Trial Blazers

The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution BY Jonathan Eig. W. W. Norton & Company. Hardcover, 400 pages. $27.

The cover of The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution

A century ago, a woman who wanted to prevent or terminate a pregnancy had to exercise ingenuity. If she was fortunate, her partner could afford condoms (and was willing to use them), or she could buy a device called a Mizpah pessary, a proto-diaphragm sold under the guise of “womb support.” More commonly, though, women douched with Lysol after sex, or, under more desperate circumstances, swallowed turpentine water, poked themselves with knitting needles, rolled down stairs, or hit their abdomens with a hammer.

Today, better options exist. Because the hormonal birth-control pill so profoundly surpassed what came before, it is easy to think that the problem of contraception is solved. But if Gregory Pincus and John Rock, the scientists who developed the first oral contraceptive, were alive today, they would marvel at our lack of progress. Most birth control now available offers only modifications of a method that is more than fifty years old. Research has been stagnant for decades, and private-sector pharmaceutical companies have all but abandoned the search for better contraceptives. During five decades of rapid technological innovation, the shortcomings of birth control have remained constant: Women who cannot take hormones have few options available to them, men do not have a pill, and the condom remains the only contraceptive that is effective in preventing both pregnancy and infection. Almost half of American women will have an unintended pregnancy before the age of forty-five, and three in ten will have an abortion.

The right wing’s hostility toward women only exacerbates the scientific inertia. For conservatives, the primary strategy for policing sexual freedom has been to make sex more costly and more risky. The forces that sought to thwart birth-control advocates like Margaret Sanger and Katharine McCormick, the pill’s primary early backers, are still strong today. The two women faced ostracism, and their success depended on impressive political will. If the story of oral contraception’s development offers a lesson, it’s that getting anything further done won’t be easy.

The history of the pill, which changed the lives of millions of women, is a tale of euphemism, underfunding, and clandestine experimentation. Like the vibrator, literary porn, or anything else related to women’s sexuality, the pill was first sold under an alibi—prescribed to women with “menstrual disorders.” Its developers received no government support, and it had a shoestring budget during testing, which often occurred under less than ethical circumstances (including in a mental hospital).

In The Birth of the Pill, journalist Jonathan Eig illustrates just how little enthusiasm there was for birth control in the early ’50s by comparing the pill’s development to Jonas Salk’s quest to develop the polio vaccine. Eig writes that, in 1954, “more Americans knew about Salk’s clinical trials than knew the full name of the president.” Salk was able to spend tens of millions of dollars and test his drug on six hundred thousand children, while the developers of Enovid, the first oral contraceptive, had an initial budget of less than twenty thousand dollars and struggled to amass a testing pool of three hundred women. Without the relentless insistence of Sanger (its primary advocate) and McCormick (who funded most of the science), the pill might not have happened at all.

Cover of Margaret Sanger’s Birth Control Review, November 1923.
Cover of Margaret Sanger’s Birth Control Review, November 1923.

Eig begins by detailing a meeting in 1950 between Sanger, the founder of Planned Parenthood, and Pincus (nicknamed “Goody”), a Jewish biologist cast out from the scientific establishment and working independently. Sanger was a lifelong advocate for the rights of women to freely enjoy sex and to limit the size of their families. She was what we might call sex positive today; as Mabel Dodge remembered, “She was the first person I ever knew who was openly an ardent propagandist for the joys of the flesh.” There had been almost no innovation in the field of contraception since 1840, when vulcanized rubber made condoms and cervical caps more affordable, and with the exception of dangerous early versions of IUDs, the options to prevent pregnancy had not changed significantly for decades. What was available was often difficult to obtain: In 1950, thirty US states , as well as the federal government, had laws intended to limit access to birth control.

Pincus, whom Eig describes as “a scientist with a genius IQ and a dubious reputation,” was forty-seven years old when he met Sanger, and “looked like a cross between Albert Einstein and Groucho Marx.” Because of his early experiments with in vitro fertilization, newspapers (driven by what Eig suggests was a dose of anti-Semitism) had compared Pincus to Victor Frankenstein, and Harvard had denied him tenure. So despite being an established scientist, Pincus worked at an institution called the Worcester Foundation for Experimental Biology, which he founded after going door to door to elicit donations and initially ran from one room in a state hospital.

Sanger asked Pincus to attempt what many other scientists had already told her was impossible: develop a pill to prevent pregnancy. Pincus and one of his researchers, a biologist from China named M.C. Chang, saw a promising idea in a 1937 study about the effects of progesterone on ovulation in rabbits, so they decided to make a pill that used hormones to mimic the effects of pregnancy. With a little bit of money from Sanger, they bought some rabbits and began testing.

When the time came for Pincus to leave the rabbits behind and test the pill on women, he had to find a respectable family doctor who looked the part. He met fertility expert John Rock, who seemed “like a family physician from central casting,” and who was also a devout Catholic. When he was a young doctor in the mid-1930s, Rock believed that sex as “an end in itself” would result in “dire consequences,” but age, and experience working with patients who had ten or eleven children (or who had undergone botched abortions), made him adopt a more lenient stance.

Pincus knew that aligning himself with a Catholic doctor was important for the cause: In the 1950s, a quarter of all Americans belonged to the Catholic Church, and its doctrine was influential in sexual politics. Though the Vatican had long said that sex beyond procreation was a sin, it did not issue the first papal encyclical about birth control until 1930, when Pope Pius XI called attempts to limit family size “a new and utterly perverse morality.” The encyclical did have one loophole: It was not a sin if married couples were inhibited from having children for “natural reasons.” When Rock heard about Pincus’s pill, he hoped that it was “natural” enough to be allowed under Catholic teachings.

In Eig’s account, Sanger provided the drive, Pincus the genius, and Rock the paternal air of respectability (and the patients). But this trifecta would not have amounted to much without money. Some of the money came from wealthy eugenicists, who wanted to prevent illiterates, criminals, prostitutes, and drug addicts from reproducing. Some came from Planned Parenthood. Most of the funding came from McCormick, a wealthy widow who had collaborated with Sanger in the 1920s to smuggle hundreds of diaphragms into the country. Sanger introduced her to Pincus and Rock, and she began backing their trials. Eig’s history details the many phases of testing, including trials at a Worcester mental hospital and in Puerto Rico, where student nurses were forced to take birth-control prototypes to maintain their grades in a course. Pincus and Rock downplayed the trial’s high dropout rate from side effects, and prioritized efficacy in preventing pregnancy over concerns about hormone levels. When one batch of pills was accidentally contaminated with synthetic estrogen, Pincus found that it stopped breakthrough bleeding and better prevented pregnancy, so the combination stuck. In 1957, the FDA approved the pill for “menstrual disorders.” In 1960, when the FDA approved it for birth control, five hundred thousand women were already taking it.

Eig’s research is thorough and his account exhaustive, but the book’s attempt to frame the developments of oral contraception within the larger cultural context sometimes feels rote. The pill, in this narrative, is a flash point in a Forrest Gump–style history of sexuality, where sexual mores of the time are defined by too-easy references like the first issue of Playboy, Elvis’s televised gyrations, and The Feminine Mystique. Eig interviews a handful of women about the sexual expectations and norms of the time, but generally presents sex in the 1950s as demure, hidden, and confined mostly to marriage, so the reader gets little sense of women’s desires and interest in the accrual of sexual experience beyond the fact that they hoped to avoid pregnancy. He describes certain arbitrary early decisions, like the standard twenty-eight-day cycle of most birth-control pills, without exploring the extent to which such norms have long outlasted their initial justifications (e.g., proof of the “naturalness” of birth control, and also an assurance to women who thought the pill had helped them get pregnant that it had not).

But more important, Eig doesn’t write much about what his subjects would undoubtedly be most interested in: the current stagnation in the field of contraceptive research. Sexual history does not follow a progression of dialectical liberation, and the same hypocrisy surrounding the development of the first birth-control pill affects our access to birth control today. Eig describes the conditions that made the invention of the first birth-control pill so haphazard as if they were a thing of the past and the struggle long behind us. Although organizations like the Gates Foundation have again made contraception a philanthropic cause, it is in large part because the private sector has ceased investing in the area, and government support for contraceptive research continues to be so politically embattled. As for an activist like Sanger, one imagines she would have done more in the wake of the Supreme Court’s Hobby Lobby decision than post an angry comment on Facebook. The idealism that led Rock and Pincus to devote so much energy to a thankless cause, and the desperate radicalism and relentless advocacy of Sanger and McCormick, are as necessary now as they were then.

Emily Witt’s first book, Future Sex, will be published in 2015 by Faber & Faber.