The Birth of the Pill

 by Jonathan Eig

ISBN 978-0-393-35189-7

“A movement centered on sexual pleasure would never get the support it needed, but a movement focused on health might have a chance. It was a strategic accommodation, and a shrewd one.”

In 1950, after decades of fighting for women’s rights and sexual liberation, after founding and then being largely frozen out of Planned Parenthood, seventy-one year old Margaret Sanger met with biologist Gregory Pincus, a scientist who had been ousted from Harvard for his radical views. Sanger was still searching for her Holy Grail, something that many other scientists had told her was impossible; thirty states still banned contraception, but she wanted a cheap, reliable medication that a woman could take discreetly to prevent unwanted or untimely pregnancy. Unlike previous scientists Sanger had consulted, Pincus believed it could be done. With funding from the wealthy widow and MIT graduate Katharine McCormick, and help from the Catholic gynecologist John Rock, Pincus set out to develop, test, and gain approval for the first pharmaceutical contraceptive.

The Birth of the Pill follows Sanger and Pincus’ partnership from inception, through the development of the drug, and to Enovid’s approval as a method of birth control in the 1960s. Sanger and Pincus receive the most attention, while McCormick and Rock play significant roles. Other important players, such as M.C. Chang, Carl Djerassi, and Edris Rice-Wray are largely in the background. Jonathan Eig chronicles this journey along two fronts: developing the technology to achieve the goal and fighting the publicity battle to make birth control socially acceptable.

In profiling Sanger, Eig struggles to grapple with her involvement with eugenicists, who promoted efforts to improve the human race through selective breeding for characteristics they deemed desirable. As Eig points out, in the 1920s and 1930s, espousing eugenics was much more socially acceptable than advocating feminism or birth control, and Sanger gained respectability, at least early on, by allying with them. Yet for a radical feminism seeking the social and sexual liberation of women, Sanger could be terribly paternalistic about the abilities of the lower classes. Eig uses this to argue that she was more classist than racist, since counter to eugenics, Sanger wasn’t interested in encouraging white women to have more children. However, Sanger also remained in bed with eugenicists long after they came to disrepute in the fallout of World War II, doubling down on the idea that the world would soon be unable to support its growing population even as society was becoming more open to her original arguments about sexual liberation. Eig seems to be synthesizing from his research when he opines on Sanger’s views, but given the pervasiveness of accusations of racism against her, more direct quotes from her papers to support his conclusions would have been welcome.

Unlike Sanger, Gregory Pincus deplored eugenics. His family had fled anti-Jewish pogroms in Russia, so he was profoundly aware of where such beliefs could lead. Yet perhaps more disturbing than Sanger’s troubling views on race and disability are Pincus’ free-wheeling scientific methods, which today we recognize as patently unethical. The Belmont Report on ethics in human research would not be published until 1978, in response to precisely the sort of abuses that occurred during the development of the Pill. The fact that Pincus was a risk-taker was instrumental to his willingness to take on such a controversial project, but it also led to some startling abuses. Puerto Rico was selected as the location for clinical trials because birth control was legal, and the voluntary sterilization rate after giving birth amongst Puerto Rican women led researchers to believe it would be easy to recruit willing women. When Puerto Rican women proved less willing to participate in the study than originally hoped, researchers tried to strong-arm them into continuing. For example, those who were recruited because they were medical or nursing students were told it was a mandatory part of their course work. Back in the United States, Pincus also experiment on residents of a nearby mental hospital. In addition to being unable to consent, the asylum patients were generally not sexually active, and thus there was no way to be sure the medication was actually working as intended. Pincus violated vulnerable people in order to obtain data of questionable validity, so desperate was he for research subjects. Fortunately the drug proved relatively safe—unlike say, thalidomide, which went on the market around the same time—but the violation of these women remains.

The Birth of the Pill illuminates the many violations that made possible the invention of a crucial tool that has shaped modern society, and irrevocably changed the role of women within it. But though the cost of the Pill is evident throughout Eig’s work, so too are the social conditions that led to Sanger’s fervent belief in its necessity. Eig includes portions of a number of striking letters Sanger and Pincus received from women begging for her help because their bodies were worn out from childbirth, and their homes were full of more children than they could hope to feed or care for, and yet still their husbands came to their beds. Eig also amply illustrates the fear the prospect of effective birth control aroused in society, and the particular opposition of the Catholic Church. Their hysteria is still recognizable in the tactics and arguments of today’s anti-choice advocates. However, since the book does not continue much past Enovid’s FDA approval for use as a contraceptive, what analysis there is of the social impact of the Pill is brief and somewhat simplistic.

Tragedy suffuses this fascinating chronicle of the development of a key medical discovery and the people who made it possible. It is crucial to remember what this development cost, but also what it liberated us from, as reproductive rights remain under siege.

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