The Pill at 50: Sex, Freedom and Paradox

There’s no such thing as the Car or the Shoe or the Laundry Soap. But everyone knows the Pill, whose FDA approval 50 years ago rearranged the furniture of human relations in ways that we’ve argued about ever since.

Consider the contradictions: It was the first medicine ever designed to be taken regularly by people who were not sick. Its main inventor was a conservative Catholic who was looking for a treatment for infertility and instead found a guarantee of it. It was blamed for unleashing the sexual revolution among suddenly swinging singles, despite the fact that throughout the 1960s, women usually had to be married to get it. Its supporters hoped it would strengthen marriage by easing the strain of unwanted children; its critics still charge that the Pill gave rise to promiscuity, adultery and the breakdown of the family. In 1999 the Economist named it the most important scientific advance of the 20th century, but Gloria Steinem, one of the era’s most influential feminists, calls its impact “overrated.” One of the world’s largest studies of the Pill — 46,000 women followed for nearly 40 years — was released this March. It found that women who take the Pill are less likely to die prematurely from any cause, including cancer and heart disease, yet many women still question whether the health risks outweigh the benefits.

(See “The Year in Health 2009.”)

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 social change, it became a handy explanation for the inexplicable. The 1950s felt so safe and smug, the ’60s so raw and raucous, the revolutions stacked one on top of another, in race relations, gender roles, generational 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. Thus did Woodstock, caked in muddy legend, become much more than a concert, and leaders become martyrs, and the pill become the Pill, the means by which women untied their aprons, scooped up their ambitions and marched eagerly into the new age.

That age has seen changes in social behavior that continue to accelerate. In 1960 the typical American woman had 3.6 children; by 1980 the number had dropped below 2. For the first time, more women identified themselves as workers than as homemakers. “There is a straight line between the Pill and the changes in family structure we now see,” says National Organization for Women (NOW) president Terry O’Neill, “with 22% of women earning more than their husbands. In 1970, 70% of women with children under 6 were at home; 30% worked. Now that’s roughly reversed.”

(See TIME’s special on the state of the American woman.)

Today more than 100 million women around the world start their day with this tiny tablet. So small. So powerful. But in surprising ways, so misunderstood.

Improvising Infertility
As long as people have been making little people, they’ve wanted to know how not to. The ancient Egyptians mixed a paste out of crocodile dung and formed it into a pessary, or vaginal insert. Aristotle proposed cedar oil and frankincense oil as spermicides; Casanova wrote of using half a lemon as a cervical cap. The condom is often credited to one Dr. Condom in the mid-1700s, who was said to have invented a sheath made out of sheep intestines for England’s King Charles II to help limit the number of bastards he sired, though such devices had actually been around for centuries.

(Watch a video about the Pill’s importance.)

“The Pill was not at all what separated reproduction and sex among married people,” argues Harvard economist Claudia Goldin, who calls that “among the biggest misconceptions” about sexual behavior and the Pill. Long before its introduction, women already knew how to avoid pregnancy, however imperfectly. The typical white American woman in 1800 gave birth seven times; by 1900 the average was down to 3.5.

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But well into the modern age, contraception met with unified opposition from across the religious spectrum, Protestants and Catholics, Western and Eastern Orthodox. Sex, even within marriage, was immoral unless aimed at having a baby. Fear of pregnancy was a powerful check on promiscuity — and information about contraception was treated as the equivalent of pornography. In 1873 Congress passed a law banning birth control information as obscene. So women seeking ways to limit the number of children they bore had to know how to read the papers. Through the turn of the century, advertisements for potions to treat “female disorders” or menstrual irregularities carried a bold, bright warning: “Portuguese Female Pills, not to be used during pregnancy for they will cause miscarriage.”

The warning, of course, was the ad.

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The Mothers of the Pill

The driving force to change all this was a woman born in Corning, N.Y., in 1879 to a Catholic mother and a father who carved angels and saints out of marble. When her mother died at the age of 50 after 18 pregnancies, she confronted her father over her mother’s coffin and charged, “You caused this. Mother is dead from having too many children.”

Margaret Sanger went on to train as a nurse and as early as 1912 was dreaming of a “magic pill” that would prevent pregnancy. She coined the phrase birth control in 1914, the year she was arrested for mailing her magazine the Woman Rebel, an outlaw tract with its discussions of contraceptive use. She jumped bail and fled to Europe but returned two years later and opened the nation’s first family-planning clinic in a squalid tenement section of Brooklyn. Arrested again, she served 30 days. But she did not stop.

Read a 1938 book review of Margaret Sanger’s autobiography.)

In 1917, Sanger met a woman named Katharine Dexter McCormick at a lecture in Boston. Born into money, McCormick was the second woman to graduate from the Massachusetts Institute of Technology, with a degree in biology. She married the heir to the International Harvester Co. fortune — and soon learned that he suffered from schizophrenia. McCormick, like Sanger an ardent feminist, would devote her energy and money to finding a cure for her husband’s illness. But she also set out to help women who did not want to have children be able to prevent pregnancy without their husbands’ help, or even knowledge.

In the years that followed, Sanger provided the ingenuity and energy to drive the birth control movement, and McCormick provided the capital. The movement gained momentum during the Depression, when limiting the size of families became practically a matter of survival. America went from 55 birth control clinics in 1930 to more than 800 in 1942, the year Sanger’s Birth Control League changed its name to the Planned Parenthood Federation of America.

(See how teen pregnancy is leading to an epidemic in foster care.)

In labs, research proceeded apace. The idea of a hormonal approach to birth control had been around for years, but going from a theory to a pill that women could take as easily as a vitamin required a collision of motivation, money, medicine and genius.

The genius came in the form of a brash researcher named Gregory Pincus, whom Sanger met at a dinner party in 1951 and whom she persuaded McCormick to bankroll. Pincus had been a promising assistant professor of physiology at Harvard in the 1930s, when, at the age of 31, he succeeded in creating a rabbit embryo in a petri dish — the precursor to in vitro fertilization. It was lauded as a brilliant scientific breakthrough — until a 1937 profile in Collier’s magazine suggested he was creating a world of Amazons in which men would be unnecessary. Harvard denied him tenure, and Pincus went off to form his own research lab.

He learned from his work with animals that injections of progesterone, which chemists in Mexico had been able to synthesize from wild yams, could block ovulation. But testing a formula on humans would require someone with a clinical practice. Over the decades Pincus had followed the work of the country’s pre-eminent infertility specialist, a Harvard-trained physician named John Rock, whom he ran into at a conference in 1952. A devout Catholic with five children and 19 grandchildren, Rock had made it his mission to help barren women have babies. When Pincus and Rock began to collaborate, Rock was experimenting with using hormones to help women conceive. The idea was to use progesterone to suppress ovulation for four months, then withdraw the drug and hope for a rebound effect; several of the women in his trials did get pregnant. Using hormones to prevent pregnancy followed the same logic: the progesterone prevented the release of a fertilizable egg, thus making it impossible for a woman to conceive.

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Testing hormonal pills on women for infertility was not illegal, but testing the pill as a contraceptive was, so in 1956 Rock and Pincus conducted clinical trials in Puerto Rico, where many women were desperate for some better means of birth control. The Pill proved effective at blocking ovulation and was approved for the treatment of “female disorders” in 1957. Thirty states still had laws against promoting birth control — so for its early life, the Pill existed only undercover. But there was a sudden epidemic of menstrual irregularity among women across the U.S.

In 1959 the pharmaceutical firm G.D. Searle & Co. applied to the FDA for approval of the Pill, which would be marketed as Enovid. On May 9, 1960, the FDA gave its blessing. “Approval was based on the question of safety,” said associate commissioner John Harvey, noting that “our own ideas of morality had nothing to do with the case.”

(See how ovarian transplants may prolong fertility.)

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The Catholic Conundrum

Searle, which was family owned, worried about a backlash. Would Catholics object and boycott the company’s other products? While maintaining its view that contraception — or “sterilizing” the act of intercourse — was morally wrong, the Catholic Church in the 1950s had accepted the rhythm method as a valid approach to family planning; since women were fertile only during certain days around the midpoint of their menstrual cycle, the idea was that couples would limit intercourse to the woman’s “safe” period. But this was by no means foolproof, especially for women with irregular cycles.

Rock thought the Pill provided an exquisite chemical escape hatch. With the Pill, there was no barrier preventing the union of sperm and egg; all the Pill did, Rock argued, was mimic naturally occurring hormones to extend the safe period, so that sex was safe all month long. The church wouldn’t need to change its historic teaching, he suggested; the Pill just fell outside its definition of contraception.

In 1962, when Pope John XXIII convened the Second Vatican Council, many lay leaders and clergy anticipated a relaxation of restraints on family planning as part of a general liberalization of church teaching. By the time his successor, Pope Paul VI, appointed a commission to study the issue two years later, roughly half of American Catholics were already practicing birth control. Leaked reports of the commission’s findings suggested that nearly all its theologians and a majority of the Cardinals favored changing the church’s teaching on the immorality of contraception — but the following year, Paul?VI issued his encyclical Humanae Vitae, in which he sided with the minority. The teaching against contraception stayed in place. Hundreds of American theologians issued a statement that this was not an infallible teaching and that Catholics could in good conscience dissent. And in any event, it was too late to reverse the trend; by 1970, two-thirds of Catholic women were using birth control, more than a quarter of those the Pill.

Social and Sexual Revolution

Meanwhile, the Pill’s promoters had gained traction with a different line of argument. As East and West waged proxy wars in the developing world, anti�communist crusaders saw in the Pill a new weapon: control runaway population growth, and you reduce the risks of war, famine and political instability that left young countries vulnerable to communist infection. Others hoped the Pill might help bring down abortion rates, which in countries like East Germany matched the number of live births and which Planned Parenthood’s Alan Guttmacher called “the most severe pandemic disease in the world today.”

Whatever the public arguments in its favor, the Pill was embraced by millions of women for a very personal reason: it provided, for the first time, an effective, convenient and nonintrusive means of avoiding pregnancy. The number of women using it climbed from roughly 400,000 in 1961 to 1.2 million a year later, then triple that in 1965.

Alarmists were inclined to see the Pill as the catalyst for harrowing change. A 1966 cover story in U.S. News & World Report asked, “Can its availability to all women of childbearing age lead to sexual anarchy?” There were reports of the Pill turning up in high schools. “A wife swapping’ scandal made headlines in California,” the magazine reported, “while Long Island’s suburbs were rocked by police accounts of housewives earning money as prostitutes — some with the knowledge and consent of their husbands.”

But as is so often the case with vast and complex social changes, the seeds were many and the roots deep. In 1920, in This Side of Paradise, F. Scott Fitzgerald alarmed mothers by telling them “how casually their daughters were accustomed to being kissed,” and studies showed that premarital sex was common even then. Ernest Hemingway provided the manifesto: “What is moral is what you feel good after, and what is immoral is what you feel bad after.” In 1964, TIME declared that the “second sexual revolution” was built on the message that “sex will save you and libido make you free.” Open-mindedness was the new normal; the pursuit of pleasure overtook the pursuit of happiness. As Methodist bishop Gerald Kennedy of Los Angeles put it, “There is more promiscuity, and it is taken as a matter of course now by people. In my day they did it, but they knew it was wrong.”

But just because the arrival of the Pill coincided with a liberalization of attitudes does not mean the Pill caused it. The Pill hadn’t yet been invented, after all, when the Kinsey Report was published in 1953, asserting that half the women studied had had sex before marriage and 1 in 4 had committed adultery by her 40s. More important, there was no way to know: studies of contraceptive use in the 1960s focused on married women — which made sense, since the vast majority of women on the Pill were married. In some states it was illegal to prescribe it to single women; fewer than half of U.S. college health clinics offered it, though one elite school would give a prescription to girls if they brought a note from their minister attesting to their impending wedding date. Even Planned Parenthood required that patients be married to get the Pill.

And most young women did not rush to embrace it. Many were uncomfortable with the idea of premeditation; “nice girls” could be swept away by the passion of the moment, but they didn’t take precautions. As for those notorious “fast girls,” “the consensus among both physicians and sociologists is that a girl who is promiscuous on the pill would have been promiscuous without it,” TIME concluded in 1967. At a private lecture at a California resort, a psychiatrist asked roughly 30 mothers whether they would allow their teenage daughters to take the Pill. A few said no, most were undecided — and one admitted she was already slipping it into her daughter’s milk at breakfast.

In later years, commentators claimed that the Pill changed everything for women. But real social change required the meeting of means and opportunity. “If there were no opportunities out there, it would just be another contraceptive but not revolutionary,” argues Elaine Tyler May, author of America and the Pill: A History of Promise, Peril and Liberation. “The revolutionary potential of the Pill could never have been achieved without the opportunities that came about because of women’s activism.”

Changing Roles, Changing Lives

If the Pill’s early impact on private behavior is hard to measure, its role as a flash point in public life soon became clear. When Dr. C. Lee Buxton, chairman of the department of obstetrics and gynecology at Yale Medical School, and Estelle Griswold, head of the Planned Parenthood League of Connecticut, opened a clinic that provided women with contraceptive information, they were promptly arrested — use of birth control was still a crime in their state — and the case attracted national attention as it advanced all the way to the Supreme Court. In 1965, in Griswold v. Connecticut, the Justices ruled 7-2 that the Bill of Rights implicitly included a right to privacy and overturned the bans on contraceptive use by married couples.

By that time the Pill was already the most popular form of birth control in the U.S., with 6.5 million American women using it. Many complained of side effects — dizziness, weight gain, nausea, even blood clots — which were partly alleviated by the introduction of a lower-dose Pill. But there were other concerns as well; within a few years of its introduction, powerful African-American leaders were denouncing the Pill as being aimed at “black genocide.” They urged black women not to take it, arguing that a high birthrate was necessary to change the balance of power in America.

Many black women, however, fought to ensure maximum availability for the same reasons other women did: when contraception was put under a woman’s control, it put many other things under her control as well. As Steinem wrote 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 toward her role.”

By the 1970s the true impact of the Pill could begin to be measured, and it was not on the sexual behavior of American women; it was on how they envisioned their lives, their choices and their obligations. In 1970 the median age at which college graduates married was about 23; by 1975, as use of the Pill among single women became more common, that age had jumped 2.5 years. The fashion for large families went the way of the girdle. In 1963, 80% of non-Catholic college women said they wanted three or more children; that plunged to 29% by 1973. More women were able to imagine a life that included both a family and a job, which changed their childbearing calculations. As an Indiana teacher, 23, told TIME in 1967, “When I got married I was still in college, and I wanted to be certain that I finished. Now we want to buy a home, and it’s going to be possible a lot sooner if I teach. With the Pill I know I can keep earning money and not worry about an accident that would ruin everything.”

Employers, meanwhile, lost a primary excuse for closing their ranks to women. It helped that as more women were knocking on the doors, more companies were eager to open them; by 1966, unemployment was around 3.8%. Federal manpower expert Howard Stambler said, “There are almost no men left” to hire. That year the number of adult women working jumped nearly 10%. For the first time, they were hired as clerks on the New York Stock Exchange. “We never would have done this before the Pill,” admitted one Midwestern publisher who began hiring mostly women. Female workers’ median income, however, was not far above the federal poverty line.

For that to change, a new generation of feminists fought to expand the opportunities that the Pill made possible. Title IX, enacted in 1972, ended discrimination in education, throwing open the doors of colleges, law schools and medical schools to women. But the Pill played a role, argues Harvard economist Goldin, in persuading colleges and graduate schools not to reject female applicants on the assumption that they would just wind up getting pregnant and dropping out. After 1970, as states lowered the age of majority and young people were granted more rights, college and graduate students had easier access to contraception. From 1970 to ’80, Goldin notes, women went from comprising 10% of first-year law students to 36% and from 4% of business-school students to 28%. “I’ve taken a lot of grief by people who insist the Pill had nothing to do with this, it’s all the women’s movement,” she says. But her research showed the connection between the point at which different states allowed access to the Pill and the progress women in those states made.

Looking back, women talk about lives transformed. “Eliza” and her boyfriend had had sex only a few times when she got pregnant in 1978. “If they offered birth control counseling at my school, I don’t remember it,” she tells TIME. “But there was no way I was going to tell my parents I was having sex. I was raised Catholic. I thought I was going to go to hell.” She did have the book Our Bodies, Ourselves, which had grown out of Barbara Seaman’s women’s-health movement. She would read the chapter on the rhythm method over and over again. “I can remember going back over it and thinking, How many days has it been?”

When her parents found out she was pregnant, it was crushing. “My mother came to me and said, ‘You made your father cry.’ It was horrible. My mother said to me, ‘Do you realize how much you could embarrass the family?’ There was never even the idea that I would keep the baby.” She had an abortion. And then she went on the Pill. “I picked it up from the pharmacy myself. I didn’t like it. It said I was having sex. It meant that anyone waiting on me at the pharmacy knew.” “Margaret” recalls the college powwows about what a girl should do if she decided to sleep with her boyfriend. Her boyfriend didn’t want to use a condom. “I was too scared of getting pregnant to risk using nothing,” she says, “though he tried to convince me.” So she got a diaphragm from her doctor — and hated it. “I thought, Well, this is what you have to put up with. Birth control is inconvenient.” When she finally went on the Pill, it was a revelation. “The second I went on the Pill, all the mess and the worry and holding my breath every month to see if I got my period was completely lifted off my shoulders. I wish I had used it from the get-go. You forget how that anxiety can rule your life.”

Slowly but surely, the availability of the Pill changed the way women viewed their choices. And for many people watching the ground shift beneath the American family, that was the whole problem.

Backlash

Opposition to the Pill among conservative Catholics was consistent from the beginning, but it was only after it had been in widespread use for years that some conservative Protestants began rethinking their views on contraception in general and the Pill in particular. “I think the contraceptive revolution caught Evangelicals by surprise,” observes Albert Mohler, the president of the Southern Baptist Theological Seminary. “We bought into a mentality of human control. We welcomed the polio vaccine and penicillin and just received the Pill as one more great medical advance.”

But beginning in the 1990s, many conservative Christians revisited the question of what God intends in marriage and pondered the true nature of the gift of sexuality. The heart of the concern, in this view, is that using contraception can weaken the marital bond by separating sex from procreation. The ideal of marriage as a “one-flesh union” places the act of intercourse, with the possibility of creating new life, at the center of the relationship. “Go back a hundred years,” Mohler says. “The biblical idea you’d have adults who’d intend to have very active sex lives without any respect to the likelihood of children didn’t exist. And it’s now unexceptional.” This is not to say that everyone has an obligation to have as many children as possible; Mohler has two, not 12, he notes, and as long as a couple is “not seeking to alienate their sexual relationship from the gift of children, they can seek to space or limit the total number of children they have.” But the ability to control human reproduction, he says, has done more to reorder human life than any event since Adam and Eve ate the apple.

Steinem disputes this whole framework, noting that sex and procreation have never been as tightly connected as Mohler suggests. “Most animals seem to have periods of heat, in which sexual activity is most concentrated and they are most likely to conceive,” she says. “Human beings uniquely don’t. So for us, sexuality is a mark of our humanity, like our ability to reason or remember or think about thinking. Sexuality is not only a way we procreate but also a way we communicate and express love and caring and community.”

Women’s-rights leaders see multiple agendas at work in the counterrevolution: an attempt not just to roll back access to contraception but also to return women to more traditional roles. “The cynic in me says, Hmm, they are winning the abortion fight, so they need to raise money some other way, which means go somewhere else. They go to contraception,” says NOW president O’Neill of social conservatives. “If the project is to re-establish patriarchal structures, where women are subordinate to male family members, they have to end women’s access to contraception.”

Mohler does not dispute every charge. That would be intellectually dishonest, he says. The Pill “changed the woman’s moral horizon from a likelihood of becoming pregnant to a total lack of likelihood. I’m certain feminists champion that as a tremendous gain necessary for their liberation in the workforce and elsewhere — I think it’s fair to say social conservatives have great concerns about that entire package.”

The reconsideration of contraception has had concrete implications for public policy. “When I was growing up, Rob and Laura Petrie didn’t sleep in the same bed, but we were taught about birth control in health class,” recalls Cecile Richards, president of Planned Parenthood. “And I grew up in Texas! Not exactly the cutting edge. My kids grow up with sex everywhere, but birth control is not talked about in school.” When the GOP controlled both Congress and the White House after 2000, funding shifted away from family-planning programs and into abstinence education. The Deficit Reduction Act of 2005 increased the cost of birth control at campus health clinics four- to fivefold. The promotion of “conscience clauses” allowed hospital workers and pharmacists who have moral qualms about contraception to refuse to fill prescriptions. “We’re still fighting those battles in Congress,” says Katherine Spillar, executive editor of Ms. magazine and executive vice president of the Feminist Majority Foundation. “To think that in 2010, 50 years after the birth control pill, we still have to fight for access and effective family planning — it’s painful.”

If conflict abides around the politics and morality of the Pill, it may help explain why young people are so confused about using it. A study by the National Campaign to Prevent Teen and Unplanned Pregnancy found that 86% of young men and 88% of young women say it is important to avoid pregnancy in their lives right now. Yet 63% say they know little or nothing about birth control pills, and much of what they think they know is wrong. More than 40% think that even when using the Pill, a woman has a 50% or higher chance of getting pregnant in any given year; actually, the Pill is 92% effective. Four in 10 blacks and Hispanics think the government uses minorities as guinea pigs to try out new birth control methods, and even more think the government is pushing birth control in order to reduce the minority population. Some of the women who were on the family-planning front lines 50 years ago get a little impatient when they hear young women talking ungratefully about the freedoms they take for granted. But Steinem, for one, takes the longer view. “I don’t walk around saying, ‘Thank you for the vote,’ ” she says of a battle even longer past. “I might add, as Susan B. Anthony said, Our job is not to make young women grateful. It’s to make them ungrateful so they keep going. Gratitude never radicalized anybody.”

It is possible that somewhere in some lab, the next big thing is being invented that will twist the whole debate another 90 degrees. Maybe it will be an artificial womb, which would allow unwanted pregnancies to be carried to term, just not by the reluctant mother. There was a time when researchers imagined that Plan B, or the morning-after pill, might become not an emergency form of contraception but a routine one; women would take it once a month to induce a period and never even know whether they had gotten pregnant. Would just enough ignorance appease the twitching conscience while solving the cost and convenience challenges as well? Traditionalists, meanwhile, press for progress not in medicine but in marriage, to restore it as the central social institution shaping people’s sexuality. As the conversation of the past half-century makes plain, science alone will not resolve questions that reach this deep into our relations with one another.

— With reporting by Deirdre van Dyk and Kathleen Adams / New York

An unabridged version of this riveting story is now available as an e-book. Love, Sex, Freedom and the Paradox of the Pill: A Brief History of Birth Control is available exclusively in Amazon’s Kindle Store by searching “the Pill on Kindle” and can be read on the Kindle and Kindle reading apps [on the iPhone, the iPod touch and the iPad, plus the BlackBerry, PC and Mac.]