbai) to discuss the problem of overpopulation. The site of the conference was not accidental. India, one of the most densely populated and impoverished na- tions in the world, was a telling backdrop, a living showcase of the need for population control. Participants included doctors

from all over the world, and Indian physicians comprised the largest group in attendance. Between the Western male doc- tors wearing suits and the sari-clad female physicians from India, where reproductive medicine was the domain of women, the contrast could not have been more striking.

The most dramatic moment in the conference came when an American doctor made the claim that oral contraceptives would solve India’s overpopulation troubles. With a theatrical flourish, he unfurled a roll of birth control pills like a streamer and tossed it into the packed auditorium. The assembled med- ical professionals watched as the plastic-wrapped promise of health and prosperity rose into the air and hovered above them for an instant before gently settling across attendees’ laps. The presenter then declared that the pill offered the solution to world hunger and poverty. Even in small villages with little ac- cess to medical facilities and low levels of literacy, women could easily learn to take the pill every day and control their fertility. This simple tablet would bring an end to India’s most pressing problems. His extravagant prediction was breathtak- ing.
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As it turned out, it was also wrong. India, with a popula- tion spread across the country in remote villages lacking the medical personnel required to provide prescriptions and exams, was one of the countries most resistant to the pill.
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Nevertheless, many experts and leaders in the United States and around the world believed that overpopulation was a seri- ous problem and that the pill could help resolve it. World pop- ulation had nearly doubled between 1900 and 1960, from 1.6 billion to 3 billion. It would double again by the end of the century. The population bomb seemed to be exploding, un-

leashing unforeseen human misery. Many believed that finding a solution would bring peace, prosperity, and the good life to all. Cold warriors in the West saw overpopulation as a political problem: Impoverished people in overcrowded countries might be tempted to turn to communism.

Woven into this prediction was the same ambivalence about scientific progress that had greeted the atomic bomb. Science had discovered the huge destructive power of nuclear energy— now it had to figure out a way to turn it to good use. Similarly, scientific and medical discoveries had improved life expectancy so dramatically that the death rate had declined, but the birthrate had not. Science would now need to find a way to lower the birthrate. The pill promised to be the stealth weapon that would defuse the “population bomb” by limiting the size of “nuclear” families across the globe.

Both at home and abroad, population control generated considerable controversy. Advocates who agreed on the need for access to family planning services did not all agree on goals or methods. Some were motivated by humanitarian concerns, others hoped to achieve cold war political aims, and still others were primarily interested in social engineering and eugenics. In the United States, population controllers included conserva- tives who considered the children of poor people to be a bur- den on taxpayers, eugenicists who believed in curbing the fertility of the “unfit,” and environmentalists who saw the na- tion’s growing population as detrimental to the natural world and a drain on resources.

Some experts believed the pill was the perfect solution be- cause of its effectiveness and simplicity. Others thought the pill

wasn’t suitable for use among poor people. They feared that needy, uneducated women would not be able to take it prop- erly and consistently, or that it was too expensive and required too much medical monitoring to be useful in remote areas. Is- sues of cost and medical care were real concerns, but in clinics where the oral contraceptive was offered free or for a modest fee, poor women requested it and used it with the same success as more affluent women. Women made their own decisions ac- cording to the contraceptive options available to them.

Wo men’s desires fo r effective birt h control
converged with population controllers’ efforts at social engi- neering. These efforts gained tremendous momentum in the mid-twentieth century due to the era’s rapid population growth and the political imperatives of the cold war. But pop- ulation control has a history that dates back to the nineteenth century. The birth control movement emerged parallel to the population control movement, and although they did not al- ways have the same aims, the two often intersected. Population control was not a concern of the early birth control pioneers. The radical beginnings of the movement were grounded in the quest for women’s rights. Birth control advocates argued that women could never achieve equality unless they were able to control their own reproduction. This was the starting point for Emma Goldman, Katharine McCormick, Margaret Sanger, and other leaders of the movement. At the same time, they saw contraception as vital to alleviating the suffering of poor women burdened by constant childbearing. This impulse brought birth control into the eugenic conversation. Radicals

were as likely to advocate policies that dovetailed with eugen- ics as conservatives, albeit for different reasons. While conser- vative eugenicists aimed to reduce the population of the “unfit,” women’s rights leaders hoped to improve the health and well-being of mothers and children. As Emma Goldman asserted, “Woman no longer wants to be a party to the produc- tion of a race of sickly, feeble, decrepit, wretched human be- ings. Instead she desires fewer and better children.”
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Over time, the birth control movement, especially under Margaret Sanger’s leadership, became more fully aligned with the population control effort. By the 1950s, when the birth control movement shifted to an emphasis on family planning, these currents converged. The two terms—family planning and population control—were often used interchangeably, but they did not mean the same thing. Family planning empha- sized individual choice, whereas population control focused on large-scale reduction of fertility rates.
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These movements merged into a coherent public policy agenda that was first articulated during World War II. Initially, family planning was geared toward domestic needs, reflecting the rational, scientific approach to family life. By the time the United States entered the war, birth control clinics had prolif- erated around the country.
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In 1942, when the Birth Control Federation of America changed its name to the Planned Par- enthood Federation of America, it marked a change in the or- ganization’s direction fully in keeping with this new national focus. According to Abraham Stone, medical director of the Margaret Sanger Research Bureau, “Planned parenthood” sig- naled “the need for individual couples to plan their families

and for nations to plan their populations.” Sanger vigorously opposed the name change. She believed that “planning” weak- ened the woman-empowering message of “birth control.” Nonetheless, she was overruled.
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Wartime brought new attention to rational preparations. Family planning experts urged contraception as a scientific ap- proach to personal happiness as well as national security. One poster declared, “M
ODERN LIFE IS BASED ON CONTROL AND SCI
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ENCE
. We control the speed of our automobile. We control ma- chines. We endeavor to control disease and death. Let us control the size of our family to ensure health and happiness.” PPFA proclaimed, “A nation’s strength does not depend upon arma- ments and manpower alone; it depends upon the contentment . . . of its people. To the extent that birth control contributes to the health and morale of our people, it makes them less receptive to subversive propaganda, more ready to defend our national sys- tem. . . . Victory cannot be won without planning.” With rational family planning, “more healthy children will be born to maintain the kind of peace for which we fight.” Margaret Sanger herself called for “national security through birth control.”
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At the same time, the war gave rise to the first direct con- nections between the American birth control movement and population control abroad. Looking toward the postwar era, the PPFA became more concerned with the international im- plications of contraception, not only for poverty and political unrest, but in relation to healthy markets abroad. After the war, concern shifted to the dangers of overpopulation in developing countries, where the population was growing twice as fast as in the industrialized world.

Population control seemed a panacea for the world’s ills. The movement included government officials and professionals from around the globe, but most of the leadership and funding came from the United States. Years before the pill became available, population control advocates saw contraception as the key to development, prosperity, and the success of democracy and capitalism in developing countries—and the best means to avoid war, famine, and the spread of communism. To that end, new organizations took shape. Margaret Sanger founded the International Planned Parenthood Federation (IPPF) in 1952. That same year, John D. Rockefeller III established the Popu- lation Council. He promoted progressive, noncoercive princi- ples geared toward alleviating human suffering rather than reducing the population: “Our concern is for the quality of human life, not the quantity of human life.”
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Observers and commentators had a wide range of perspec- tives on the dramatic rise in world population, but all seemed to agree that it was reaching crisis proportions. Humanitarians voiced concerns about increasing poverty and the plight of the poor, who would likely face starvation and disease. Less chari- table were the cold warriors who worried that overpopulated poor countries would be drawn to communism and align with the Soviet Union, or that the large families in the developing world would be unable to afford American-made consumer goods, undermining the potential for vast foreign markets.

Not everyone shared these concerns. The Catholic Church remained staunchly opposed to population control efforts, and others continued to argue that contraception was not a matter for public policy. Anticommunist crusaders could also be found

on both sides of the issue. Some argued that contraception and population control were essential to stop the spread of commu- nism, but a smaller group, including Senator Joseph McCarthy, claimed that birth control was a communist plot to weaken the country and spread immorality.
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Population alarmists, however, seemed to dominate the debate.

McCarthy’s opposition notwithstanding, anticommunism fueled much of this alarm. The Hugh Moore Fund distributed a pamphlet,
The Population Bomb
, frequently reprinted through the 1950s and 1960s, claiming that there would be “300 mil- lion more mouths to feed in the world four years from now— most of them hungry. Hunger brings turmoil—and turmoil, as we have learned, creates the atmosphere in which the commu- nists seek to conquer the earth.”
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Moore and his allies made it clear that they were not particularly concerned about human suffering: “We’re not primarily interested in the sociological or humanitarian aspects of birth control. We
are
interested in the use . . . which the Communists make of hungry people in their drive to conquer the earth.”
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