In Our Control (5 page)

By the start of the twentieth century, the military had seen dramatic rises in infection rates. Advances in science allowed doctors to test for venereal disease, and scientists worked on compounds that could prevent and treat them. By 1915, as Margaret Sanger was preparing to open her first clinic, the Navy had distributed and then banned the distribution of “preventative packs,” containers of supposedly prophylactic ointment.

After America entered the war in April 1917, moral anxiety about unsanctioned sexuality was quickly trumped by practical concerns about
the financial and human cost of preventable disease. A campaign mounted in 1917 sought to educate soldiers about the importance of self-restraint. However, not trusting too much to the boys’ self-control, chemical prophylactics were reissued and soldiers’ sexual activity was closely monitored. While the military never officially endorsed condom use, it is clear that manufacturers did a booming business during the war, and there is evidence that military doctors provided them secretly to interested parties. When soldiers, accustomed to resistance to condoms at home, were exposed to European society, where condoms were legal, many young men returned home to wives and girlfriends carrying contraband European rubbers.

In 1918, the same year that Judge Frederick Crane decided that Margaret Sanger could open her clinic for the “cure or prevention of disease,” Congress voted to spend millions of dollars on studying and treating sexually transmitted diseases, a decision that opened the door for eventual increased use of condoms. Birth control was slowly being decriminalized, if only under the pretense of disease prevention. While this was a wonderful thing for American women and men, it meant that practically the only way women could prevent pregnancy was by playing the invalid or the victim. The only means to reproductive power was in the guise of weakness or illness.

It is important to mention that while concern about venereal disease during World War I allowed greater acceptance of contraceptive tools, it also led to shocking violations of women’s civil rights. During the war more than fifteen thousand women—mostly poor, immigrant, or working class—were detained without charges on suspicion of having sexually transmitted diseases (STDs). Those who did were held for months and even years while they underwent treatment. The tendency to place the burden of preventing STDs—sometimes coercively—on women continues in the United States and other parts of the world to this day.

By the 1930s, the Great Depression had created a compelling and non-pathological need for family limitation. Even married, middle-class couples no longer necessarily had the means to support large families. Worrying about poor women having babies they couldn’t support constituted a national pastime. Lest we think this tendency is past us, we need only look at the frenzy generated during our current economic crisis by
California mother Nadya Suleman, who had the audacity to have octuplets that she had no visible means of supporting. The social fury directed at Suleman went well beyond a normal response to a possibly unstable young woman who made a bad decision, and indeed, she became a symbol for members of society who refuse to fall in line in times of economic and social crisis and expect others to sacrifice for them.

In 1930, Mary Ware Dennett, a vocal advocate of birth control, won an important court case. When her sex education pamphlet, “The Sex Side of Life,” was deemed obscene, she argued that the information she provided was accurate, clinical, and necessary. The court agreed with her, signaling that information about sexuality could now be circulated.

In 1936 two major court decisions effectively legalized birth control in the United States.
Youngs Rubber Corporation v. C. I. Lee & Co
. established the acceptability of transporting some forms of contraception for the purpose of treating and preventing disease, and
United States v. One Package of Japanese Pessaries
found more broadly that a doctor could prescribe contraception even when a patient wasn’t sick or in danger of illness. Women no longer needed to pretend to be ill to get birth control, but they still had to go through doctors to obtain it. The medicalization of birth control was complete, and the AMA officially endorsed it as a legitimate part of a doctor’s practice in 1937.

During this time, the Catholic Church emerged as a foe of legal birth control. The pope advocated the rhythm method and periodical sexual abstinence. Interestingly, the church also provided important anti-eugenicist arguments that every person, regardless of status or race, had the right to have children. The church would not mobilize so strongly against birth control again until the 1960s, with the legalization of the hormonal birth control pill.

Postwar America and the Development of the Birth Control Pill

World War II finished the work that World War I began: by the late 1940s, the majority of Americans used some form of contraception. Even as the placid suburbs of the 1950s contained the rumblings of second-wave feminism that would burst on the scene only a decade and a half later, the
social politics of the postwar era set the stage for the development of one of the true great contraceptive innovations of all time: the birth control pill.

The story of hormonal birth control goes back to the turn of the century. Late nineteenth-century editions of
The Merck Manual
reveal that a coarse brown powder called Ovariin, made from the pulverized ovaries of cows, was being prescribed for menopausal symptoms and female complaints.
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In 1889 a respected French scientist, Dr. Charles Edouard Brown Séquard, caught the attention of his colleagues when he announced that he had revived his aging body by injecting himself with extracts from guinea pig and dog testicles. The age of hormone exploration had begun, and doctors started imagining the possibilities these chemicals might possess. The various hormone developments between 1930 and 1960 are too numerous to mention individually, so I will attempt to highlight a few key discoveries here.

It took a few decades for the enthusiasm around hormones to turn to women’s reproductive organs. It wasn’t that doctors weren’t eager to gain knowledge in this area; they simply didn’t possess enough knowledge about women’s bodies to know where to start. This changed in early 1919 when Ludwig Haberlandt, a professor of physiology at the University of Innsbruck, surgically implanted the ovaries of a pregnant rabbit into another rabbit, causing temporary sterility in the second animal.
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In 1920, Edgar Allan, a Brown University student, successfully mapped the reproductive cycle of a mouse, including the monthly ripening of the egg and cellular changes. In 1929 the American biochemist Edward Doisy isolated and identified estrone, a type of estrogen, as well as two similar compounds in following years. The race was on to use this new knowledge to develop marketable drugs. As women’s health pioneer Barbara Seaman wrote:

Hormone research was hot, a frontier not just for science but for its Jekyll-and-Hyde counterpart, the development of new drugs for market. Easing the financial way for some researchers, drug manufacturers dreamed about new hormone product lines. They thought menopause, they thought menstruation. They thought beautiful skin, thicker hair, more passionate sex. They thought of curing infertility, preventing miscarriages, and drying up breast milk in mothers who preferred to bottle feed. Some of the more daring were also thinking birth control.
³⁹

The first hormone drugs for women were biological, meaning they were made from processing natural products, primarily urine. Early versions of Premarin—a drug that is still today, even after substantial scientific evidence of its dangers, one of the best-selling drugs in America—were formulated from the urine of pregnant Canadian women. At some point James Bertram Collip, one of the fathers of Premarin, realized that this wasn’t cost effective; he switched to the urine of pregnant horses, which of course continues to be a main ingredient in the drug today (PREgnant MARes urINe).

Soon after, in Nazi Germany, a chemist named Adolph Butendant raced with colleagues to synthesize estrogen. Their first drug was urine based, but eventually the team developed others, leading to the creation of ethinyl estradiol, an estrogen approved a decade later that is still in nearly nine out often birth control pills.

In 1938, a British scientist named Sir Edward Charles Dodds became aware of the Germans’ successes. Dodds was terrified that Hitler would be able to use this new technology to terrible ends, including, of course, sterilizing people he didn’t like and making a huge sum of money in the process. Dodds became determined to develop his own estrogen. The good doctor, after a manic quest, succeeded in synthesizing diethylstilbestrol (DES), an estrogen that was significantly cheaper than the German drug. To ensure, with finality, that the Germans would have no market to corner, Dodds published his formula in the journal
Nature
.

At this point the genie was out of the bottle, and doctors, scientists, and drugmakers all over the world raced to discover new uses for this wonder product. Estrogen at that time was a drug in search of a disease. No one really knew what it would do and what it wouldn’t. What they did know from the beginning was that it caused health problems, especially cancer, as Food and Drug Administration (FDA) documents and medical journal articles from the era show.
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If synthetic estrogen was a European product, progestin (synthetic progesterone)
was largely a North American one that came into existence, in part, under the guidance of refugee European scientists. Cholesterol was used to make the hormone in the 1930s because it was easily modified to make progesterone. The process through which this transformation occurred was both time consuming and expensive: it cost $1,000 to make one gram of progesterone during the 1930s.
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By the end of the decade, drug companies were racing to find cheaper, quicker alternatives. Working with advances by Japanese scientists, American organic chemist Russell Marker traveled to Mexico to search for a plant and a process that would produce the sought-after hormone. Brilliant and volatile, Marker tested more than four hundred species of plants before determining that the Cabeza de Negro plant, a wild Mexican yam, yielded the highest amount of diosgenin, a substance that could be used to make progesterone.

Marker wanted to break the European monopoly on the production of sex hormones and saw his opportunity to do so. Unfortunately, he had just lost his funding from Parke-Davis, the drugmaker who had previously supported his work but who wasn’t particularly interested in sex hormones. Marker decided to use his own money and joined with two other scientists to form Syntex, a pharmaceutical company, in 1944. Using his distinctive technique for processing progesterone, Syntex quickly became the largest international supplier of the hormone.

Quickly disenchanted when he felt that he wasn’t receiving enough of the money from this enterprise, Marker left Syntex within a year of its founding, taking his formula with him. His former partners hired two European-born Jewish chemists to reconstruct Marker’s work: George Rosenkrantz and Carl Djerassi. The scientists quickly explored new plants and possible techniques for making progesterone. In October 1951 Djerassi and a young student, Luis Miramontes, made a pure crystalline progestin product that they called norethisterone,
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a substance five times stronger than any available alternative and powerful enough to potentially work as a contraceptive.

By then, Margaret Sanger, now in her seventies, returned to her dream of the “magic pill.” To this end, she made an important match when she introduced Katherine Dexter McCormick, a wealthy heiress with a degree in science, to Gregory Pincus, a Massachusetts-based reproductive scientist. Both Pincus and McCormick were, in different ways, outsiders with
painful pasts. Pincus was one of the most knowledgeable people in the world about the female egg. A Cornell graduate, he had originally worked as an assistant professor at Harvard, where he had created the first test tube rabbit embryo. This discovery was ahead of its time and stirred up a flurry of social fear about the ethical implications of such an advance. Instead of being lauded as an innovator, Pincus was characterized—sometimes in anti-Semitic terms—as a mad scientist.
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After leaving Harvard, Pincus created his own laboratory, the Worcester Foundation for Experimental Biology, with colleagues.

Katherine McCormick had known Margaret Sanger since 1917, when she helped smuggle diaphragms into the United States. Katherine had married Stanley McCormick, heir to a large industrial fortune, the same year she became the second woman in history to graduate from MIT. Stanley was diagnosed a short while later with schizophrenia, and Katherine nursed him for decades. Sanger had been hoping to get money out of McCormick for many years, but while Stanley was alive, her funds went to schizophrenia research. After her husband’s death, McCormick approached Sanger about getting involved in the birth control movement in a more significant way. Sanger jumped at the opportunity to nurse her pet project.

McCormick gave Pincus $150,000 and told him to find the miracle drug they were all waiting for. Pincus—“the egg man”—was joined by Chinese scientist Min Chueh Chang, a specialist in human sperm. Rounding out the team was Boston obstetrician and gynecologist Dr. John Rock, who had been conducting research on the effects of progesterone on fertility to try to help women who were struggling to conceive. He observed something he called the rebound effect—that while progesterone blocked ovulation during its administration, it seemed to trigger it once the hormone was withdrawn. Rock, an ardent Catholic (and a man who Margaret Sanger observed was as “handsome as a god”) was a powerful ally who lent a certain mainstream legitimacy to what was otherwise the product of outsiders.