Fifty years of the Pill

[Note:  This article appeared about four years ago, but was recently highlighted again by Zocalo, which brought it to my attention.  Definitely worth a read!  –Paula Tavrow]

 Fifty Years of the Pill

MAY 17, 2010

Elaine Tyler May has a professional and personal connection to the birth control pill. She’s a historian at the University of Minnesota who has long studied family and sexuality, particularly

the intersection of private life and public policy. And her parents both helped bring the pill to being – her father was a clinical researcher who worked on the development of the pill, and her mother was a birth control activist. “The pill was a really obvious choice for me to take a look at, 50 years after the FDA approved it,” said May, author of America and the Pill: A History of Promise, Peril, and Liberation. Below, she chats about the great expectations for the pill at its introduction, how it transformed women’s lives along with the medical and pharmaceutical industries, and why it still remains inaccessible for many women.


Q. What
was the political and cultural atmosphere when the pill was approved 50 years ago – and where were you then?

A. I was 12 years old when the pill was approved. It
was very exciting. At the time, that excitement seemed to be part of the belief in progress that so many felt in those early postwar years – that science and technology and medicine were going to solve the problems of the world and cure diseases. There were
a lot of high hopes attached to what science could bring to the world. It was also the time of the Cold War. There was a lot of anxiety about communism, about unrest around the world, about the possibility of atomic war, the possibility of war and conflict breaking out around the world.

The pill fit into all of these large global concerns in a number of ways. Its advocates and developers believed it would help bring down the population in the overcrowded and overpopulated areas of the developing world, and that by bringing down the population and helping to alleviate poverty there would be less social unrest and misery. Those countries would be less likely to turn to communism. They would embrace capitalism because they could afford goods and provide markets for the West and allies for the U.S. At the same time there were these geopolitical hopes, within the U.S. I guess you could say there was an idealistic optimism that the pill would put an end to unwanted pregnancy and unwed pregnancy, and would alleviate the pressure on married couples who were worried about having too many children. If they could control their fertility, women could enjoy sex more and be happier in their marriages. As a result the divorce rate might decline and children would be well-adjusted and contented.

So there were a lot of goals centered on individual happiness and well-planned families and a kind of rational social order. At the same time, there were some anxieties – some feared that the pill would unleash sexual chaos and single women’s promiscuity, and unravel the social order and damage or destroy the family. There were the naysayers and those who were afraid of the pill. Either way, whether the predictions were positive or negative,
it turned out that they were all pretty much wrong.

Q. How did
the predictions go wrong, and when did it become clear that the pill wouldn’t have all these effects?

A. It became clear pretty quickly that the pill would
not have a real impact on the population around the world in most places where populations were growing at the highest rate, people were poor. They didn’t have access to clinics and medical professionals to get prescriptions and have check-ups and get refills.
It just wasn’t practical. At the same time, it wasn’t just the availability of contraception that would allow women to get a handle on their fertility – it required women’s education and empowerment. They had to have some status and equality in their communities
to be able to take advantage of contraceptive products.  In very traditional patriarchal communities, even if there were contraceptives available, they wouldn’t be able to take advantage. So the pill itself didn’t have any impact on populations in the developing
world until many years later.

At home, as we know, the pill didn’t suddenly change cultural values. The pill, as we know now, had no impact on the sexual revolution. Single women didn’t really have access to it –
it was very difficult to get. Even married women had trouble for some time. Twenty-two states prohibited contraception being prescribed to anyone. Between the double-standard and the stigma and the need to have a plan and be bold to get the pill, it was very
unlikely that a single woman would suddenly decide that since the pill was available, she should go get it and then have sex with someone.

Q. How did
the pill interact with the budding feminist activism of the time?

A. That’s really where the pill had its biggest impact.
It’s a coincidence, really, that the pill arrived just as the feminist movement began to gain momentum. It’s really because of the feminist movement that the pill became a truly revolutionary tool for women. As the feminist movement pushed open doors for women
to join graduate programs, professional programs, to get training for careers and opportunities in public life, the pill made it possible for married women to control their fertility predictably, and effectively to take advantage of those opportunities. If
there hadn’t been a feminist movement, and if opportunities for women were confined either to the home or to very limited kinds of job opportunities, then the pill would have still been important because it put contraception in the control of women. It just
would not have been revolutionary in the way it was.

So the pill coincided with the feminist movement and the women’s health movement, allowing women to control their lives. The pill also became a tool for challenging institutional authorities.
Women demanded, for instance, that pharmaceutical companies provide information with each prescription – they ended up getting Senate hearings, and public policy eventually mandated that information packets come with every prescription of the pill. Women also
demanded prescriptions – the situation was no longer one where a woman would go to a doctor and be told what to do.

Women also challenged laws that prohibited contraception. In 1965, the Supreme Court ruled that states could not prohibit married women from gaining access to contraception, and in 1972
the Court extended that right to unmarried women. The Catholic Church is another great example. Even though it came very close to approving the pill before the Pope decided to reinforce and confirm the ban on contraception, pretty soon Catholic women were
taking the pill at the same rate as other women. It ended up forging a wedge between church authorities and Catholic women – they just did what they wanted to do regardless of what the church said they should do. You have a whole range of ways in which the
pill was a tool for women, both in their personal lives and also in terms of challenging these larger institutions.

Q. Did activism
around the pill change the pharmaceutical industry and healthcare generally?

A. It was certainly the first time women would interact
with doctors in that way, and probably in general, the medical profession was set up in such a way that doctors were sort of gods. Also I think particularly in the 1950s and early 1960s there were very few women doctors, so when a woman went to her doctor,
it was likely that she would be interacting with a man. The pill was a vehicle for changing those power relationships.

Q. What
other contraceptives were available at the time, and why was the pill different?

A. The diaphragm had been around a long time. It was
effective if used properly. So the pill wasn’t the first contraceptive available. What made the pill different was that it completely separated the practice of contraception from the sex act. The pill was the first to do that, and that was very remarkable.
It was also remarkable because it was the first time women could actively take care of contraception without their sex partner’s participation or cooperation or even necessarily his knowledge. It put a lot of control into the hands of women.


Q. Is
it still difficult for women to access the pill today?

A. That’s one of the things I found most striking taking
a look at the pill in the 50 years since it was approved. There are still very real barriers to access and affordability and availability. I did an Internet survey and heard back from more than 100 young women talking about their experience of the pill – some
loved it, some hated it, some had been on it for years, others only tried it for a short time. Whether they wanted it or liked it or not, overwhelmingly, the message was one of frustration that the pill and other legal contraceptives were not available to
them. There were various restrictions – either it was too expensive, and subsidies were removed from many college campus clinics, or conscience clauses meant pharmacists could deny these women a prescription. The morning after pill – Plan B, emergency contraception
– was not available to them when they needed it. We’ve seen a backlash against the reproductive rights movement that has made it in many ways more difficult to access affordable contraceptives. The women I surveyed also complained about abstinence-only sex
education, where they could not get the knowledge they needed to make decisions about their healthcare.


Q. Has the
recently passed healthcare legislation limited or improved access to contraceptives?

A. I think that remains to be seen, whether anti-choice
politicians are going to implicate contraceptives in the same way they have implicated access to abortion. The effort to collapse the two into one issue posed some very serious challenges. I think it remains to be seen if insurance will continue to pay for
contraceptive and provide prescriptions.


Q. How is
access in the developing world today?

A. The pill is taken by millions and millions of women
around the world. U.S. participation in that has to do with whether or not the pill – or contraceptive products at all – have been part of foreign aid. That has been a political football since the Reagan administration. Reagan cut off all aid to foreign clinics
that provided any kind of information that might lead to a woman having an abortion – even if the clinics weren’t funding abortion services. They would then refuse to make contraceptives available to those countries, and that was devastating. It just goes
back and forth between Democratic and Republican presidents. Within the first week of Clinton’s presidency, he reversed it, and within the first week of the George W. Bush administration, he reinstated it. I think the second day of the Obama administration,
he reversed it again. So unfortunately women around the world are held captive in some ways to American political swings.


Q. Where
do you see the future of the pill going? Will it ever reach the expectations set when it was first approved?

A. I think that depends where the country is moving
in the future. I don’t know. It’s worrisome. I would like to think that we are as a nation increasingly affirming of women’s autonomy and personal choices. But that’s not universally something that people in this country hold dear.