Chemical revolution

Sexual chemistry: a history of the contraceptive pill Lara V. Marks New Haven and London: Yale University Press; 2001 352 pp. 26 illustrations US$29.95 (cloth) ISBN 0-300-08943-0

As a physician and a woman of a certain age I cannot recall a time when we didn't have the pill. No other method of birth control is so entrenched in our consciousness. In Canada, 28% of all women of reproductive age are using it, and virtually all women know about it.¹ With the pill we have a therapy that can effectively prevent pregnancy. Not so 50 years ago. Women expected that birth control methods would fail and lived their lives accordingly.

In Sexual Chemistry medical historian Lara Marks leads the reader through the fascinating journey from then — the pre-pill era — to now. The result is an absorbing, scholarly account that carefully traces the social, political and scientific trends that gave birth to the pill, and the aftermath of its introduction. The story of the pill involves concerns of Western governments about global overpopulation, the politics of the pharmaceutical industry, the influence of the Holy See and a cast of fascinating characters.

The pill could not have come to be without the interplay of politics, social change and science. European scientists were familiar with sex hormones before World War II, but it was only after the discovery that progestins could be extracted from a type of Mexican yam that large-scale hormone production began. Access to the necessary raw material would not have been enough to guarantee the development of the pill, as research activity in this area was very marginalized. It was growing concern in the developed world about global overpopulation and its potential to destabilize social and political systems that brought support to the development of the pill. Ironically, the pill was never embraced by the developing world as the ultimate means of controlling their burgeoning population.

As early as the 1950s, high-dose pills with more than five times the hormone content of current formulations were used for reproductive disorders such as endometriosis and irregular menses. Their contraceptive side-effect was known, but it was not their therapeutic intent. In fact, the Vatican supported the use of these pills to assist in regulating women's reproductive systems. Although Pope Paul VI eventually condemned the use of all artificial contraception, there was hope in the Catholic community that the Vatican would support the use of the pill for birth control as a more technologically advanced form of the rhythm method.

The first pill, Enovid, was approved in the United States and Britain in the early 1960s. Many women who used these early high-dose pills withstood severe nausea and headaches as the price of freedom from pregnancy. The stories of these women — their constant anxiety about becoming pregnant and the relief afforded by the pill — reveal how much we take for granted in 2002.

The initial enthusiasm for the pill was soon tempered by reports of serious unexpected cardiovascular side- effects and concerns about its carcinogenic potential. Some women protested against manipulation and medicalization by pharmaceutical companies and doctors. Although extensive research has subsequently provided reassurance about the safety of the pill, those of us who prescribe it are well aware of the fear and mistrust its use still raises for some women.

The pill was revolutionary in many senses. The Los Angeles Times declared in 1969 that “modern woman is at last free, as a man is free, to dispose of her own body, to earn her living, to pursue the improvement of her mind, to try a successful career.” It put women in charge of their birth control, a responsibility that had previously rested with men when condoms were the primary contraceptive used. It also changed the doctor–patient relationship. Rather than consulting a physician for a disease or symptom, women visited doctors with their own agenda: to obtain the pill. Provision of contraception was historically “not the function of a doctor.” This alteration in medical practice helped to foster the growth of preventive health care. Because the pill was given for years to healthy women, there was real concern about potential harmful effects, specifically cardiovascular risks and cancer. Periodic screening for these problems became part of the care expected for women on the pill.

The marketing of the pill is a fascinating story in itself. Often couched as a method for fighting unfettered population growth, it was initially marketed to married women and was first embraced by middle-class women as a long-sought-after tool for family planning. Younger unmarried women soon became the predominant users as the pill became a method of avoiding premarital pregnancies and delaying first pregnancies rather than of spacing children. The packaging was a marketing tool in itself. The initial dispensing of pills in a regular pill bottle understandably made it difficult to remember to take one daily. The revolutionary Dialpack of pills was the invention of an American man who'd had a series of rows with his wife about whether she had remembered to take her pill.

Central to the story of the pill are the people involved in its development. In the US, Margaret Sanger, the lapsed Catholic who had witnessed her mother's early death from the effects of too much childbearing, was an ardent advocate for birth control throughout her life. It was she who encouraged Gregory Pincus, a controversial biologist, to create the pill. Pincus had suffered severe criticism in the 1930s for work on parthogenic (fatherless) rabbits. Katherine McCormick, trained in biology and married into a fortune, financed the project. The first human trials in the US were undertaken by John Rock, a gynecologist and devout Catholic who became an outspoken and convincing advocate for the pill.

Marks' story of the pill is told in brilliant detail using extensive primary sources and interviews with those involved in the research, development and marketing of the pill. Occasionally, as in the detailing of the early trials, the narrative bogs down — but never for long. Marks handles the complicated interweaving of politics, culture and science with real clarity. In the end the reader is left with an elegant understanding of how the complex interaction of these forces led to the development of one of the 20th century's truly revolutionary discoveries.

Sheila Dunn Medical Director Bay Centre for Birth Control Sunnybrook and Women's College Health Sciences Centre Toronto, Ont.

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Photo by: Fred Sebastian