The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (22 page)

SIXTEEN

The Trouble with Women

P
INCUS WAS STILL
operating the Worcester Foundation as if it were a race car built to go quickly over short distances. In the fall of 1953, the Foundation appeared to be thriving, with forty-six grants providing
a total of $622,000 in income
. That was a lot of money for a relatively small, independent laboratory, but there was a catch. Pincus and his partner Hoagland were pouring almost every dollar possible into research while neglecting more mundane matters such as building maintenance and support staff.

The Foundation’s business manager was exasperated. He’d been telling Pincus for years that the organization needed to devote 25 percent of income to overhead, but Pincus wouldn’t listen. He kept overhead costs down to about 11 percent of the operating budget. The attic and basement were jammed with animals, as Pincus kept ordering more rabbits and rats regardless of whether he had any place to put them.

“Right now the directors want a new animal building,” the business manager, Bruce Crawford, wrote in a 1953 memo to the finance committee, “and the need is really desperate, not just for the new work but
to do the jobs on hand
.” Yet there was no money for construction, or anything else, because Pincus had refused year after year to set aside funds for future projects.

If Pincus had been trying to build an institution to last for generations, he might have considered launching a campaign to create an endowment, something typically considered essential at academic institutions. He might have hired a consulting company to advise the Foundation on establishing better business practices or hired an executive with a business background to run the organization as chief executive officer or chief financial officer. But Pincus did neither of those things. He was too focused on his research, on the next discovery. Hoagland, who spent more time than Pincus on operations, never tried to rein in his brilliant partner. So instead of developing a long-range business plan, the men went to Katharine McCormick and asked her for money to build an animal testing center, and she immediately agreed,
pledging fifty thousand dollars
. Problem solved.

Pincus wrote to thank McCormick, saying he was gratified to have the money but even more gratified by her strong interest in the work being done. As construction for the new building got underway, Pincus pursued more funding from big foundations, telling them that he would soon have increased capacity to do research. In one letter to the Josiah Macy Jr. Foundation, which had supported his work on
in vitro
fertilization at Harvard, he said he was working on a system that would allow women to freeze their eggs the same way men froze their sperm. Without mentioning birth control in particular, he bragged that whole new possibilities in the field were beginning to emerge. “It is my honest opinion that a science is being developed in this field, a science which is
young, lusty and full of promise
,” he wrote.

Meanwhile, he continued to try different progestin compounds to see which worked best and continued to look for ways to test on women. It’s difficult to tell from his notes and papers whether the birth-control work had become a great priority or whether he considered it a long shot, one among many on his agenda. In the final months of 1953, he was juggling more than a dozen projects, including studies on cholesterol, adrenalin, schizophrenia, and the
metabolism of steroids
. His notes and letters give no indication that the birth-control project was of any greater priority than the others. In fact, when he gave annual updates to the Foundation’s trustees, he scarcely mentioned birth-control research, saying only that his current work included “
new studies in reproduction control
.” Pincus understood the potential of a birth-control pill. He understood that it might not only change women’s lives but also help tame the world’s population growth. In spite of this understanding, he was not yet an evangelist for the cause; he was a scientist following good leads and chasing grant money, and if it had not been for the persistence and extraordinary beneficence of Katharine McCormick, the birth-control project might have gone nowhere.

More than ever, McCormick was taking charge. Sanger was in poor health, low on energy, and increasingly cantankerous. Her diaries indicate that she was spending much of her time seeing doctors, taking art classes, and helping to plan local festivals in Tucson. “I do not know how the Pincus project is progressing,” she admitted
in a letter to McCormick
dated February 13, 1954. McCormick wrote back to say how disappointed she was by the performance of top officials at Planned Parenthood. William Vogt, the organization’s director, had come to Boston and had failed to make time to visit Pincus in Shrewsbury. Vogt had met with McCormick but failed to ask for money and “
merely said he hoped I was still interested
in their work!” McCormick was mystified.

She followed up on the meeting in Boston by going to New York to visit Vogt at the Federation’s headquarters. But while she had arranged the trip weeks in advance, upon arrival she found that no one from either the medical or research committee was on hand to speak to her. “
As I became somewhat impatient
,” she wrote, “I could not help saying that I seemed to be the only person really interested in an oral contraceptive.” In response, Vogt revealed one of the reasons he had been treating McCormick coolly. He thought she was wasting her money on the Worcester Foundation’s animal house. Vogt had been gradually losing interest in scientific research, convinced that Planned Parenthood’s money was better spent on education and clinical organization. McCormick was taken aback. She told Vogt that she believed strongly that the progesterone research offered the best chance for a birth-control pill but that it was also a distinct possibility that “an allied steroid,” meaning something akin to progesterone, would prove even more effective. Since Pincus and his team in Worcester were the only ones testing the hormone’s contraceptive powers and the early results were promising, she did not want the research to lapse. Even as human trials were getting underway, McCormick understood that continued animal testing would be essential to find the most effective chemical compound. She concluded that no one at Planned Parenthood was “really concerned over achieving an oral contraceptive and that
I was mistaken
originally in thinking they were.” With Sanger at times distracted and at times incapacitated by illness, it was McCormick who urged the work forward. She was beholden to no one and was free to speak her mind. While Planned Parenthood officials and even Margaret Sanger tried to be careful to say that new forms of birth control were being sought only for married women, McCormick alone among the team of developers had the courage and independence to declare that all women, married or not, should have access.

Pincus and Hoagland were completely reliant on McCormick’s direct support, but they cautioned her that it would be unwise to ignore Vogt and the others at Planned Parenthood. Though its leaders were often at odds with Sanger and sent mixed signals about Pincus’s research, the organization remained a valuable ally, one that Pincus was not inclined to alienate.

Increasingly, McCormick dealt directly with Pincus. In November 1953, she made the drive to Shrewsbury to visit Pincus and ask when he and Rock would be ready to report the results of their
first human trials
. Pincus explained that they had been testing about seventy women since July—most of them patients of Rock’s or Dr. Kirkendall’s, plus a few nurses from the Worcester State Hospital—but nearly half the women had dropped out of the trials, complaining that the procedures were too rigorous or else that the treatments were making them nauseated.

“Human females are not as easy to investigate as rabbits in cages,” McCormick wrote to Sanger in November 1953, summarizing her conversation with Pincus. “The latter can be intensively controlled all the time, whereas the human females leave town at unexpected times and so cannot be examined at a certain period; they also
forget to take the medicine sometimes
.” And those weren’t the only complicating factors. Unlike rabbits, women had to explain to their husbands why they were taking experimental drugs that might stop them from making babies. Unlike rabbits, women asked questions. And, unlike rabbits, women complained when they felt sick.

Testing a birth-control pill would be more difficult than testing other drugs. It was one thing to try a new medication for sick people. Sick people wanted to get better. Sick people were often under close medical supervision, either in clinics or hospitals. Sick people were willing to accept side effects and risk because the alternatives were worse. But these were healthy women—healthy
young
women—volunteering for the experiments. What if the pill made them sick? What if it made them permanently sterile? What if it caused deformities in their babies? What if it somehow altered a woman’s hormones so that she could only give birth to girls?

To be certain that the medication was safe, Pincus told McCormick, he would need to test hundreds if not thousands more women. And to test more women he would need more staff—doctors, nurses, and clerks—as well as more examining rooms. Past experience told him McCormick might volunteer to fund the research, but there was one thing McCormick’s money couldn’t supply: patients. After nearly a year of work and a dropout rate of about 50 percent in their first round of testing, he and Rock had completed research on only about thirty women.

Psychiatric hospitals and gynecology practices would never be enough. But Pincus knew a place where women wouldn’t ask many questions and wouldn’t complain too much (or so he believed), a place where birth control was legal and widely accepted.

“Mrs. Pincus and I recently returned from a trip to Puerto Rico,” he wrote McCormick on March 5, 1954. While there he had lectured at medical schools and before groups of doctors. Pincus was impressed by the quality of the work done on the island, and he was encouraged to learn that dozens of birth-control clinics were in operation. “I came to the conclusion that experiments could be done in Puerto Rico on a relatively large scale,” he wrote. He thought it would be fairly easy to get between one hundred and three hundred women “with some intelligence” to cooperate in a series of experiments. The same experiments, he said, “
would be very difficult in this country
.”

Pincus had made the trip to San Juan to lecture a group of scientists on “Biological Synthesis and Metabolism of Steroid Hormones,” but he took the opportunity to rest and get some sun. He’d been working too hard, and feeling worn. It concerned him enough that he went to see a doctor, who ran tests that showed Pincus’s white blood cell count was “
somewhat elevated
.” When Pincus wasn’t sunning on the beach, however, he spoke to several doctors about the state of birth control on the island. His host in Puerto Rico was Dr. David Tyler. During World War II, Tyler and Pincus had collaborated on a study into the adrenal gland’s function in fatigue. Tyler was now the head of the Department of Pharmacology at the University of Puerto Rico. It occurred to Pincus that with a qualified scientist like Tyler supervising, it might be possible to do high-quality scientific research on a population
desperate for better birth control
.

McCormick was skeptical, for reasons perhaps suggesting racial bias as well as class bias. She doubted whether Puerto Rican women could be trusted to follow the rigorous testing regimen, and she wasn’t sure the doctors and nurses in Puerto Rico were qualified to run the tests and record results. On the other hand, she believed in Pincus, and she wanted his work to move more quickly.

Pincus had not mentioned Puerto Rico casually. He had settled on the Caribbean island, an unincorporated territory of the United States, after considering India, Japan, Hawaii, Mexico, New York City, and Providence, Rhode Island. Tyler wasn’t the only American working on the island; there were many others. That meant the language barrier would be low and professionalism high. Flights between the United States and Puerto Rico were frequent and often direct. Best of all, birth control had been legal in Puerto Rico since 1937.

Pincus was ready to push ahead.

Like McCormick, however, John Rock was concerned. He wanted
“ovulating intelligent” women
who could be relied upon to carry out his instructions, and he wanted to see firsthand how they responded to the experiments. But even if they acquired sufficient numbers of women in Boston, Rock wasn’t sure testing would ever work. The only women who had consistently stuck with the onerous procedures to that point had been his infertile patients, who were motivated to follow doctor’s orders in the hopes of getting pregnant. Rock believed that working women and women with children would never have the time to submit to all the urine tests, Pap smears, and endometrial biopsies required.

Pincus had a different view. Women in Boston might indeed be more reliable, and infertile women might be highly motivated, but he and Rock would never get enough of them to participate. Puerto Ricans, on the other hand, appreciated the gifts bestowed by Americans, or so many Americans of his generation liked to think. The island had long served as a test tube for social scientists, never more so than in the years after World War II. And overpopulation and poverty had long been serious issues on the island. Puerto Rico was poor and crowded, and family sizes were large. Between 1940 and 1950, the island’s population had grown 18 percent, to 2.2 million, and its urban population had jumped by an astonishing 58 percent. The fertility rate in Puerto Rico was 17 percent higher than in seven other Latin American countries, and 34 percent higher than the United States. By the time she was fifty-five years old, the
average mother in Puerto Rico had borne 6.8 children
. There was a sense of urgency about the rapidly growing population, and even though Puerto Ricans were predominantly Catholic, they were already familiar with birth control. Leaders of the eugenics movement had long promoted campaigns for voluntary sterilization among Puerto Rican women, funded largely by Sanger’s friend, Clarence Gamble. Gamble had been working on birth control almost as long as Margaret Sanger, although he had done so more quietly.