The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (24 page)

But what about a miracle drug?

On the final page of his report, Stycos noted that scientists were reportedly working on an oral contraceptive and that some believed it could be a panacea for the world’s population problems. The young scholar was skeptical. The problems in Puerto Rico ran too deep, he said. No miracle drug could change the way people lived and loved, especially in a place as poor as Puerto Rico, he argued.

When Pincus visited the island in February 1954, he met Dr. Edris Rice-Wray, medical director of Puerto Rico’s Family Planning Association. Rice-Wray was not a Puerto Rican; she was a native of Detroit who earned a bachelor’s degree from Vassar College and a degree in medicine from Northwestern University. Those meeting her in Puerto Rico might have mistaken her for the wife of a doctor or diplomat. She wore her reddish-brown hair in a carefully curled bouffant and adorned her practical suits and dresses with pearl necklaces and glittering brooches. But Dr. Rice-Wray’s appearance was the only thing conventional about her.

“I remember when I was in medical school saying to the boys, ‘Well . . . I’m going to get married, I’m going to have two children, but I’m going to practice medicine.’ And they said, ‘Well, maybe you’ll get married and have two children, and maybe you’ll practice medicine,
but you won’t do both
.’ ”

She did both.

Rice-Wray was an active member of the Bahá’í Faith, a religion founded in the mid-1800s that teaches there is only one God and one human race, and that all of humanity will one day come together in a peaceful society. Rice-Wray pursued her education and career in Puerto Rico in large part because she believed she could help fulfill the mission of her religion. But there were also practical reasons behind her decision to get involved in contraceptive work. During her second year of medical school, she got married and visited a Planned Parenthood office to get advice on how best to avoid pregnancy. She told the volunteers there that she did not want children to come too soon and ruin her chances of becoming a doctor.
They recommended a diaphragm
.

After graduation, she had two girls and began working as a physician in private practice on Chicago’s North Side. Once or twice a week she would work at health clinics for the poor, where the problems women faced
came as a revelation
. “You know, women with five or six children, poor, with a husband who’s very demanding, and has a terrible life. You’re stuck. You’re in a trap,” Rice-Wray reflected later. Even with her medical practice and relative prosperity, Rice-Wray felt trapped eventually, too. “If you know about suburban life,” she said, “you take your husband to the train, and you put him on the train, and you . . . take the kids to school and you . . . go get the laundry . . . and that’s what the wives were doing . . . and, well, you know,
it wasn’t enough for me
.” Rice-Wray divorced her husband and decided she wanted to see more of the world than suburban Chicago, and that she wanted to do something
to help the other women
who felt trapped. She’d been taking Spanish lessons, and a friend from Puerto Rico offered to write a letter on her behalf to an official in the Puerto Rican health department, the Departmento de Salud, recommending Rice-Wray for a job. In 1949,
she moved with her children to San Juan
and went to work.

A few months prior to Pincus’s visit to Puerto Rico, Rice-Wray and another official at the Puerto Rican Association of Population Studies, Rafael Mendez Ramos, had written an impassioned letter to William Vogt at the Planned Parenthood Federation of America, pleading for help. “People probably wonder what Puerto Ricans are doing about this situation,” they wrote. “The answer is, first, that the people are gradually becoming conscious of their problem; second, that
they are doing nothing about it
.”

There was talk of creating more jobs, and, of course, there were planes leaving daily for New York City, but it wasn’t enough, they complained in their letter. Dozens of public health clinics were operating across the island, with ample funding from the government, yet neither the government nor the doctors and nurses operating the clinics were interested in promoting birth control. Political and religious pressure kept the government from doing more, but there was nothing stopping private groups like Planned Parenthood from stepping in, Rice-Wray and Ramos said. They argued there were good reasons for Planned Parenthood to get more deeply involved in Puerto Rico. For one, researchers on the island were already engaged in a comprehensive study of birth-control habits, interviewing more than a thousand women on why they chose not to take advantage of birth-control clinics, why they frequently stopped using birth-control devices, and what could be done to help them make better uses of available resources. Once the study was complete, the researchers planned to launch a campaign to promote greater use of the clinics and the birth-control methods they provided.

But Rice-Wray worried that sociologists conducting the studies were not equipped to carry out a public education campaign. For that, she wanted Planned Parenthood’s help. She proposed making her organization, the Puerto Rican Association of Population Studies, an affiliate of Planned Parenthood. “
We have 160 clinics
on 3500 sq. miles of land and yet the results have been disappointing,” she and her colleague wrote. But the clinics were all in place and education campaigns had already been launched. With only a little more money and effort, Puerto Rico could become ground zero in the war on unwanted pregnancy. “Such a program would surely have world wide significance,” they wrote, “for it could point the way for programs in other highly populated under developed areas.”

When Rice-Wray met Pincus, she had the feeling he was desperate, “
looking for anybody
.” Rice-Wray was cautious. “I was kind of scared at first really, because I had never heard of a pill,” she said. “But he convinced me. He’s a very persuasive fellow.” Once convinced, she urged him to move fast. “
Our great opportunity
,” she said, “is now.”

For Pincus, the choice came down to practicalities. Margaret Sanger wanted him to enlist women from her New York birth-control clinic, known as the Margaret Sanger Research Bureau, where Dr. Abraham Stone would supervise the testing. But Pincus wasn’t sure women in New York would put up with the strenuous tests required. He never explained in his letters why he thought Puerto Rican women would be more compliant than New Yorkers. Maybe it was easier to imagine them going along with the program because they were poor, or because they were farther away, or because they were desperate for a better way to control the growth of their families. Another reason: The island was crowded, which meant he had more potential subjects from which to draw.

Pincus didn’t discuss it much, but he knew that the women enrolled in future progesterone trials would have more than annoying medical procedures to complain about. At the same time that he was scouting locations for the next round of experiments, he and Rock were tallying the results of their tests on infertile women from Boston and Worcester. Of the seventy women who participated over the course of the first year of those small-scale, somewhat informal trials, fifty-six women experienced a change in the pigment of their nipples; fifty-three suffered breast soreness; thirty-seven said their nipples became enlarged; forty-four experienced nausea, vomiting, or both; fifty experienced vaginal discharges; twenty-three endured increased urination; twenty-one reported increased libidos; four reported reduced libidos; and four experienced lactation.
Only five reported no side effects
.

Even so, side effects were low on Pincus’s list of concerns. No doubt the fact that he was a man and had never been pregnant contributed to his callousness. On the other hand, Sanger and McCormick were not raising concerns about side effects, either, and Pincus was planning to include several women, including Dr. Rice-Wray, on his team. It’s more likely that Pincus was, as usual, trying to take a practical approach. There would be no point worrying about side effects if he couldn’t get women to participate in the trial. Also, he was still experimenting with different compounds. That meant he might yet find a form of progesterone that worked at lower doses and produced fewer unwanted reactions. The thing to do was to keep trying.

On October 19, 1954, Pincus wrote to Dr. Manuel Fernández Fuster, one of the doctors he’d met at the University of Puerto Rico, asking him to “
assemble a group of 50 women
.” In a memo to Rock, Pincus cautioned that suitable subjects for the experiment “must be informed, intelligent, cooperative females who give evidence of normal ovulation.” Women with children, he observed, might be too distracted to take their temperature readings at precisely the same time each day. He added that the ideal subjects would be women for whom “pregnancy would be acceptable, or
at worst inconvenient
,” in case the pills failed.

To keep the work simple and boost chances of cooperation, they would begin with nurses and female medical students, and they would ask them only for daily temperature readings. Pincus was learning. He knew it would be difficult to find women willing to take big doses of progesterone and submit to daily urine tests as well as temperature readings. By seeking only temperature readings, he would find out whether the university was capable of recruiting women and whether the women could be counted on to show up every day for their tests. And if the women did cooperate, the temperature readings would tell him if they were ovulating regularly. The women who stuck with the program and ovulated regularly would then be recruited to join the clinical trial.

But Pincus wasn’t counting on the Puerto Rican women alone. He had a backup plan—another group of women available for testing—and he found them close to home, in Worcester. These women would not be motivated in the same way the patients of Rock and Kirkendall were by a desire to get pregnant; nor would they be inspired as the nurses and medical school students in Puerto Rico were by an interest in furthering medical research. The women Pincus had in mind were even better subjects in at least one respect because they would have no choice but to participate.

EIGHTEEN

The Women of the Asylum

O
NCE, FLORENCE KOUVELIOTIS
had been a great beauty—petite, brown-haired, brown-eyed, with a smile that flashed and warmed. But by 1953 she was a wreck.

Genetics had done some of the damage, but men and marriage and childbirth had taken their toll, too. Kouveliotis’s parents had both showed signs of severe mental illness, although neither of them was formally diagnosed. Their instability meant that Florence, the oldest girl, had to take care of her five siblings from the time she was still a schoolgirl. Once she reached her teens, the cracks in her own sanity were beginning to show. She became paranoid and delusional. She grew deathly afraid of germs. She found work and managed to hold a job stitching shoes at a factory in Lowell, Massachusetts, but maintaining a normal routine became increasingly difficult. By the age of twenty-nine she was still unmarried, which was unusual for a woman at the time. Perhaps she knew she was unstable, or perhaps men recognized it once they got past gazing upon her pretty features. But when she was thirty, some of her relatives arranged a marriage with a bridge painter from Greece who needed an American wife to avoid deportation. Florence quickly became pregnant. Her husband drank heavily and traveled in search of bridges to paint, leaving Florence at home to raise their son. Rather than calming her turbulent mind, motherhood made her more anxious than ever. To a woman with a phobia of germs, a baby was horrifying, a crawling, drooling incubator of filth and disease. She tried everything, even bathing him with bleach, but nothing helped. Unable to cope, she often left him alone, unwashed and unfed.

Before anyone noticed that she was struggling, Florence was pregnant again. In 1949, when she went to the hospital to deliver, she brought her two-year-old boy with her. Hospital officials, seeing that the child was covered in sores, immediately removed the baby from her custody and helped arrange for adoption by a relative. But her second and third children were not so lucky. Florence heard voices telling her to kill the children, and several times she tried. When they got older, the children ran away. They told their teachers on several occasions how they were being treated at home and at least once told police. Finally, in 1953, her two youngest children were placed in orphanages and Florence was sent to the Worcester State Hospital for the mentally ill. She was diagnosed with paranoia, schizophrenia, and multiple-personality disorder, according to her daughter, Tina Mercier. Doctors treated her with insulin therapy and at one point performed a lobotomy, although her family would not learn about it until decades later, when an X-ray revealed the telltale indentation in her skull. She was also used as a subject by Gregory Pincus and his staff for some of the earliest tests of progesterone as an oral contraceptive, a fact that Tina, some sixty years later, would find sadly ironic. A birth-control treatment, she said, is the one thing that might have done her mother some good—if it had come along earlier.