Delivering "The Pill" Wasn't Easy

Author Jonathan Eig talks about the hard labor of designing the first birth control pill.

In 1957, the U.S. Food and Drug Administration approved a new drug called Enovid for menstrual regulation. On the bottle was a warning label stating that this drug had another function—it also prevented pregnancy.

At a time when birth control was still illegal in many states, this warning label was the best marketing tactic that a drug company could ask for. Within two years, more than 500,000 women were taking this pill, which would soon become known as the pill.

But the pill's contraceptive effects were no accident—they were the result of a years-long struggle by doctors and birth control advocates to give women control of their reproductive destinies, despite social and legal barriers.

In his new book, The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, Jonathan Eig tells us why a group of men and women were driven to create a new form of birth control, why it was so difficult for them to test it in clinical trials, and why the first birth control pill's real purpose was originally listed as a side effect.

Your Twitter profile says: "My new book is on the birth-control pill. Last one was Al Capone. Go figure." What prompted you to write a book about the pill?

Maybe 10 or 12 years ago I heard a sermon at synagogue where a rabbi talked about the birth control pill and said it was perhaps the most important invention of the 20th century. And at the time it struck me as odd. I didn't really think that could possibly be true, but it stayed with me. And then years later I was thinking about what to write for my next book, and my wife said, "You should really write a book that women might read."

I remembered that sermon about the pill, and what struck me was that I had no idea where the pill came from or how we got it. I wondered, why would anybody in the 1950s or '60s invent the birth control pill to give women greater equality and allow them to enjoy sex without fear of pregnancy? You know, in the 1950s that doesn't feel like something that would be on the public agenda, when men really controlled everything. So that's where I got curious, and I started looking into the origin story. And once I filled in that, I fell in love with the characters. And that was really when I knew I had something good.

You open your book with the night that Margaret Sanger, who founded Planned Parenthood, asked Dr. Gregory Pincus to begin work on a birth control pill. When they had this meeting in 1950, birth control methods such as condoms, intrauterine devices (IUDs), and diaphragms were already available, though not always easy for women to access. Why did Sanger think it was important to develop a pill form of birth control?

Well, the problem with all those other forms that were available was they were not easy to access, they were not very effective, and they still required the participation of a man. In some cases, like condoms, you needed a man in the most direct way. In other cases, you needed a man in the form of a doctor to fit them or to prescribe them.

She wanted something that women could control completely on their own, that they could hide from men if necessary, and something that was modern and scientific that would work like magic. That was really her dream, and for years—decades, really—people told her it was nuts, that it was impossible. So when she met Pincus, and Pincus said, "Yeah, I can do that"—it was a huge moment for her.

How did she think that the pill would change women's lives?

Well, she believed that it would accomplish many things simultaneously. That it would allow them to enjoy sex, first of all, and that it would allow them to control their bodies and avoid unwanted pregnancies, and that, once that happened, they would have all kinds of real opportunities to assert themselves and to fight for equality—to stay in school longer and pursue advanced degrees, and enter the workforce. [Sanger] really believed that this was something that would shift the whole context in which men and women lived.

Research on the pill was led by Pincus and Dr. John Rock. Explain the scientific and cultural shifts that made their work on the pill possible. Why was this actually an interesting time for everything to come together?

It was perfect timing. It was merely miraculous in that [scientists were] beginning, for the first time, to understand hormones and how they could be harnessed to regulate the functions of the body. You've got insulin and cortisone coming into use, and scientists are excited about the possibilities of making these synthetic hormones. [There is] this whole new wave of science coming, and without that it's impossible.

You've also got this new concern over population growth that comes after World War II. There's a sense that the world's population is suddenly growing too fast, and it's a morally acceptable reason to advocate birth control in addition to just promoting it for better sex. So that's very important, and you've also got more openness about sex after the war, after the '40s. Men go off to fight, and they enjoy recreational sex while they're in the military. Women, while their men are overseas, they're leaving their parental homes, and they're dating men they have no intention of marrying, they're entering the workforce.

So there's all these tides starting to turn, and it becomes a perfect storm for this project, for the birth control pill to come together.

Speaking of things that all seemed to come together, I was fascinated by Katherine McCormick's role in the story. Can you explain who she was and why she was so important to the pill's creation?

I would argue that all four of these important characters are essential. If any one of them drops out, this thing falls apart, and McCormick is important because she's willing to fund the entire project at a time when no drug company and no university, no government agency, is going to spend money on this. Even Planned Parenthood was reluctant to spend money on it because it seems so risky.

Katherine McCormick is this elderly woman, a wealthy heiress. She's spent all of her money and time taking care of her mentally ill husband, and when he dies, she inherits hundreds of millions of dollars and contacts Margaret Sanger and says she's ready to get to work on birth control and she's willing to do whatever it takes. She really single-handedly funded the entire project.

She's also a scientist, one of the first women to graduate from MIT—and she keeps an eye on Pincus and Rock too to make sure that they're pushing this thing hard and fast. She's worried that if they don't move quickly, this thing could fall apart and will never succeed. In part because she's old too, she wants them to get done before she dies.

When Pincus and Rock first started their work with the pill and with the hormone progesterone, they had some trouble obtaining women for their trials.

This was probably the biggest challenge they faced once they figured out that the chemistry worked: How do you test it when birth control is illegal in 30 states, and there are still federal laws on the books?

They have to be sneaky about it, and they begin by giving it to women who are going to Dr. Rock asking for help with infertility—and it's kind of crazy to think about, but the first women to get tested for the birth control pill are women who were trying to get pregnant. That was very important because [Pincus and Rock] were able to see that the pill didn't do any serious harm. It made [the women] nauseous and dizzy at times, and there were some serious side effects, but no lasting harm.

That gave Pincus and Rock confidence that they could move forward and try to find more women, but it remained difficult. They went to an insane asylum and gave the hormone to women there. And then when they needed more women, lots more, they finally settled on Puerto Rico. They went into the slums of Puerto Rico and tested it on poor women there who were desperate to stop getting pregnant, and that's when they finally found a decent number of women willing to participate in these experiments.

Even then, it's fairly controversial, because the ethical standards in the 1950s were not what they are today. Women did not always realize that this was an experimental drug, and they were not required to sign consent forms, so these guys were flying by the seats of their pants.

Enovid—the first version of the pill—was approved by the FDA for menstrual regulation, with a warning label that said it stopped ovulation. You wrote, "In other words, the real purpose of the drug was listed as if it were a side effect." Why was this?

When they first decided that they were ready to seek FDA approval, they wanted to approach this thing as cautiously and as quietly as possible. So they thought, instead of asking for approval as birth control, let's just ask for approval as something that regulates the menstrual cycle. It seemed like the bar would be lower, because they're not claiming that it prevents pregnancy. And that's exactly what they did. And the bottle even came with a warning on the label that said "warning: prevents pregnancy."

So, this had the effect of sending the message to women that if you're really desperate to avoid pregnancy, this pill can help. Women began going to their doctors and asking for it, because they knew what it really did, even if it was only advertised as regulating cycles. Doctors knew what it really did too, so they began telling women, and that helped get the word out. It helped create this word-of-mouth, grassroots movement where the pill was becoming popular even before it was "the pill."

You write that "the pill became widely known as The Pill, perhaps the only product in American history so powerful that it needed no name." Did the pill achieve the results that Sanger had hoped for in how popular it became?

I think it did achieve all, or most, of her goals. It certainly allowed women to have sex without worrying so much about getting pregnant. It certainly allowed them more opportunities in terms of education and career. It did not have the huge impact that she had hoped on world population growth, but that's a complicated matter and probably one product alone was never going to work for the whole world.

But I think that for the most part, [these four individuals] saw a change that the pill began to have on the culture. They saw the sexual revolution begin to flower. They saw the Supreme Court rule for the first time in 1965 that a woman did have the right to use contraceptives. So I think that they were pretty on target with their predictions for what kind of an impact the pill would have.

One of biggest tensions in your book was the tension between the idea that birth control was good for population control—often for populations deemed "undesirable"—and the idea that birth control was good for women's health and gender equality. Can you unpack that a little bit?

There's an essential conflict that's pretty deeply rooted, because the pill on the one hand is designed as something that promotes freedom and allows women greater equality; on the other hand, it's also being pushed in some quarters—especially hard by eugenicists—as something that will discourage certain kinds of women from having more children. You're trying to design something that's going to set women free, and certainly there are women all over the world who would like to have fewer children. At the same time, there's this sense that there's a racist element to it-that populations are being discouraged from having too many children.

It's one of the great philosophical and ethical conflicts that's at the heart of the Margaret Sanger story, and of the invention of the pill, because one of the reasons that they were able to get this done is because there's this population control movement, and there's also this more prejudiced band of eugenicists who are pushing for a greater tool that will allow the "right" people to reproduce more and the "wrong" people to stop having children.

And this is all caught up in the mess of this work that they're doing. And it's very hard to separate the good intentions from the bad, except I think that in the larger sense, Sanger, Pincus, and the rest believed that overall this would be a huge force for good, and that it would promote greater equality and freedom. But they clearly saw that it was complicated; it wasn't a black-and-white picture.

After the pill was created, Pincus and others discussed creating a birth control for men. Why did they believe that it was important to create a pill for women first?

I think the key for Sanger, in particular, and McCormick was that they couldn't trust men. They felt like if men had any hand in this, it could somehow be subverted, and that if women didn't have the power to control their own bodies, if they had to rely on men to make it happen, they would never really succeed in gaining equality.

I think that you can look at the politics today and see that maybe they were right, because there's still a lot of men who seem uncomfortable with the idea of women controlling their own fertility and making their own decisions about what to do with their bodies.

So they felt like we can talk about birth control for men later, but first we have to give women the powerful tool that they need, or else the problem will never be taken seriously—women will never have the opportunities that they should.

Without Sanger, Pincus, and Rock, and without McCormick's funding, do you think that anyone else would have developed a pill, and if so, when? Was anyone else working on something like this?

I think without these four, it might never have happened. Pincus and Sanger got the ball rolling, and then other drug companies began to look at it after they demonstrated that it might work. But if not for these four and this bizarre confluence of events, with outside funding, it might never have happened.

I would also argue that if it had been delayed even by six months or a year, it might not have happened, because once the thalidomide disaster occurred, and people became aware that this drug was causing hideous side effects—it was causing hideous deformities—the FDA began applying much more rigorous standards for approving their drugs. And the birth control pill might never have been approved by the FDA in the wake of the thalidomide situation.

So if they hadn't been pushing, if these four people hadn't been willing to operate outside the system, it might never have happened.

This interview has been edited and condensed.

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