America and the Pill: A History of Promise, Peril, and Liberation,
by Elaine Tyler May
Sunday, May 9, 2010
The pill: Making motherhood better for 50 years
By Elaine Tyler May
Forget the single girl and the sexual revolution. The pill was not anti-mother; it was for mothers. And it changed motherhood more than it changed anything else. Its great accomplishment was not in preventing motherhood, but in making it better by allowing women to have children on their own terms.
Today, we celebrate both motherhood and the pill. It is Mother's Day, and it is the 50th anniversary of the day the Food and Drug Administration announced that it would approve the pill -- though the dream of an oral contraceptive is much older. The birth control pioneer Margaret Sanger first envisioned such a "magic pill" in 1912, two years before Congress established a national Mother's Day. She wanted to do more than honor mothers: She wanted to change their lives.
While in her 30s, Sanger worked as a nurse in New York City, and she saw many poor mothers become sick and die from the strain of frequent pregnancies. A turning point, she would recall later, came when she heard a physician instruct Sadie Sachs, a frail 28-year-old mother of three who was desperate for contraception, to "tell Jake to sleep on the roof!" Sachs's death from a self-induced abortion inspired Sanger to begin her crusade for birth control.
The sixth of 11 children born to Irish Catholic parents, Sanger was also motivated by her mother's death at the age of 50, which she blamed on her 18 pregnancies and her lack of access to contraceptives. Although women in the 19th century, when Sanger was born, practiced contraception through various means -- sponges, pessaries and coitus interruptus among them -- none were particularly effective. As a result, even young middle-class women who were eager to get engaged found creative ways to postpone their weddings -- sisters who needed help with children, mothers who needed help with housework. These young women knew that as soon as they married, babies would start coming, and with them, the loss of their independence and the likely weakening of their health.
To some extent, these methods and strategies worked. In 1800, American women had an average of seven children. By 1900, that number had declined by half, thanks to a combination of late marriage or no marriage, sexual restraint, contraceptive devices, and abortion. Nevertheless, for women with ambitions for higher education or a career, the only sure way to avoid being tied down by a continuous stream of babies was to refrain from marriage. And many did. Until recently, the highest rate of childlessness on record in the United States -- 20 percent -- was among women born in the first decade of the 20th century.
Against this backdrop, Sanger must have realized that the only way to keep women from having to make such choices was effective birth control. It was she who coined that term, in 1914, and who went on to open the network of family-planning clinics that would one day be known as Planned Parenthood. And it was she who, decades later, collaborated with her good friend, the feminist and philanthropist Katharine McCormick, to organize and fund the medical research that would bring the pill to fruition.
When the pill hit the market in 1960, at the peak of the baby boom, it was overwhelmingly mothers who rushed to get it. There may have been hand-wringing in some quarters -- and celebrating in others -- about a "sexual revolution," but the pill had very little to do with it. Single women had a difficult time getting prescriptions, and as late as the 1970s, most sexually active unmarried couples used contraceptives rarely or not at all. Of the 6.5 million women who used the pill by 1964, the vast majority were married.
The number of births per woman in the United States proceeded to plummet by more than half, from 3.65 in 1960 to 1.77 in 1975. The pill was not the sole cause of that decline, but it certainly contributed to it. It let women avoid the interruptions and hassles of barrier methods, and put contraception totally in their control. A woman on the pill did not need her partner's cooperation; he didn't even have to know. And if used properly, it was nearly 100 percent effective. Suddenly, it was possible for women to plan for children, to limit their number and to space them according to their own aspirations -- all to a degree that earlier forms of contraception hadn't been able to deliver.
The pill, quite simply, liberated mothers, and popular culture expressed their jubilation. Contemporary celebrations of the pill, such as Pete Seeger's ballad "The Pill," looked on it not as a boost to the sexual revolution but as a boon to mothers. When, in 1966, it appeared that the Catholic Church was on the verge of approving contraception, Seeger sang the story of a Catholic mother with a house full of children, waiting for the pope to "bless the pill . . . before my man comes in." (Although the Catholic Church reaffirmed its opposition to contraception in 1968, that decree did not stop Catholic women from taking the pill at the same rate as non-Catholics.)
Country singer Loretta Lynn's 1975 ode to the pill also focused on how it had liberated mothers, improving their opportunities not just outside the house but also in the bedroom. Long burdened by a new baby every year, a woman sings to her husband that she's tired of staying home with the children while he has all the fun. Thanks to the pill, she sings, she's giving up her maternity clothes for miniskirts, hot pants and good times. She also promises him sexual bliss, because without the fear of pregnancy, "the feelin' good comes easy now." She reassures him, "Oh Daddy don't you worry none 'cause Mama's got the pill."
At first glance, it seems as though Margaret Sanger's dream that the pill would empower and emancipate mothers came true. Today, 80 percent of women of childbearing age have taken the pill at some point, to say nothing of the other forms of hormonal birth control that followed it onto the market. And, thanks in large part to birth control, women have been able to time motherhood so that it is compatible with a career. In 1950, less than 20 percent of women with children under 18 were in the paid labor force. But after the pill arrived, these women became the fastest growing part of that labor force. By 1975, mothers of children under 18 were employed at a higher rate than any other group of women, and by the end of the century, more than 70 percent of them had jobs.
But there is a bitter irony in the fact that the same pill that gave mothers the ability to combine childbearing and a career by controlling fertility has also led many women to delay childbearing so long that they jeopardize that fertility. Contraception makes it possible to postpone motherhood, but it doesn't solve the problem of how to combine caring for children with going to work. As a result, many women wait to have a child until they are financially secure enough to afford child care.
In some sense, the pill let employers and the government off the hook by giving women the means to juggle jobs and families. Sanger and Katharine McCormick hoped that the pill would allow women to control their lives, but they did not count on women being stuck with such hard choices. For while mothers' lives have changed over the past 50 years, the work world has lagged behind: Most jobs are still 9 to 5 -- or longer -- leaving little time to care for children. The cost of child care is, for many women, ruinously high. Paid parental leave is still too rare, and where it exists, usually too brief. For the most part, it is women who, aided by the pill, have adjusted to the demands of the workforce, rather than the other way around.
The pill may have been a gift to mothers. But 50 years on, it could use some new accessories. This Mother's Day, instead of jewelry, candy or flowers, how about some more novel presents: lengthy paid parental leaves, government-supported child care and flex-time.
Elaine Tyler May is a professor of American studies and history at the University of Minnesota and the author, most recently, of "America and the Pill: A History of Promise, Peril, and Liberation."
Sunday, May 30, 2010
America and the Pill: A History of Promise, Peril, and Liberation
Elaine Tyler May,
ISBN 978-0-465-01152-0, 214 pages
"I would be perfectly happy if not for the same old thing -- too many babies too close together," wrote a young mother to birth control pioneer Margaret Sanger in a letter Sanger included in her 1928 book "Motherhood in Bondage." Like many women seeking Sanger's advice about contraception, this mother was probably poor, uneducated and, by her own admission, desperate. One pictures her at her kitchen table, pen in hand, a child in each arm and on a knee. "My third baby was born a week after the first one's third birthday," she went on. "Just three babies in three years and I am only twenty-two years old. ... I am also so nervous sometimes I don't know what to do."
Sanger is one of the heroes of "America and the Pill," a new cultural history of the birth control pill written by Elaine Tyler May, a professor of American studies and history at the University of Minnesota. Throughout her long career as a nurse and activist, Sanger was a tireless advocate for an oral contraceptive, calling as early as 1912 for a "magic pill." By the time this dream was realized in 1960, six years before Sanger's death, other contraceptives were widely available, but the pill stood out for three main reasons: First, it was the only form of contraception that was not directly linked to the act of sex (that is, no coitus interruptus necessary). Second, it was nearly 100 percent effective. Third, and most important for Sanger, women controlled it. Unlike with condoms or the rhythm method, men's cooperation didn't matter at all. They didn't even have to know.
Despite these benefits, from its inception the pill was shrouded in controversy and in some senses doomed to fail. May argues succinctly -- at just over 200 pages, the book is as compact and powerful as the pill itself -- that expectations for it were too high. "When 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." This ambition led to the messy business of separating humanitarians who were truly concerned about world poverty from politicians and corporations (and, shamefully, Sanger herself to an extent) who wanted to use eugenics to weed out "undesirables." Smaller, wealthier families were considered a plus for the Cold War fight against communism as they bolstered capitalism by buying more consumer goods. The pill was further promoted as a key ingredient to happy, nuclear families, and women were expected to use it despite many concerns about negative side effects.
May devotes many pages to delineating the moral and physical risks posed by the pill, and rightfully so. But there are lots of reasons to celebrate the pill, and she is at her best when allowing herself to do that. She gives a wonderful account of Margaret Sanger's advocacy and also of Katharine McCormick, a women's rights activist who bankrolled the pill's development. Likewise, she skillfully shows how women fought for access to the pill, as well as for a safer pill, against some pretty big contenders, pharmaceutical companies and the Catholic Church among them.
May stops short of arguing that the pill triggered the women's movement of the 1960s and '70s, but she does rightly claim that it was a very useful tool for women's-rights advocates, who saw the ability to control one's fertility as essential to securing educational and economic opportunities. The pill may not have cured world poverty or unhappy marriages, but it's safe to say that -- on the 50th anniversary of its approval by the FDA -- it has been a great boon to women. The ability to organize key events in their lives is now a right most women hold dear -- 82 percent of American women have used the pill, making it the nation's most popular form of birth control. As May shows, they frequently do this despite opposition from familial, political and religious sources, suggesting that freedom over their bodies is something women from all backgrounds can agree on.
Ashley Sayeau writes regularly on women, politics and culture for the Guardian and other publications.
The morning after
It neither ended poverty nor unleashed sexual anarchy, but ‘the pill’ did change America in surprising ways
By Kate Tuttle
May 9, 2010
Elaine Tyler May
America and the Pill: A History of Promise, Peril, and Liberation
Basic, ISBN 978-0-465-01152-0, 214 pages
The women’s movement gave us the truism that the personal is political, and nowhere is the tension between private life and public policy more acute than in the realm of sex and procreation. In her previous books, historian Elaine Tyler May probed baby boom family life and the status of childlessness in a country obsessed with reproduction. Now she’s taking on the history of the birth control pill, which turns 50 this year. An invention spawned amid lofty policy goals (early advocates hoped to eradicate worldwide poverty) and often credited or blamed for sparking the sexual revolution, the pill perhaps surprisingly has had its greatest impact on the lives of married women, according to May.
“America and the Pill’’ is no sweeping historical narrative but rather a sober assessment of a medication that didn’t live up to its hype but still became, May writes, “central to some of the most profound developments in both public and private life over the last half century.’’ Through research into the medical, social, and political conflicts surrounding the pill, as well as the voices of women contacted through an Internet survey, May charts the progress of this most personal and political innovation.
Women have always sought to avoid unwanted pregnancies, of course; condoms emerged by the Middle Ages, and pessaries, herbal potions, and withdrawal have been with us even longer. But May reminds us that an inexpensive, reliable contraceptive was a revolutionary dream in the decades leading up to the pill’s commercial arrival. “Science,’’ in the words of Margaret Sanger, activist and Planned Parenthood founder, “must make woman the owner, the mistress of herself,’’ through allowing her the choice of whether or when to have a child. Sanger, who grew up one of 11 children in a working-class, Irish Catholic family, saw a future in which poor women would “use direct action by refusing to supply the market with children to be exploited, by refusing to populate the earth with slaves.’’
Sadly, May points out, Sanger’s activism on behalf of gender and economic equality was overshadowed by her collusion in the 1920s with those who sought population control for reasons of racial purity. By the ’50s, on the verge of the pill’s debut in the marketplace, Sanger sounded more hateful than heroic, writing of the need for contraceptives in “slums, jungles, and among the most ignorant people,’’ and advocating “national sterilization for certain dysgenic types of our population.’’ The bigotry that mars her later writings has obscured the value of her earlier work, leaving a muddled legacy. I wish May had gone deeper into the story of Sanger’s reactionary evolution; to write that “Sanger compromised her initial radical socialist principles’’ in order to achieve her birth control goals feels inadequate or even defensive.
May traces the pill’s development through laboratories devoted to solving the problem of infertility: an irony that makes sense when you remember that in both assisted reproduction and contraception the scientific task is to nudge the roulette wheel of human procreation.
Once women gained the means to control their own fertility, is it any surprise that religious, social, and political forces moved in to exert their own control? As development of the birth control pill played out in the public eye, newspapers and magazines wondered whether the pill would solve overpopulation, enable women to become effortlessly promiscuous, or both (the answer, it turned out, was neither, really).
The pill never took hold among the populations whose growth was perceived as problematic by mid-century scientists — that is, poor people in the developing world — and was slow to be embraced by those whose fertility upset the eugenicists. As May points out, black women in particular had good reason to mistrust anybody trying to control their childbearing; for decades after the pill’s release, many were torn between “desire for access to contraception and suspicions of the motives of birth controllers.’’
But while women and their families felt reasonable ambivalence at the pill’s promise and risks, negative reactions from other quarters revealed a simple fear of women’s sexual agency. Birth control provided a perfect battleground for social changes already afoot in American post-war society, especially the fight for women’s equality and the toppling of monolithic authority figures — chief among these was the Catholic Church, whose own tortured history with the pill is one of the book’s most fascinating sections. Many will be shocked to learn how close the Vatican came to accepting the pill in the early 1960s. In the end, of course, Pope Paul VI sided with the minority of his advisory council (60 of 64 theologians had proposed ending the ban) and affirmed the church’s continued opposition to any form of contraception (save for the rhythm method, which they only approved in 1951). The move, May writes, “weakened the power of the papacy in the lives of Catholics, and . . . turned many Catholics away from the Church altogether.’’
It’s difficult to calibrate just how influential the pill has been, and May is careful not to overstate. The pill didn’t end worldwide poverty or create the sexual revolution (though it did coincide with the end of the high teenage marriage rates seen in the 1950s — in 1959, the year before the pill debuted, nearly half of American brides were under 19). Still, May writes, the pill profoundly benefited married women, who were now able to expand the time between wedding and babies, filling it with educational and occupational opportunities previously unavailable to them. It’s in such small but seismic shifts, this slender but important book reminds us, that history is made.
Kate Tuttle is a writer living in Belmont.
Friday, May. 07, 2010
To its backers, it would transform the family planning, becoming a source of miracles; for its critics, the Pill was going to destroy morality
Elaine Tyler May
America and the Pill: A History of Promise, Peril, and Liberation
978-0-465-01152-0, 214 pages
Momentous change is rarely the thing of a moment. When we celebrate (or denounce) the 50th anniversary of the Pill on Sunday – Mother's Day, for the ironists in the crowd – we're picking out the date in an amazingly far-off calendar when the U.S. Food and Drug Administration voiced its approval for a revolutionary form of birth control.
The little pill was going to transform the entire world, according to its wide-eyed backers, who predicted that dependable family planning would be a source of miracles that went well beyond keeping unwanted babies unborn. As often with utopian believers, they were on the right track for all the wrong reasons.
And according to its critics, the Pill was going to destroy the world. As often with moralizing, fearful conservatives, they were right about the disruption but wrong about the direness of the consequences. It was only their stratified world view that suffered an irreversible body blow.
“After 50 years of the Pill, we're still wrestling with the idea of what it means,” says Christabelle Sethna, a professor of women's studies at the University of Ottawa. “Whatever people said at the time, it's taken decades to understand the Pill's effects medically, culturally and politically.”
Indeed, the Pill ended up hastening modernity almost in spite of the early, extravagant claims made for and against it. “The biggest mistake in the early days was to see the Pill as a magic bullet,” Prof. Sethna says. “It was supposed to do all these amazing things – mend unhappy marriages, make sex lives more satisfying, eliminate the need for abortion, eradicate global poverty, stave off communism and solve the population crisis. Those beliefs now seem funny and even poignant.”
Instead of fighting the Cold War and saving Mad Men marriages, the Pill became the marker that separates us from a past belonging to an outmoded people, a drug (and a mode of thinking) that defines a boundary between ancient attitudes and new behaviours – from women's powerful sense of independence in the home and the workplace and the rights of adolescents to take charge of their bodies, to emotional debates over international aid programs and the freedom we now possess to question doctors and drug companies about their contributions to our well-being.
A revolution less in sex than in conversation
Freeing up sex now looks like the least of the Pill's many achievements, despite media fascination with the subversive role it played in rousing the bedrooms of the nation.
As late as the end of the 1960s, says Elaine Tyler May, author of America and the Pill: A History of Promise, Peril and Liberation, four-fifths of the women graduating from universities were still virgins.
“What was most dramatic about the sexual revolution initially was not how much people changed their sexual behaviour but how much more they talked about it. The Pill accelerated that conversation; it didn't create it.
“But in the long term, I think big public discussions generate changes in behaviour,” Prof. May says.
After five decades of those conversations, women's ability to control their fertility undeniably determines the innermost workings of our society and our economy. Government ministers may talk openly of restricting foreign-aid funds for family planning in developing countries – with the implication that Canada could come next. But Stephen Harper is politically attuned enough to mute the chatter.
“Every study in the last 15 years demonstrates that it would be political suicide in Canada to start messing with contraception,” says John Lamont, president of the Canadian Federation for Sexual Health.
Messing with sex education, the most basic and universal format of conversation about birth control, still has a political advantage, to judge from Ontario Premier Dalton McGuinty's climb-down on proposed curriculum changes. But however much traditionalists prefer to keep a reverent silence on sexual matters, after 50 years of the Pill young people have found their way to an openness unknown a few decades ago.
“The Pill has been a motivator in how society has changed,” says Jeff Bloom, physician-in-chief for the family health team at Toronto Western Hospital. “Young women are much more receptive to talking about birth control, and feel much more comfortable about coming in and asking for it.”
That freedom of conversation is the starting point of the Pill's gift to the modern world. In the not-so-distant past, the subject of birth control often meant furtive anxiety in family situations, awkward negotiations between man and woman, or simply a cowed silence accompanied by a fear of what the future could deliver: the life-altering accident of pregnancy.
“The Pill put contraception completely in the hands of women – men didn't need to consent or participate or even know about it,” says Prof. Tyler May. “But what made the Pill revolutionary as a social force is that it came about at a time when the feminist movement was opening up new opportunities for women.
“The Pill made it possible for women to control their fertility so effectively that they could plan their lives long-term and no longer have to make the choice between career and family,” she says.
The idea that a woman's place was in the home sounds unbearably quaint now, but it passed for inescapable logic. Domestic fundamentalism rested on the belief that pregnancy was ultimately unpredictable and inevitable, and therefore should be desirable.
Clearly birth control was practised before the Pill was developed (from hormonal compounds synthesized from Mexican wild yams). Apart from faith-inspired pockets of fecundity such as Catholic rural Quebec, birth rates dropped dramatically during the Industrial Revolution. The acidic lemon-half that 18th-century roué Casanova used as a cervical cap is a testament to the power of human ingenuity – or persuasion – when sex is involved, but by the mid-19th century, mass-produced rubber condoms simplified and democratized contraception.
Up to a point. As with the Pill a century later, moralists became convinced that easy contraception would lead to promiscuity and societal breakdown. Hence, Criminal Code limits on birth control came into effect in 1892. While exceptions could be made in the name of the public good – condoms to prevent dreaded venereal diseases, for example – the law effectively drove contraception underground, silencing public conversations and curtailing research into more effective methods.
The world’s most influential science project
It was in this climate of enforced ignorance and avoidance that U.S. birth-control activist Margaret Sanger and women's-rights advocate and philanthropist Katharine McCormick decided to force the issue in the early 1950s. The Pill, amazingly for what is now a multibillion-dollar global industry and a societal sine qua non, was essentially their personal science project.
“Pharmaceutical companies and governments were unwilling to invest money in contraceptive research,” Prof. May says. “They thought it was unseemly, or they were afraid of the reaction from the Catholic Church.”
Mrs. McCormick's fortune subsidized the investigations of an independent hormonal researcher, Gregory Pincus, with the goal of producing the perfect contraceptive – “harmless, entirely reliable, simple, practical, universally applicable and aesthetically satisfactory to both husband and wife,” according to the specs proposed by the Planned Parenthood Federation of America.
The language is revealing, of both the ideals of the Pill's pioneers and the society in which they campaigned – nothing on liberation or sexual freedom, though the genteel phrase “aesthetically satisfactory” sounds like code for the promise of pleasure. Nice people were having sex, even outside marriage, as the Kinsey Report showed, but they still had trouble talking about it with other nice people.
Pharmaceutical companies at first kept their distance. But pent-up demand had a way of loosening corporate inhibitions. In 1957, the Pill was first approved in the U.S. for the treatment of various disorders, such as painful periods. But it was birth control for those in the know.
This legalistic sleight of hand persisted in Canada as late as 1969 – only then were the dissemination, sale and advertising of birth-control products legalized by the Trudeau government. During the so-called Swinging Sixties, at least for those who played by the rules, doctors could provide the Pill only for therapeutic reasons – e.g., for menstrual problems – and married women were the target market.
This guarded approach typified the Pill's risky early years: Its promoters played to fears of encroaching communism by promising that the Pill would banish overpopulation and poverty (though it was unlikely and overly expensive for the conditions of the developing world) while marketers touted the benefits that secure birth control offered for family life.
But the Pill refused to be so easily confined. By 1965, notes Andrea Tone, Canada Research Chair in the Social History of Medicine at McGill University, “the Pill was the most widely used method of birth control in the United States.” The demand for easy, efficient, female-driven birth control meant women found ways to get past nervous, moralizing restrictions. Doctors had to adjust to a changed world or lose their patients.
The ban astonishes me now. At the time, my father was an obstetrician and gynecologist who energetically promoted the Pill as a necessity of modern life. I can remember my mother's cool-looking dispensers lying around the house, with the built-in calendar I didn't quite understand – my sisters added her discards to their toys and worked them into the little dramas they invented for their dollies. Moral lawlessness had a very strange face, at least in our household.
“There has always been a huge disjunction in medical history,” Prof. Tone says, “between what's officially recommended and what goes on. It's much more politically savvy for companies to declare that they're giving honest married women and their husbands a better way to time their pregnancies than to come out and say, ‘Let's empower all women to do what they want with their bodies.'
“These companies were smart. They knew what would sound threatening and what would be reassuring.”
So it's hardly surprising that the story of the Pill took a different turn from the first idealistic forecasts, while feeding some of the moralizers' fears. “The Pill doesn't trigger the sexual revolution,” Prof. Sethna says, “but it certainly marches hand in hand with it. For single women, the Pill was seen as a godsend.”
The fading of that just-pilled glow
All the same, many historians argue that the medicalization of birth control is a far more revolutionary consequence of the Pill than any effect it may have had on sexual relations.
“Prior to 1960, it was rare for a woman to talk to a doctor about birth control,” Prof. Tone says. “But the Pill required a gynecological exam, a consultation and discussion about intimate matters, which led to the wider conversation about women's health.”
Critical thinking about pharmacology didn't start right away – this product of the buoyant 1950s initially arrived with the kind of optimism attached to its hip contemporary, the tranquillizer. “The Pill fits into the same paradigm,” Prof. Tone says. “You can be empowered to take charge of your life, whether it's controlling your emotions or avoiding getting pregnant.”
But as the high levels of estrogen in the Pill's early formulations produced painful, even deadly effects (thrombosis, stroke), the sense of empowerment shifted. Skepticism about drug companies became much more habitual. Persistent campaigning by women's-health advocates led directly (if too slowly) to the now-ubiquitous package inserts that spell out a product's many risks and help demystify the claims of the drug makers.
My mother, a long-time smoker and an early user of high-dose birth control, suffered a massive stroke at 62. It's not hard to connect dots.
The Pill remains paradoxical on this front, revealing all too perfectly our society's wish to believe in easy miracle drugs. Whatever else it accomplished, the Pill showed for the first time how much money could be made by selling drugs to people who weren't sick.
Fifty years on, birth-control demand is driven by the kind of marketing hype the Mad Men of the 1950s would never have associated with chancy delights and risks of sexual encounters.
Health advocates like to talk about the broad range of contraceptive choices tailored to suit women's individual needs, and yet hormonal birth control (expanded to include the patch, the implant and the vaginal ring as well) is clearly top of the heap.
Drug companies have touted subtle variations on the 50-year-old theme, such as the ability to have a period only four times a year, or the “do-it-all” benefits of the popular “multitasking” pill. Yes, you can have birth control, but isn't that a bit boring when at the same time you could have better skin tone, less bloating and reduced PMS?
“There's very little that's new,” Prof. Tone says. “Pretty well everything's an iteration of what the 1960 Pill brought to the scene, and the tendency is not to be innovative but to stick to the tried-and-true in oral contraception. … It was so successful both medically and financially that it's kept all our options in the hormonal box.”
For Sari Kives, who works with adolescents at Toronto's Hospital for Sick Children, the Pill and its variants that promise ease of use, lower-hormone dosages and reduced side effects are a good fit with her young clientele.
At the same time, conscious of the culture in which she lives, Dr. Kives makes a point of noting that “taking the Pill does not equate with being sexually active. Fifty per cent of the time, I'm prescribing for painful periods or profound menstrual irregularity or bad acne. I don't even talk about sex in many cases.”
A new wave just says ‘no’
But even as health-care researchers extol the myriad benefits of the Pill, dissent is rising from a new wave of young women skeptical of adding hormones to their already potent bodily mix. My 25-year-old daughter, angered by what she suffered during years of drug experiments designed to alleviate menstrual pains, is one of them.
“During my adolescence,” Liz told me recently, explaining things I never quite knew at the time, “going on the Pill was a rite of passage into puberty as commonplace as buying one's first soft-cup pre-bra or suffering through condom-on-banana demos in sex-ed programs. I could deal with my own raging hormones, but as new ones were introduced, my body began to feel foreign.
“The moodiness, the anger, the inexplicable sadness weren't me. The drug's merits were continually touted even as I detailed marathon periods, substantial weight gain and depression,” she says.
“But when the Pill can be marketed for non-birth-control purposes, companies are able to sell kids on their product and get them hooked while they're young: It's become as practical for their needs at 13 as it will be when they're 18.”
In 2010, the biggest challenge with the Pill may be saying no to it, or finding a more body-friendly alternative.
“We're not making it easy enough for women to choose non-hormonal methods of birth control,” says Laura Werschler, the executive director of Sexual Health Access Alberta, who advocates a natural, fertility-awareness approach.
Though the designers of the Pill hoped to end abortion, Statistics Canada reports that induced abortions still occur at the rate of 25.7 per 100 live births (as of 2006).
“Why are there so many unintended pregnancies?” Ms. Werschler asks. “It's often said that the best birth-control method is the one you will use. So maybe the Pill isn't a success for everyone.”
And yet after 50 years, it's hard to dispute the Pill's place in the annals of reproduction: It's outlasted and outdistanced its cumbersome rivals, made the leap from utopian and dangerous to everyday and normal, offered easy liberation in a convenient oral format and fended off all its critics, as if they were the exception and it had become the rule.
April 22, 2010
What the Pill Gave Birth To
The convergence of modern contraception and women's liberation was not intended or expected by the pill's inventors.
America and the Pill: A History of Promise, Peril, and Liberation by Elaine Tyler May, Basic Books, 224 pages
Elaine Tyler May's new book begins by quoting the lyrics to Loretta Lynn's 1975 anthem, "The Pill," an overburdened housewife's audacious cry of reproductive independence. "Promised me if I'd be your wife/ You'd show me the world/ But all I've seen of this old world/ Is a bed and a doctor bill," Lynn croons. "I'm tearin' down your brooder house/ 'Cause now I've got the pill." No feminist theorist could have better captured both the emancipatory power of the pill and the threat it posed to patriarchy. The pill wasn't just a medical breakthrough; it was part of a social revolution, one that was messy, incomplete, sometimes disappointing, but ultimately life-altering for millions of women.
America and the Pill is a brief history of that revolution, timed to coincide with the 50th anniversary of the Food and Drug Administration's approval of the first birth-control pill. The book covers a lot of ground very quickly; reading it is a bit like being a passenger on a bus tour glancing at the passing landmarks without time to explore any of them. It lacks the depth and richness of May's superb 1995 history of childlessness in America, Barren in the Promised Land.
Still, there are worse things one can say about a book than that it should be longer. May's material is fascinating, even when her treatment of it is cursory. Although America and the Pill is sometimes celebratory, it is actually most useful in illuminating some of the darker corners of the pill's history, a history that women's health activists ought to know.
The story begins with Margaret Sanger (1879–1966), a complex heroine who for decades personified the cause of birth control and family planning. A fiery socialist in her early days, Sanger saw the gruesome consequences of unsafe abortion while working as a nurse in New York's immigrant slums and, in defiance of federal law, called for access to birth control. Though genuinely motivated by a passion for women's liberation, Sanger also embraced eugenics, a more respectable cause at the time than sexual freedom or feminist self-determination; indeed, after World War I, as Sanger's biographer Ellen Chesler has written, "eugenics became a popular craze in this country -- promoted in newspapers and magazines as a kind of secular religion." Collaboration with eugenicists provided Sanger with powerful allies, but it wasn't just a matter of convenience for her; she became an ardent advocate of population control for eugenic purposes.
May quotes a letter that Sanger wrote to her friend and patron, the heiress Katharine Dexter McCormick: "I consider that the world and almost our civilization for the next twenty-five years, is going to depend upon a simple, cheap, safe, contraceptive to be used in poverty stricken slums, jungles, and among the most ignorant people." She went on to call for immediate "national sterilization for certain dysgenic types."
One of the central tensions in Sanger's work, then, was between her commitment to reproductive freedom and her willingness to sanction reproductive coercion. A similar tension is at work throughout the history May recounts. McCormick, a brilliant feminist who was the second woman to graduate from the Massachusetts Institute of Technology, bankrolled the pill out of a commitment to women's rights. But as May writes, the scientists and doctors who developed the pill never envisioned it as an agent of female emancipation. Rather, they "hailed it as a miracle drug that would solve the global problem of overpopulation, thereby reducing poverty and human misery, especially in the developing world." They also hoped it would improve marital sex and domestic harmony, strengthening the nuclear family. In other words, they saw it as a tool for preserving existing power relations, not shaking them up.
It's a bleak irony that if the pill's inventors had been more concerned with women's health, they might have taken much longer to develop it. One of the scientists involved, Gregory Pincus, tested a version of the pill on 15 psychiatric patients at the Worcester State Hospital in Massachusetts. Early pills used far higher doses of hormones than modern contraceptives do, and during large-scale clinical trials in Puerto Rico, the side effects were so severe that a female doctor tried to halt the study, to no avail. "Pincus claimed that many of the women's symptoms were psychosomatic," May writes.
As May makes clear, such abuses weren't specific to the testing of the birth-control pill -- they were common to all drug development. "By the standards of the day, the [Puerto Rico] studies were scrupulously conducted," she writes. Furthermore, the women in Puerto Rico were hardly coerced; so many women were so desperate to control their fertility that the scientists had waiting lists of volunteers. Nevertheless, it's undeniable that the creation of the pill often involved a cavalier attitude toward poor or sick women.
May's own father, Dr. Edward Tyler, actually held up federal approval of the pill because of concerns about its safety. The head of the Planned Parenthood Clinic in Los Angeles, he had used the same hormonal compounds found in the pill to treat various gynecological disorders and discovered that they often caused weight gain, abnormal bleeding, swelling, and other problems. But eventually, Tyler assured an official of the Food and Drug Administration "that his earlier concerns had been addressed, and that he was now convinced that Enovid, as the pill was called, 'was safe.'" What changed his mind? May doesn't say.
In one of America and the Pill's most interesting chapters, May asks whether men would tolerate the sorts of side effects that women have regularly experienced. The prospect of a male pill has appeared on the horizon various times over the last 50 years, but the issue of side effects scuttled every effort. Scientists, May reports, "actually discovered an effective vaccine that completely stopped the production of sperm without interfering with sex drive." But it also made users' testicles shrink by a third, so the researchers abandoned it, concluding, "The psychological trauma of shrinking testes just cannot be overcome."
Yet for all this, as May demonstrates, the pill has been a tremendous boon for women, transforming sex and reproduction so thoroughly that it's hard for many to imagine what life was like before it. In the 1960s and 1970s, Black Power leaders denounced the pill as a tool of black genocide -- rhetoric often echoed by today's anti-abortion movement. But female civil-rights activists saw things very differently. "Although they were aware that some white proponents of the birth control pill and other forms of contraception hoped to reduce the numbers of black babies, they wanted the pill and saw it as essential to their reproductive freedom," May writes. For most women, the intentions behind the pill matter much less than its practical effectiveness.
Though May doesn't say it, right-wing opposition to the pill has probably helped temper earlier left-wing objections. As she points out, Our Bodies Ourselves, the feminist health bible, was deeply skeptical of the pill throughout the 1970s and 1980s, but by 2005, with new, low-dose formulations on the market and the culture wars in full swing, the book sang the pill's praises: "The advent of the Pill, probably more than any other event, has enabled women the world over to prevent or delay pregnancy and, in doing so, to complete our educations, choose our careers, and create more egalitarian relationships."
May herself doesn't go quite so far -- she sees the pill as much as a symbol of feminist gains as a cause. "Without the political and cultural upheavals of the last fifty years, particularly those brought about by the feminist movement, the pill would have been just one more contraceptive -- more effective and convenient than those that came before, but not revolutionary," she writes in her conclusion.
She's absolutely right. After all, the pill is widely available in Saudi Arabia, but it hasn't made a dent in that country's brutal patriarchy. Part of the problem with America and the Pill, though, is that it doesn't take the time to delve into the social maelstroms that made the pill so significant. The millions of women who, like Loretta Lynn's narrator, have used the pill to slip the bonds of biology, turning childbearing from an obligation into an option, have utterly reshaped our ideas about sex, marriage, and family. The furious, socially conservative backlash those women have engendered continues to dominate our politics. This slender book can only give us the contours of that tumultuous, still-unfolding story.
Thursday, Apr. 22, 2010
The Pill at 50: Sex, Freedom and Paradox
By Nancy Gibbs
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