Irish Times – 1 May 2010
Which came first, the pill or social revolution? As the oral contraceptive reaches a certain age, KATHY SHERIDAN assesses the impact of a ‘wonder drug’ now used by 100 million women worldwide
THE PILL is 50 years old. That’s if you date its birth from May 9th 1960, the day the US Food and Drug Administration stamped “approved” on GD Searle Co’s wonder drug, Enovid. It changed the world. Or did it? It was a panacea. Or was it a poison?
The last question is more easily answered. The early users suffered horrible side-effects, such as dizziness, nausea, weight gain, sore breasts, even blood clots, caused by the massive doses of oestrogen in the original pill, as much as 150 micrograms compared to the 20 to 30mg in the modern version.
On top of that, there was the niggle about the heft of chemical and hormonal power contained in that tiny, life-changing disc. Were users ingesting a toxic time bomb? Not according to Aberdeen University, which last month published a 40-year study of 46,000 British women. It found that users of the pill live longer and are less likely to die prematurely of heart disease, cancer or a range of other medical ailments.
The pill is now used by some 100 million women around the world and has a clean bill of health, yet questions still hang over it. In a random trawl of well-educated, thirtysomething women, one, who started using it at 14, remains enthusiastic; another has become somewhat wary (see panel); and a third says she has never taken it (“The thought of chemicals messing with my natural cycle made me queasy, so I took my chances with condoms”). They have the luxury of choice, of course.
“There are a lot more options now,” says Niall Behan of the Irish Family Planning Association (IFPA). “Before, there was only the pill. Now we’ve seen a big shift in recent years, to contraceptive coils and implants . . . There are no worries about taking a daily pill, no repeat prescriptions . . . They’re good for up to three years and easily removed.”
Talk to women in their 60s and they smile wistfully at their younger sisters’ casual acceptance of such riches. “I still remember those stomach-churning days of waiting, and checking, and praying, and checking, saying novenas, pleading and bargaining with God for your period to come,” shudders a mother of three. “It took over your life. It sucked the joy out of it . . .”
It’s easy to forget. As recently as 1983, Dr Andrew Rynne was fined at Naas District Court for selling 10 condoms to one of his patients over a weekend when the pharmacies were closed. Rynne was the first to be prosecuted under the 1979 Health (Family Planning) Act – Charles Haughey’s “Irish solution to an Irish problem” – which allowed for married couples to be prescribed contraceptives for “bona-fide family planning purposes”. All hypocritical nonsense of course; by 1978, some 48,000 Irish women were already on the pill, according to an Irish Medical Association estimate.
The pill was a toddler in 1963, when the National Maternity Hospital opened a “marriage guidance clinic” offering advice only on the rhythm method, while pharmaceutical companies were introducing the pill to Ireland as a “cycle regulator”. By 1965, when Dr Sheila Jones was working in Jervis Street Hospital, the pill was already being prescribed for women with kidney damage to ensure that they did not get pregnant. “The hospital was run by nuns, but they looked the other way,” she says.
Jones, who later became medical director of the Irish Family Planning Association (IFPA), regarded the pill’s arrival as a “miracle”. “I remember working in the Rotunda as a student and when a woman was leaving with a baby, the nurses would say, ‘bye bye, see you next year’. And they would be back the next year.”
Later, working as a GP in the inner city, she got “the calls to corporation flats, where women were having miscarriages in bed and were glad they were because they already had so many babies. Women would throw themselves off coal-houses, walk for miles, drink gin . . . Pregnancy just happened to be a way of life. The most common birth control was withdrawal, a hit-and-miss affair which depended entirely on a co-operative husband, not one who was arriving in drunk on a Saturday night . . . The other thing that was widely practised was celibacy, even within marriage – that put a strain on marriage too.”
In the mid-1950s, one in five Irish women had more than seven children, notes Diarmaid Ferriter in his book on sex and Irish society. A doctor reported delivering a baby which emerged with a Guinness bottle top on its head, an agonising – in every sense – example of failed DIY birth control. Ferriter quotes the smug, craven words of a senator who favoured the “rhythm method”, tolerated by the Catholic Church: “I come from a part of the country where we have our own natural family planning methods and they have worked reasonably well up to now. I have eight children, I know something about the subject.”
By the time Sheila Jones arrived back in the Republic in 1976 after a stint in the North, the pill was “very widely accepted here”, she says, though it was still illegal.
Thus Ireland was a country of two faces. Courageous doctors, nurses and lay supporters risked their professional lives and reputations to set up the Fertility Guidance Company Ltd (later the Irish Family Planning Association) in 1969. They gave advice, handed out condoms in return for a “donation” (to get around the law), fitted IUDs and wrote countless prescriptions for the pill, which was legal only when described as a “cycle regulator”, for a condition almost hilariously endemic among Irish women by this measure.
The pill’s arrival had a “huge effect” on male attitudes, according to Jones. It was not welcomed by the Catholic church, of course. In 1968, Pope Paul VI issued his encyclical, Humanae Vitae (reportedly against the advice of a papal commission), and Archbishop John Charles McQuaid (who was equally appalled by tampons) was his willing Irish helper. But neither was it welcomed by “a lot of male members of the medical profession”, says Jones. “I remember doctors who practically blessed themselves when the pill was mentioned . . .”
A countrywoman, now in her 80s, recalls being directed by her renowned Catholic gynaecologist to have no more children after her sixth, as another pregnancy could “kill” her. She asked him what she should do. “Go home to your husband, and live as brother and sister,” he pronounced.
It’s fair to say, however, that ours was not the only authoritarian state at war with its citizens. In the US, as late as 1965, it took the case of Griswold v Connecticut to overturn the ban on contraceptive use by married couples in that state, a case fought on the basis of a right to privacy. It was still illegal to prescribe the pill to single women in some US states.
Eight years after Griswold, a young Mary Robinson, using a similar argument – the constitutional right to privacy – won a case on behalf of Mary McGee, a young married woman with potentially fatal toxaemia, who already had four children (including twins), all born within a 23-month period. An attempt soon afterwards by a Fine Gael-Labour government to legislate on foot of the ruling was rejected by 75 votes to 61. It took over a decade longer for Dáil Éireann – led by Labour minister Barry Desmond – to clear the way for the sale of condoms to the unmarried.
Fifty years on, through serial tumultuous social upheavals, the pill debate rumbles on. In his 1992 autobiography, Carl Djerassi, the scientist who synthesised the pill on October 15th 1951, compared the impact of the discovery with the effect the first explosion of an atomic bomb had on many physicists, “overnight converting ivory-tower academics into persons tainted by the societal impact of their research”.
“Maybe it’s the nature of icons to be both worshipped and stoned, laden with symbolic value beyond their proportions. Because the pill arrived at a moment of epochal change, it became a handy explanation for the inexplicable,” writes Nancy Gibbs in Time magazine. “The 1950s felt so safe and smug, the 1960s so raw and raucous, the revolutions stacked on top of one another, in race relations, gender roles, generation conflict, the clash of church and state – so many values and vanities tossed on the bonfire, and no one had a concordance to explain why it was all happening at once.”
Many see a straight line between the pill and the changes to family structures and sexual behaviour that we see now. But, as Harvard economist Claudia Goldin told Gibbs, change was afoot long before the pill’s introduction. Clearly, women already had imperfect ways to avoid pregnancy. The typical white American woman in 1800 gave birth seven times; by 1900, the average was down to 3.5. The pill hadn’t yet reached the masses when the Kinsey report of 1953 was published, asserting that half the women studied had had sex before marriage and that a quarter had committed adultery by their 40s.
The fact is that contraception is ancient news, older than the Egyptian papyrus of 1550 BC, directing women how to mix a vaginal pessary of dates, acacia and honey, smeared over wool. It is arguable that without parallel developments (such as women’s activism) and opportunities (such as free education), the pill might have been just another contraceptive. In Ireland, some would place the turning point at around 1967, with the introduction of free secondary schooling and the resulting start of the average Irish Catholic’s journey along the road to individual conscience. A year later came the damning papal encyclical on contraception, Humanae Vitae, ignored by Irish couples in their tens of thousands.
So was the pill responsible for a new permissiveness in Ireland ? “It took away the fear of pregnancy,” says Sheila Jones. “If you were going to be celibate because you were terrified of pregnancy, then that argument could be made. But the world was changing. People had had a dire time in the 1940s and 1950s. The 1960s brought revolutions, The Beatles, people could watch British TV, soap operas started . . .”
Fifty years on, the pill is by no means perfect. Yes, the doses are lighter, but for all the choices available, women continue to carry the can of hormonal contraception and Irish doctors still hold themselves to be uniquely qualified to be the judges of women’s decisions. The latest power/money battle is over who dispenses emergency contraception. In France, school nurses are authorised to do it, here only doctors may. And at another level, it’s worth pondering Gloria Steinem’s cautious words, written long ago in 1962: “The real danger of the contraceptive revolution may be the acceleration of woman’s role change without any corresponding change of man’s attitude towards her role.”
So next Saturday, if raising a glass to the pill, do raise a toast to Carl Djerassi, Gregory Pincus and John Rock, the scientists behind the marvel. Then raise several more to Margaret Sanger and Katharine Dexter McCormick, the extraordinary American women who championed and funded Pincus when Harvard denied him tenure. You won’t read much about them in all the hoopla, of course, but that’s another story . . .
'I find something liberating about taking that responsibility myself'
Clare is a 36-year-old professional
“ I started taking the pill when I was about 19. I grew up at the height of the Aids scare, so was aware of the need for barrier methods but I had suspect polycystic ovary syndrome (PCOS) and the pill is one of the symptom relievers. I loved it. It suited me perfectly – I had perfect skin, regular periods, no mood swings.
“I stayed on it very happily for eight to 10 years, but came off it while abroad and decided to see what would happen. I’d been told that the return of periods might take a while, but there was nothing for a year and it took a long time to establish a pattern . . . The doctors thought I might have stopped ovulating, but they were never able to determine the cause satisfactorily. The advice was that if I was thinking about having kids, it could take the same amount of time again, so I never went back on it. I was quite freaked, and it certainly made me a little more wary.
“Would I want any daughter of mine to have it? Well, I did wonder what I had been taking . . . But there are many benefits of it and my experience wouldn’t make me feel I had to warn people off. The big stipulation is that it doesn’t protect against sexually transmitted diseases, and I suppose in my day that became as big an issue as unwanted pregnancy. But it has not been my experience that people on the pill become complacent.
“Should men take more responsibility? Well, the main contraceptive method now tends to be the condom because of the risk of sexually transmitted diseases. The pill only comes into play within relationships. I suppose you can share the expense of it, but not the physical consequence. I find something liberating about taking that responsibility myself. An unwanted pregnancy would affect me most of all, and I was happy that it was within my control.”