Celebrated, vilified, feared and forsaken throughout its half-century history, the tiny, hormone-packed drug known simply as "The Pill" has never ceased to cause a fuss.
And what a fuss it’s making as it celebrates its golden anniversary – sort of.
The subject of countless magazine and newspaper articles over the past few weeks, Enovid, the original oral contraceptive comprised of synthetic hormones that inhibit ovulation, was approved by the U.S. Food and Drug Administration on May 9, 1960, for use by married women to control birth.
That was three years after it came to market to assist with menstrual disorders.
Of course its last surviving founder Carl Djerassi, considers the pill’s "real birth date" to be Oct. 15, 1951, the day his lab "completed the first synthesis of a steroid eventually destined to be used for oral contraception."
In Canada, the pill arrived in 1961 and wasn’t actually legal for sale as birth control until 1969.
Hailed as the harbinger of the sexual revolution, the answer to unwanted children and a burgeoning global population, and the launching pad for women in the workforce, it was equally denounced by the religious right for fear it would promote promiscuity and criticized in media after women started taking ill and dropping dead from its side-effects.
So, 50 years later, what’s changed?
Last month, about 800 Canadians filed a class-action lawsuit alleging the maker of several popular new-generation pills put market share ahead of safety, leading young women to suffer complications ranging from blood clots and high blood pressure, to cardiac arrest and death.
The global population now tops six billion, 38 per cent of Canadian couples divorce before their 30th anniversary, half of all pregnancies in the U.S. are unintended and the most recent abortion rates in Canada, while dropping, stood at about 14 for every 1,000 women of child-bearing age.
Despite so-called women’s lib, some say a battle of the sexes is currently underway on Parliament Hill as critics slam the Conservative government for cutting advocacy funding to women’s groups and for trumpeting a maternal-health and family-planning strategy in the developing world that fails to include abortion funding.
There are still regular debates about how women earn less money than men, are under-represented in business and politics and are hindered professionally as childcare remains grossly underfunded.
Christabelle Sethna, an associate professor in women’s studies at the University of Ottawa, wonders how anybody could possibly have expected that a tiny pill would be the panacea for so many of the world’s biggest social ills.
"It would be extremely foolish for anyone to believe that any kind of technology was the magic bullet that was going to solve problems across the board," says Sethna, who is currently writing a book about how the pill, originally meant to help married women space out their children, became the leading form of birth control for young, single women.
Now used by about 100 million women worldwide, oral contraceptives are the second most popular form of birth control in Canada after condoms.
"Fifty years ago, when the pill came on the scene, people thought, ‘Isn’t this fantastic? Now the pill is going to solve unhappy marriages, it’s going to solve the problem of illegal abortions, it’s going to solve the problem of poverty and overpopulation. Clearly the pill has not done any of that," Sethna says.
"What the pill has done, it’s given women . . . an incredible and revolutionary amount of sexual and reproductive autonomy that was unimaginable 51 years ago."
Elaine Tyler May, a University of Minnesota historian and author of a newly released book, America + The Pill: A History of Promise, Peril and Liberation, argues it’s no coincidence that the pill and the feminist movement evolved at the same time.
In fact, early feminists Margaret Sanger, founder of the American Birth Control League – the precursor to Planned Parenthood – and philanthropist Katharine McCormick helped secure the funding that led to the invention of the birth-control pill when no pharmaceutical company would dare bankroll such a controversial idea.
While the feminist movement "opened doors" to women that were previously shut, May says the pill "allowed women to walk through those doors because now they could control fertility and plan their lives in a predictable way."
Originally packed with three to 10 times as many hormones as today’s most popular brands, the pill soon became associated with a myriad of health problems, giving rise to the women’s health-care movement, May says.
At a time when consumer labelling was uncommon, by the 1970s, the birth control pill was coming with inserts outlining its risks and side-effects.
After it was approved by the FDA, 22 states continued to ban it. Women fought the matter and in 1965, the Supreme Court ruled states couldn’t pass laws prohibiting married women from obtaining the pill. In 1972, May says, the Supreme Court extended that right to single women.
"The pill had a huge, unanticipated impact on the lives of women and on social institutions," she says.
In Canada, Sethna says, the legalization of the pill in 1969 is associated with a couple of other important judicial reforms, including the legalization of consensual homosexual acts between adults, and abortion.
There are other ways in which it was "truly revolutionary," according to Andrea Tone, a McGill University history professor and author of Devices and Desires: A History of Contraceptives in America.
"It was the first time in history that millions of women . . . began taking a pill almost every day, not to treat or prevent disease, but to improve the quality of their lives by being able to space pregnancies," she says.
"In some ways, the pill inaugurated our modern era of lifestyle drugs."
Nearly 100 per cent effective, it eliminated the need to double up on less reliable forms of birth control and it could be used without anybody’s knowledge, she says.
She says it further changed the relationship between women and their doctors, giving rise to the annual Pap smear and gynecological exam.
Yet the battle over reproductive choice rages on.
Some pharmacists continue to refuse legally available products and services if they goes against their values; abstinence teaching in schools remains popular even though studies suggest it’s ineffective; rural communities struggle with access; price remains a factor; and there are still safety concerns with the pill.
"There’s a lot of good news but there’s still a lot of change that needs to take place before we could fully realize the potential that both the feminist movement and the availability of effective contraception can offer," May says.
Tell that to Nancy Hopper.
She too is marking an anniversary this weekend, only hers is a far more sombre affair.
It’ll be seven years since her daughter, Gail, died suddenly of a pulmonary embolism after collapsing at her kitchen table in Winnipeg.
The otherwise healthy 27-year-old had been taking Yaz, one of two birth-control pills now the subject of a massive class-action lawsuit.
While the allegations haven’t been proven in court, the claims filed last month say Yaz and Yasmin have caused blood clots, gallbladder problems, high blood pressure, cardiac arrest, stroke and at least seven deaths in Canada and more than 50 in the U.S.
The Merchant Law Group behind the class action argues maker Bayer concealed the adverse effects of its products from regulatory authorities.
But these are hardly the only health concerns plaguing the birth-control pill.
Anne Rochon Ford, co-director of the National Network on Environments and Women’s Health at Toronto’s York University, argues many stronger contraceptive pills developed as treatment for acne, for example, are improperly being used as long-term solutions to birth control.
She also cites studies that suggest 50 years of birth control may be adversely impacting fertility as hormone-infused urine leaches into waterways.
"It also unleashed an era, which has gone unabated, of rising sexually transmitted diseases, because (the) use (of) other forms of protection went out of vogue and only came back in with the onset of AIDS," she says.
"It’s allowed women to explore their own sexuality freely without the worry of pregnancy and it has definitely, as was the publicity from the 1960s, liberated them, but there has been a price."
Though still in its infancy, concerns over the health and environmental impacts of the birth-control pill and the multitude of spinoff rings, patches, injections and implants now on offer, is prompting a growing number of women to look for non-hormonal forms of birth control, says Laura Wershler, executive director of Sexual Health Access Alberta.
In fact, oral contraceptive prescriptions dispensed by Canadian pharmacies started to taper off between 2007 and 2008, according to industry consultant IMS Health Canada.
While a new generation of inter-uterine devices appear to be making a comeback and a number of health columns, blogs and magazine articles suggest natural family planning and calendar methods are gaining ground, Wershler says access to anything but condoms is difficult.
Once considered the "queen of contraception," the diaphragm fell out of favour when one of its primary manufacturers stopped making them and the spermicidal gel that typically came with it, Wershler says.
She says many doctors have stopped fitting them, and getting a prescription filled can be tough.
"We’ve not really paid as much attention as we might to providing information, support and services to women looking to use non-hormonal methods," she says.
"It’s not as easy to access these methods as it should be for women who want to make that choice."
For better or for worse, one thing few would deny is that oral contraception has become so ubiquitous that a lot of people take for granted the fact that women largely bear the burden of birth control.
In fact, May points to the fact that there have been no new contraceptives for men in years despite promises every decade since the 1950s that a "male pill" is on its way to market.
It’s a phenomenon not lost on little Enovid’s surviving founder.
"A pill for men has been solved. We know exactly what it looks like," Djerassi says in an interview from Vienna.
Tested "off-and-on" since the 1970s, Djerassi argues that because men are designed to remain fertile indefinitely, proper clinical testing would be "monstrously expensive."
Fearing lawsuits, he says, pharmaceutical companies have no interest in the male pill.
That said, he believes the future of contraception may lie in more permanent methods. Between the proliferation of assisted-reproductive technologies and the fact more and more women are postponing childbirth, he says people will eventually start to bank their sperm and eggs while they’re young and virile.
"You can have yourself sterilized," he says.
"Then when you want one or two children, you could go to the bank, check it out and do in-vitro fertilization. That’s a scenario that I’m sure will happen. It’s not necessarily an ideal one, but I think it’s an option that more and more initially highly educated and more affluent women and also men will select."
Comments