On May 9, 1960, the Food and Drug Administration approved the marketing of the first birth control pill in the United States. As far as I am concerned, nothing in my lifetime has done more to empower women and improve their lives. There would have been a feminist movement without the pill, but lacking the ability to control their fertility–with or without the consent of men–many fewer women would have been poised to take advantage of the economic and educational opportunities opened up by feminism in the 1970s. Yet Gloria Steinem tells Time magazine that the importance of the pill is “overrated”. In The Huffington Post, Dr. Christiane Northrup–one of those New Agey MDs who has made a fortune emphasizing holistic healing over science-based medicine–writes that the pill “fits well with society’s view of the female body as something that requires outside control.” Perhaps Northrup possesses some magic formula by which sexually active women can click their heels three times to limit the number of their children.
This denigration of the pill’s importance is the worst sort of historical revisionism, based not only on a distrust of the male medical establishment that was a strong and well-founded strain in feminism in the 1960s and 1970s but on a general antagonism to science itself that is part of the unreason pervading American culture today. For feminist leaders like Steinem, the idea that the importance of the pill has been exaggerated may simply be a matter of ego, of a reluctance to acknowledge that feminism, like so many successful social movements, was the product of many forces converging simultaneously.
Let me tell you how it was. I was 15 when the FDA approved the pill, and I was the product of a time and a community in which nice girls didn’t have (or at least they didn’t admit to actually having) sex. In my junior year of high school, a girl I knew quite well became pregnant, and there was a huge fight over whether she would be allowed to stay in school after her pregnancy became visible. Surprisingly (most pregnant girls at this time were simply expelled), she was permitted to finish her senior year. In fact, there could have been no scarier anti-sex lesson than the sight of this girl, hardly able to fit behind her desk, removed entirely from the anything resembling normal teenage life. I never discussed my real views on sex, any more than I talked about my atheism, but I read all about the pill and promised myself that when I met someone with whom I wanted to begin my life as a sexual woman, I would somehow manage to obtain a prescription for the pill.
It wasn’t easy. When I entered college in 1963, 18-year-olds were still minors, and birth control was theoretically obtainable only if you could show that you were married. Even Planned Parenthood did not dispense contraceptives to unmarried women. It was only in 1965, in Griswold v. Connecticut, that the Supreme Court established a right to privacy allowing the distribution of contraceptives to married couples–a right that was not routinely extended to the unmarried for some years. Nevertheless, the pill–which could be prescribed for “menstrual irregularity”–already gave many doctors cover for bending the old rules. In 1964, I concocted a story about being engaged and wanting to start the pill so that my cycles would be regular by the time of my wedding. It was humiliating to tell this lie, and I am quite certain that the doctor did not believe me, but he wrote me a prescription anyway.
I wanted to become a newspaper reporter, and I was already working for a professional paper while going to school. I knew that a pregnancy would be the end of my ambitions. I’d already seen it, as more than one girl dropped out during her freshman year because she “had to get married.” I also knew girls who had gone through the terrible, life-altering experience of being sent to a home for unwed mothers and giving up their babies for adoption. And one girl in my dormitory bled to death from an illegal abortion. Then there was the amount of emotional energy wasted by young women checking every hour to see whether they had gotten their period.
You may say, as the religious right does today, that celibacy is the way to deal with pregnancy anxiety. I say, as a woman and a secularist, that saying yes or no to sex–without having to “pay” by risking the rest of one’s life–is a basic human right. And it is harder for women to exercise that right. With the exception of a committed couple in a long-term, monogamous relationship, there is no situation in which a man has as great a stake in preventing an unwanted pregnancy as a woman. This is not a criticism of men but a biological fact: pregnancy and childbirth happen within a woman’s body.
The battle over birth control–a term coined by Margaret Sanger in the early 20th century–was being waged long before there were effective means of artificial contraception. In 1873, Congress passed a law defining information about contraception as obscenity and banning its distribution through the mails. State and local “Comstock laws,” named after the anti-vice crusader Anthony Comstock, remained on the books until the 1960s–as the Roman Catholic Church took over the anti-birth control crusade from reactionary Protestants in the 20th century. Birth control was always a secularist cause: Before World War I, only freethinkers and socialists unequivocally condemned the Comstock law definitions of birth control information as obscene. Robert Green Ingersoll, the “Great Agnostic,” was one of the first public figures of either sex to link birth control with the independence of women. Speaking in 1899, Ingersoll envisioned the day when science would “make women the owner, the mistress of herself” by enabling her “to decide for herself whether she will or will not become a mother.”
That promise was realized by the pill, which was the result of a collaboration between physiology researcher Gregory PIncus and Dr. John Rock, a Catholic who was trying to develop a hormonal method to help infertile women conceive. In one of the many unintended consequences in the history of science, Rock discovered that a hormone-based pill could also be used to prevent conception by suppressing ovulation. The research was financed initially by Katharine Dexter McCormick, a longtime friend of Margaret Sanger and wife of the heir to the International Harvester fortune. Sanger, who was born in 1879 and watched her Catholic mother die after 18 pregnancies, had a lifelong dream of a contraceptive that women would be able to use to limit their fertility without the cooperation or even the knowledge of men. She dreamed of a world in which a woman’s fate would not be determined by a husband who did not care whether he made her pregnant 18 times. That dream was realized, for millions of women around the world in societies with widely varying attitudes toward women’s rights, with the development of the pill.
Thus, the pill was hardly a male plot to “control” women’s bodies; it was the culmination of a long research effort, financed at the outset by a woman and carried out by two men who wanted women to have more, not less, power over their reproductive lives. Dr. Rock had even hoped that the pill, because it works by manipulating a woman’s hormonal system, would be approved by the Catholic Church, which forbade older barrier methods of birth control. In this he was disappointed, but Catholic women used the pill in huge numbers anyway.
The Christian Right is still trying to block unmarried women’s access to contraceptives (though its representatives don’t campaign against selling condoms in drugstores), and it has also played a huge role in limiting teenagers’ access to birth control information. But that does not explain the disparagement of the pill’s importance by veterans of the feminist movement, who ought to be celebrating the anniversary of this scientific advance as one of the keys to women’s liberation in our time.
Part of the explanation is the mush purveyed by people like Northrup. She writes, “Other methods, for example diaphragms, condoms and fertility awareness, have been actively downplayed even though, when used properly, they are nearly as effective as the pill.” This is simply not true, according to Planned Parenthood, which keeps the best statistics on all forms of birth control.
In case you don’t know what “fertility awareness” means, it’s another name for the rhythm method, a.k.a Vatican roulette–being aware of the timing of your menstrual cycles and avoiding sex around the time of ovulation. According to Planned Parenthood, “fertility awareness” is the least effective of all methods of contraception–if it can be called contraception at all. The lowest pregnancy rate (for couples who have the greatest success with this dubious method) is 12 unplanned pregnancies per 100 women each year. The more likely rate is 25 per 100–not very good odds for a young woman trying to plan her future. The diaphragm’s rate of unplanned pregnancies is 6 to 16 percent–again, ranging from the most consistent use to average use.
The pill, however has a pregnancy risk of only 1 per cent risk if used correctly, rising to 8 per cent if used incorrectly. The condom actually does have almost as low a rate as the pill, if used correctly every time–2 percent–but the figure that rises to 15 percent if used incorrectly. In truth, the effectiveness of all birth control methods is best measured by assuming that everyone slips up once in a while. So the rate of unplanned pregnancy, which is only 8 per cent per year even if a woman does forget a pill once in a while, is nearly double that for the condom and diaphragm, and more than three times higher for the so-called “natural” rhythm method. And, above all, the pill is entirely under a woman’s control. How, pray tell, can any woman ensure that a man will use a condom with utmost care? (The Huffington Post’s publication of Northrup’s assertions about the comparative effectiveness of various birth control methods, without vetting them with standard medical sources, provides an excellent illustration of the inadequacies of fact-checking on Internet news sites.)
Male and female sterilization (which are, by the way, the most popular forms of contraception among married couples who already have all the children they want) are also 99 percent effective–but they are obviously inappropriate for young women. The pill is the only reversible method of birth control that, when used properly, provides near-certain protection.
The pill is not perfect. Much of the early feminist opposition, stated most forcefully in 1969 by Barbara Seaman in The Doctors’ Case Against The Pill (reissued and updated in the 1990s) rested on the fact that it had not been extensively tested and represented an unprecedented experiment involving the use of a drug by a huge, healthy population. It is true that the pill had been tested on fewer than 900 women in Puerto Rico when it was approved by the FDA in 1960. (At the time, most states had laws against testing any drug to be used for contraceptive purposes.) And it is also true that the first pill had many more short-term side effects than later, lower-dose pills. Moreover, it is still true that the pill should not be used by women who smoke, because it increases the risk of stroke. (Of course, these women would be a lot better off if they would just quit smoking.)
But Seaman, who died in 2008 and was a friend of mine, never took into account the vital risk-benefit equation that applied even in the pill’s early years: It did represent an unknown risk, but the unknown risk was being taken for a huge and certain benefit. Moreover, time has proved that the pill is safe for most healthy young women. A 40-year study of 46,000 women, conducted by the Royal College of General Practitioners found that women who had taken birth control pills have a longer life expectancy and are less likely to have died from any cause than women who have never taken the pill. This study is not the final word, as it cannot analyze long-term effects on younger women who have used later versions of the pill. But there is nothing in this study to bear out the early fears that the pill would have long-term, severely adverse effects on women’s health. Nor can this study ever measure what the impact of the hundreds of thousands of unwanted pregnancies would have been had these women not used the pill.
The pill also does not offer any protection against sexually transmitted diseases (a subject that neither doctors nor the public knew much about in the 1960s). But neither does any other method of contraception except condoms. And one thing is certain: a man who doesn’t care enough to use a condom in order to protect his partner and himself from pregnancy certainly won’t do it to guard against STDs.
In any event, I simply do not agree with anyone who does not see the pill as a major boon to women. Opposition to birth control–particularly to woman-controlled contraception–was always based on the idea that without fear of pregnancy, all sexual prohibitions would collapse. This attitude was well embodied by a 1966 cover story in U.S. News and World Report that asked ominously, “Can its [the pill's] availability to all women of childbearing age lead to sexual anarchy?” The word “promiscuity” was used constantly in all of these hand-wringing critiques of the pill, and the premise–a very revealing one about the double standard–was that women were the guardians of chastity and they would stop acting in that role once they no longer risked unwanted pregnancy.
I have no doubt that the pill dealt a death blow to the idea that all women should be virgins on their wedding night (an idea that never, of course, reflected reality). But there is a huge difference between promiscuity–which implies indiscriminate sex–and having a number of selected sexual partners before marriage.
Gloria Steinem has a short memory if she thinks that the significance of the pill has been overrated. When I was young, one of the most common excuses used by employers who refused to train women for high-level jobs–and by professional schools with a tiny female quota–was that women would just get pregnant at an early age and the investment would be wasted. Indeed, when I applied for a job at The Washington Post at age 19, I was asked by the director of personnel to sit down and write an essay about how I would combine motherhood with a career (a subject on which every 19-year-old is surely an expert). The new anti-discrimination laws championed by the women’s movement during the 1970s played a huge role in ending these practices, but so did the growing realization of employers that all young women, thanks to the pill, were delaying childbirth and were having fewer children altogether.
So thank you, Margaret Sanger, Katharine McCormick, Gregory Pincus, and John Rock.
I am convinced that the fruit of your dreams, your money and your science did more good for more people than any other invention of the 20th century. And it does not in any way underrate the importance of 1970s’ feminism to say that we might not have been able to achieve what we did if you had not achieved what you did.