On the Pill: A Social History of Oral Contraceptives 1950-1970

  • Elizabeth Siegel Watkins
Johns Hopkins University Press: 1998. 202pp. $25.95, £21.50 (pbk)

In 1960, the US Food and Drug Administration accepted the G. D. Searle pharmaceutical company's Enovid pill as an oral contraceptive. By the thirtieth anniversary of this event, 80 per cent of US women born since 1945 had used contraceptive pills at some time in their lives. The pill had been swallowed as a daily routine by more humans than any other prescribed medicine. The US Ladies' Home Journal declared on this anniversary that the pill had “transformed our lives” even more than “winning the right to vote”, while The Economist included the pill as one of the seven wonders of the modern world.

Elizabeth Siegel Watkins set herself the tasks of testing these claims in her intelligent and well-structured monograph, and of documenting changing perceptions of oral contraception from a “private vice” to a “public virtue” and finally to an issue of individual discretion. There is one drawback to her approach. Her evaluation is exclusively concerned, by her own admission, with “the impact of the pill on middle-class American society”. In confining her researches to the United States, and by focusing on the experiences and practices of that nation's more articulate citizens, her work can seem insular. Bernard Asbell's The Pill: A Biography of the Drug That Changed the World (Random House, 1995) is more journalistic, but his careful placing of US experiences in an international context provides a more suggestive treatment of social policy issues than Watkins.

In 1951, the feminist American philanthropists Margaret Sanger and Katherine McCormick commissioned the scientist Gregory Pincus to develop an infallible oral contraceptive, intended to liberate women's sexual acts from anxieties about their fertility. This stimulated other researchers to enter the field. In 1957, the G. D. Searle pharmaceutical company began marketing Enovid, ostensibly to treat gynaecological disorders. Its anovulant and therefore contraceptive properties became so well known, however, that by 1959 half a million US women were using it.

Contrary to widespread public and professional beliefs, the contraceptive revolution of the 1960s did not cause a sexual revolution. As demographers analysed the contraceptive habits of married women to document the contraceptive revolution (the pill was unavailable to unmarried women in many areas until the early 1970s), sociologists surveyed the sexual practices of unmarried women to depict long-term changes in sexual behaviour, and journalists bastardized their findings to present their caricature of ‘the swinging sixties’. Yet years before Enovid, Alfred Kinsey and other sexual researchers had reported rates of pre-marital sexual intercourse steadily rising since the late nineteenth century. During the 1950s, the US marriage rate reached an all-time high, and the average age at which people married reached its all-time low; by 1959 almost half of brides were aged 18 or less. Many did not want to be burdened immediately with children, but reliable contraceptive information and technology was often unavailable. American puritanism flourished then as now. In 1960, 30 states of the union retained statutes prohibiting or restricting the sale or advertisement of contraceptives. Only in 1972 did the Supreme Court declare unconstitutional a Massachusetts law prohibiting the sale of contraceptives to unmarried people.

Watkins summarizes medical controversies surrounding the pill's safety. From the 1960s, medical studies linked the pill with an increased risk of strokes and breast cancer (although other studies reported that oral contraceptives protected against uterine and ovarian cancers). The validity of these findings has never been conclusively settled. Indeed, during the 1970s, the subject was confused by an often sensationalist ‘media blitz’, and mired by the intervention of individuals who objected to ‘planned parenthood’ on religious grounds, or to sexually independent women for other reasons. As a result of these ‘health scares’, by 1988 almost half of US married couples relied on either male or female sterilization to avoid pregnancy. American physicians' fear of malpractice suits raised important issues of ‘informed consent’ when prescribing oral contraceptives.

Some American feminists also turned against the pill in the 1970s. They regarded it as a technological ‘fix' which did not address fundamental issues of oppression. Resenting any form of birth control kept within the jurisdiction of the medical profession, they advocated the diaphragm and cervical cap as barrier contraceptives that women could personally administer. The identification in the 1980s of the sexual transmission of HIV led to a revival in the popularity of condoms. In the early 1990s, Norplant, a subdermal implant that releases a synthetic hormone into the blood, and Depo-Provera, a hormone injection with contraceptive effect, have become available in the United States. However, further contraceptive innovations are unlikely to be developed in the United States. All but one of its pharmaceutical companies were scared out of contraceptive research and development in the 1980s by the intolerable litigiousness of American society.

On the Pill, which contains splendid illustrations, is, within its declared limits, an admirable exercise in social history. It depicts the cultural and ideological pressures on US medicine while demonstrating why about 19 million American women still use the pill in 1998.