In Our Control (6 page)

Lara V. Marks points out that women were involved throughout the development and testing of the Pill and were agents in its creation. Among the women she names are technician Anne Merrill, who conducted significant portions of the human and animal trials, and her
assistant Mary Ellen Fitts Johnson.
⁴⁴
These women initiated a tradition of active scientific participation in the making of the Pill that would be continued in the Puerto Rico trials by, among others, Dr. Edris Rice-Wray. Marks points out that the participation of these women provides a powerful counterargument to Pill critics who argue that it was a male product imposed on female bodies.

After small-scale investigations in Boston, Israel, and Japan, Pincus began to survey the globe for ideal locations to conduct the large-scale trials that would be required for FDA approval. It quickly became clear that such experiments would be impossible in the continental United States. Katherine McCormick, who continued to supply funds and active opinions, lamented to Sanger in 1955 that they needed a “cage” of ovulating females if they were to proceed.
⁴⁵
The group eventually settled on Puerto Rico for several reasons. It was an island, which meant that it was more difficult for trial participants to disappear mid-experiment, and the territory was part of the United States, so doctors there were trained in “American style” medicine. Finally, the densely populated, largely impoverished community had an active need for and interest in family planning technology. Two main study locations were established. The first, in urban San Juan, was administered by Edris Rice-Wray. The second was in the more rural area of Humacao under the direction of another American woman, Dr. Adaline Satterthwaite.

There were problems with both locations. Many women dropped out, some because of side effects including nausea, dizziness, headaches, and vomiting. Others left when they read articles in Puerto Rican newspapers warning that the Pill was part of a eugenic plot to sterilize local women. Most seriously, two women died from mysterious causes that weren’t conclusively tied to the Pill, but seemed likely a byproduct of hormone exposure.

Critics of the Pill would later point to serious problems with these trials as one piece of evidence that the drug was prematurely marketed to an eager population without adequate knowledge about safety. Writing over forty years later, Barbara Seaman noted, “How much Pincus wavered is evident in his papers, which are now available at the Library of Congress. They comprise approximately 44,000 items, filling 213 containers on 85.2 feet of shelf space. They reveal an awesome scientific and entrepreneurial
brinkmanship, and make one wonder why Pincus didn’t burn the evidence.”
⁴⁶
Among other scientific transgressions, Pincus falsified a control group after learning late in the trial that the FDA would require one, instructing recruiters to relabel “drop out” folders as controls.

Lara V. Marks defends Pincus and his cohorts, noting that scientific standards in the 1950s were vastly different from what they are today. She writes, “Any analysis of the Pill has to take into consideration the historical context in which it was developed. If the Pill is compared with other pharmaceutical products also coming on to the market at the time, those conducting the trials cannot be accused of negligence and supplying a questionable drug.”
⁴⁷
The Thalidomide tragedy in the 1960s would usher in more rigorous standards, and had such methods been applied to the Pill, it is possible that countless women could have been spared the “unanticipated” tragedies, including potentially fatal strokes and cardiovascular problems, that emerged in the decade following the Pill’s approval.

Despite the problems it had encountered, the drug company G. D. Searle was given permission to market Enovid, the first Pill, for contraception in 1960. The world would never be the same.

The Big Round World and the Small Round Pill: Responses to Oral Contraception

When hormonal birth control hit the mass market in the 1960s, the most striking thing about it was how uncontroversial it was. Women embraced the Pill, and “between 1960 and 1962 the number of new prescriptions for the Enovid birth control pill increased tenfold, from 191,000 to 1,981,000.”
⁴⁸
While white women remained the largest consumers of oral contraceptives, women of all races and social groups utilized the new technology in growing numbers.

As Lara V. Marks argues, the story of the Pill is essentially a Cold War tale. Fear of rising populations in Communist and developing countries as well as poor and minority communities in the United States paved the way for more immediate acceptance of the drug’s possible benefits. John Rock claimed that Communism and burgeoning world populations were “more than synchronous.”
⁴⁹
Critics of the increasing numbers of unwed
mothers in the United States deployed military metaphors to make points about changing patterns of both black and white sexuality: the former were included in a sinister popular image, “the population bomb”; the latter were portrayed as dangerous agents of social change, part of the so-called sexual revolution. In the 1960s and 1970s these fears went a long way toward ensuring public acceptance of the Pill.

And of course, from women’s perspective, the Pill offered freedoms they had never before enjoyed. Sexuality could be explored without restraint, family size could be limited, and extramarital affairs could be swept under the rug without a trace. For all these social actors—women, policy makers, and fear mongers alike—the Pill represented a potential solution.

In the mid 1960s, just as the Pill was becoming a household item, Barbara Seaman was working as a magazine columnist for
Bride
and
Ladies’ Home Journal
. She began to receive disturbing letters from women and their families detailing complaints of Pill side effects that ranged from annoying to unacceptable to tragic. It was becoming clear that the Pill had been put on the market too early. Incensed by the implications of these women’s experiences, Seaman was moved to research the Pill and write a book on her findings. In 1969, despite an injunction that nearly halted publication (and was based on accusations that later proved false), Seaman’s book
The Doctors’ Case Against the Pill
was published. In sharing the stories of women who had contacted her as well as the information she gleaned from top scientists working in the field, Seaman exposed the serious health implications associated with the Pill. Her book is generally credited, along with
Our Bodies, Ourselves
, with sparking the women’s health movement.

Seaman’s book caught the attention of Wisconsin senator Gaylord Nelson, who decided to hold hearings based around its findings. At the hearings, doctors testified for and against the Pill. Determined to have their voices heard, a group of young women who found themselves increasingly frustrated by the proceedings began a makeshift protest. Led by Alice Wolfson, a young Barnard College graduate, members of DC Women’s Liberation shouted questions disrupting the hearings. “Why are ten million women being used as guinea pigs?” they demanded. The women were eventually removed from the hearings, but their protest caught the attention of the nation.

The combination of these incredible pieces of activism—Seaman’s book and Wolfson’s uprising—fostered the creation of the first patient package insert, the mandatory list of side effects that now comes with many prescriptions.
⁵⁰
After studies confirmed the health dangers of the high-dose Pill, they were replaced by the low-dose Pill and eventually removed from the market in the 1980s.

While it has never regained the uncomplicated adoration it received in its early years, the Pill remains the most popular contraceptive for American women. By the 1990s, 80 percent of all American women born since 1945 had tried the Pill. Among other things, the Pill fundamentally changed the relationship between doctors and their patients, cementing the connection between contraception and the medical establishment. It also helped to give birth to—no pun intended—the concept of preventative medicine.

What lessons can women making contraceptive decisions learn from the history of birth control? For one thing, it is worth asking when, historically speaking, contraception has been tolerated and when it has been discouraged. Who was in power and what interests dictated policies about reproductive options? In what ways have women in diverse historical and social contexts resisted controls to their fertility? Most importantly, we must try to understand the patterns that run through histories of reproductive control and resistance as we try to understand the issues and controversies facing us today.

Chapter Two
A Pill Primer: Hormonal Contraception for the Twenty-first Century

When you make a thing, it is so complicated making it that it is bound to be ugly, but those
that do it after you they don’t have to worry about making it and they can make it pretty,
and so everybody can like it when the others make it
.
—Gertrude Stein,
The Autobiography of Alice B. Toklas

Edris Rice-Wray had made up her mind: no one would ever be able to stay on this drug.

She was a faculty member at the Puerto Rico Medical School and medical director of the Puerto Rico Family Planning Association when Dr. Gregory Pincus asked her to assist him in enrolling eligible women to test the first contraceptive pill. Rice-Wray had been unaware that such a drug was in the works: “I thought about it and then I asked a lot of questions. I had to be sure it was safe, you know. I wasn’t going to give them anything that wasn’t all right.”
¹
Pincus assured her that it was perfectly safe. What he failed to mention was that it had been tested on a very small group of women for only four months. No one knew what would happen when women were given the drug for a longer period of time.

Enrolling women under age forty who had at least two children (to ensure that they were fertile), Rice-Wray began what would become one of the greatest experiments of the twentieth century. As she would recall later, getting women to sign on was no problem. Getting them to stick with the Pill regimen was another matter. Reasons for discontinuation were numerous and ranged from the social—some started to fear that hormonal contraception was an imperialist action to cut the Puerto Rican population—to the physical, as women began to experience multiple unpleasant effects. One young mother, Elsa Robles, began taking “Enovid” after the birth of her first child. She later recounted what happened:
“I had horribly prolonged periods. Really long, sometimes they lasted almost a month. I was using so many sanitary pads—it really shook me up. It was like I was hemorrhaging. When I went out I was afraid to sit down in case I would bleed through.”
²

When Edris Rice-Wray wrapped up her part of Pincus’s trial, she told him that from what she had observed, it just wasn’t going to work; women would never knowingly subject themselves to these side effects. History would prove she was right about the Pill’s dangers, but wrong about the willingness of female patients to endure them.

Half a century later, in the early winter of 2009, a young writer named Holly Grigg-Spall decided to go off the Pill after nearly ten years, multiple brands, and a particularly unpleasant interaction with one drug, Yaz. Grigg-Spall describes what changed her mind about the Pill: “At the end of 008, I began to experience overwhelming anxiety, depression, debilitating brain fog and intense panic attacks which affected my work and relationship. For six months I thought I was losing my mind. After questioning every aspect of my life, and my sanity, I eventually discovered it was not me, but the birth control pill I was taking.” Her moment of clarity came while sitting in a parking lot after a shopping trip with a friend, who had also been “feeling down lately, like nothing excited her anymore. She’d gotten more excited about leggings than anything else that month—including her long-term boyfriend. Her head felt like it was full of cotton wool, she couldn’t think straight. She had no sex drive to speak of, but not just that, she had no drive at all.” After sharing stories, Holly started to wonder if perhaps their birth control pills were part of the problem. Like so many women, Holly and her friend took the Pill every day without thinking of it as medicine or considering that it might impact their bodies in ways that went beyond preventing pregnancy. It took another year, but Grigg-Spall finally came off the Pill. All these years later, women like Grigg-Spall are learning through hard-won experience what Edris Rice-Wray saw from the beginning: that the choice to take the Pill is not always a simple one.

When I began learning about the Pill with Barbara Seaman at the end of 1999, women were marking its fortieth anniversary. The mood was
decidedly celebratory, the moment was replete with widespread magazine and television coverage, and the message was clear: the creation of the Pill was a triumph for the feminist movement, and a huge step forward for women everywhere. In the midst of all of this good feeling, honest conversations about the Pill—about its history of safety concerns, its many risks and benefits—were noticeably absent.

A decade later, as we get ready to mark the fiftieth anniversary, little has changed. In twenty-first century American life it is taken as a given that the Pill is “safe.” Pill hormone levels have been reduced since its birth, and life-threatening complications with the modern drug are purported to be rare. One hundred million women around the world are “on the Pill,” and as a recent book on the subject posits, “100 million women can’t be wrong.”
³
But the lack of serious examination of the Pill has created an environment where women live with life-disrupting side effects for decades, unaware that a large consumer health movement has been asking questions about the dangers of hormonal contraception for fifty years.