Pill-History-FactSheet_June2015

Birth Control – History of the Pill • 1

In the middle of the 20

century, an age-old

quest for safe and effective oral contraception

was realized. The woman who made that happen

was Margaret Sanger (1879–1966), the founder

of the American Birth Control League, the fore-

runner of Planned Parenthood Federation of

America (Chesler, 1992).

Planned Parenthood has played and continues

to play a central role in making safe and effective

family planning, including the pill, available to

women and men around the world:

• from 1916, when Margaret Sanger opened

the ﬁrst birth control clinic in America

• to 1950, when Planned Parenthood

underwrote the initial search for a

superlative oral contraceptive

• to 1952 when Planned Parenthood

helped found the International Planned

Parenthood Federation

• to 1965, when Planned Parenthood of

Connecticut won the U.S. Supreme Court

victory, Griswold v. Connecticut (Griswold),

that ﬁnally and completely rolled back state

and local laws that had outlawed the use of

contraception by married couples

• to today, when Planned Parenthood

continues leading the family planning

movement by successfully defending and

expanding women’s reproductive rights and

options against those who would diminish

them (Chesler, 1992; Feldt & Knowles, 2002).

Margaret Sanger’s Brainchild

In her 70s, and years after most people retire,

Sanger achieved one of the greatest accom-

plishments of her career. As honorary president

and chair of Planned Parenthood Federation of

America, she drove the research and develop-

ment of the century’s most revolutionary medical

breakthrough — after penicillin — the pill. Sanger

had won for most women in the U.S. the right to

use contraception. Now she would develop a

method that was nearly 100 percent effective.

The Birth Control Pill

A History

2 • Birth Control – History of the Pill

Katharine Dexter McCormick

(1875–1967)

In the 1940s and 1950s, Sanger closely followed

scientiﬁc research on birth control and person-

ally funded some of it. Planned Parenthood

Federation of America also made support for

new birth control technology a major focus of its

advocacy efforts. The turning point came when

Sanger’s longtime friend — Katharine Dexter

McCormick — threw her ﬁnancial support behind

research to produce an oral contraceptive

(Chesler, 1992).

McCormick was Sanger’s closest collaborator

during her career. She was an avid crusader

for women’s rights, had been a leader in the

suffrage movement (Fields, 2003), had helped

establish the League of Women Voters (Fields,

2003), and was the second woman to graduate

from the Massachusetts Institute of Technology

(Fields, 2003), where she studied biology.

McCormick was also heir to the International

Harvester fortune. In 1950, following the death

of her husband, Stanley, McCormick wrote to

Sanger to ask how she could use her inheritance

to contribute to contraceptive research (Chesler,

1992). This helped Sanger shift her search for an

oral contraceptive into high gear during 1951

(Chesler, 1992).

In 1953, Sanger took McCormick on a personal

visit to the Worcester Foundation for Exper-

imental Biology in Massachusetts, where

research scientists Gregory Pincus and Min

Chueh Chang were conducting experiments that

Sanger considered promising — at her behest,

they were trying to produce an oral contracep-

tive based on synthetic progesterone.

Inspired by the visit, McCormick — also in her 70s

— used her scientiﬁc knowledge to watch over

the research process. As Gregory Pincus said,

“she knew the ﬁeld” (Fields, 2003). And she used

her inheritance to supply the ﬁnancial backing

that was so desperately needed.

McCormick ﬁrst pledged $10,000 toward the

research. Soon after, she began contributing

$150,000 to $180,000 a year, funneling a portion

of the money through Planned Parenthood’s

research grant program. (Planned Parenthood

had supported Pincus’ early studies on mamma-

lian eggs that led him to the work he would do

on the development of the pill.) The total of

McCormick’s gifts to the research was $2 million,

which would be more than $18 million in today’s

dollars (Asbell, 1995; Chesler, 1992; Grimes,

2000).

All in all, McCormick donated the lion’s share of

the ﬁnancial resources needed for the research

that enabled the fulﬁllment of the dream she

shared with Sanger — making birth control safe,

dependable, affordable, and controlled by

women (Chesler, 1992).

The efforts to develop an oral contracep-

tive would have been for naught, however, if it

hadn’t been for the medical folk traditions of the

descendants of the Aztecs. The basic research

for the pill became possible when Russell

Marker discovered that generations of Mexican

women had been eating a certain wild yam —

the Barbasco root, also called cabeza de negro

— for contraception (Asbell, 1995). It was from

these yams that Marker was able to extract the

progestin that Gregory Pincus combined with

estrogen to formulate the ﬁrst birth control pill

(Grimes, 2000).

Dr. John Rock (1890–1984)

McCormick also funded the ﬁrst clinical trials

of the pill, which were conducted by Dr. John

Rock, an eminent gynecologist and a Roman

Catholic, with patients in his private practice.

Rock, who came to be regarded as a co-devel-

oper of the pill, worked with Planned Parenthood

staff on a closely reasoned book, The Time Has

Come: A Catholic Doctor’s Proposals to End the

Battle over Birth Control, in which he argued —

Birth Control – History of the Pill • 3

unsuccessfully — that the Catholic church should

accept the oral contraceptive as a natural exten-

sion of the “rhythm method” (Chesler, 1992).

But distributing contraceptives or information

about contraceptives was illegal in Massachu-

setts, so Rock had to ﬁnd another venue for

wider clinical trials, or pay a $1,000 ﬁne each

time he or one of his staff gave a contraceptive

or contraceptive advice to one of the women in

the trial (or spend ﬁve years in prison) (Marks,

2001). Holding yearlong, large-scale trials in

other states where contraception was legal was

also challenging because, after World War II,

American women of reproductive age became

highly mobile. Keeping a trial cohort together for

up to three years was absolutely necessary, so

less mobile populations of women were sought

(Marks, 2001).

After also considering Japan, Hawaii, India,

Mexico, and New York, Rock and his colleagues

settled on Puerto Rico as the best place to hold

the trials (Marks, 2001). From the very beginning,

this decision opened them to fallacious charges of

racism (Tone, 2001; Marsh & Ronner, 2008). In fact,

they settled on Puerto Rico for several reasons:

• It had no laws against contraception.

• It had a well-established network of birth

control clinics.

• It was close enough to the U.S. to allow easy

visits from the research team.

• Many medical practitioners on the island

had been trained in the U.S., and Pincus

knew and trusted them.

• Many of the women were semi-literate or

illiterate, which allowed the researchers

to test whether or not the pill could

also be used by women around the

world, regardless of their educational

accomplishments.

• Puerto Rico was an island with a relatively

stable population that could be followed for

the full length of the trial.

• Many Puerto Rican women were eager to

have more effective methods of reversible

birth control than those that were available

to them (Marks, 2001; Tone, 2001; Marsh &

Ronner, 2008).

Participants had to meet four criteria: They had

to be in good health. They had to be under 40.

They had to have had at least two children — to

prove they were fertile. And they had to agree to

have a child if they became pregnant during the

study (Tone, 2001).

Critiques of the Clinical Trials for the

Pill

Critics of the early pill trials point out retrospec-

tively that the women involved did not give

informed consent with their signatures. In the

late ‘50s and early ‘60s, however, having subjects

sign informed consent documents to participate

in clinical trials was not a common procedure.

In the 1980s, Dr. Luigi Mastroianni, one of John

Rock’s colleagues, recalled that

The concept of informed consent that is so

talked about now, and is a legal requirement

of any research project involving human

volunteers, didn’t exist then. But Rock prac-

ticed it [informed consent] before it was

ever deﬁned. There were always long and

large discussions of the risk factors. It didn’t

matter that Rock had no formal guidelines,

he set his own, and they were high standards

indeed (Marks, 2001).

Retrospective critics have been concerned that

the clinical trials did not meet today’s standards.

But the pill was thoroughly tested by the stan-

dards of the day. Today, the numbers of women

in the trial and the amount of time they were

observed would not be acceptable. Before the

Food and Drug Administration (FDA) approved

the pill in 1960, 221 women in Puerto Rico had

taken it in two clinical trials. More than 130 of

them had used it for between one and three

years. Thousands more in Australia, Britain,

4 • Birth Control – History of the Pill

Ceylon, Chicago, Haiti, Hong Kong, Japan, Los

Angeles, Mexico City, Seattle, and Tennessee

were involved in clinical trials of various formu-

lations of the pill. Another 500,000 women had

used the ﬁrst brand — Enovid — for up to three

years for menstrual regulation. But in the end,

Searle submitted reports on only 897 women in

its application for FDA approval (Asbell, 1995;

Marks, 2001; Marsh & Ronner, 2008).

By today’s standards, these were small clinical

trials, but small trials were not unusual at that

time. For example, the 1960 approval of Librium

to treat anxiety was based on the experience of

only 570 psychiatric patients, although 593 other

patients used it for a wide range of conditions

that included ezcema, “frigidity,” heroin addic-

tion, and spastic colon (Junod & Marks, 2002;

History of Psychology, 2010).

A Smashing Success

The clinical trials began in April 1956 (Marsh

& Ronner, 2008). That same year, the journal

Science announced their ongoing success. In

1957, the FDA approved the use of the pill to

regulate menstruation. By 1959, 500,000 women

were ostensibly using it to keep their periods

regular, while enjoying its contraceptive “side

effects.” They knew the medication had contra-

ceptive effects because every package had a

warning about its “contraceptive activity” on the

label (Asbell, 1995).

On June 23, 1960, the FDA approved the sale

of Enovid for use as an oral contraceptive. It was

manufactured by G.D. Searle and Company, a

ﬁrm that had also supported Gregory Pincus’

research for many years (Chesler, 1992; FDA,

2000, Grimes, 2000; Lange, 2007).

By 1965, one out of every four married women

in America under 45 had used the pill. By 1967,

nearly 13 million women in the world were

using it. And by 1984 that number would reach

50–80 million (Asbell, 1995). Today more than

100 million women use the pill (Christin-Maitre,

2013).

Sanger’s tenacious efforts, even as her health

declined, brought about the advent of safe and

effective oral contraception and changed the

human sexual landscape forever. It reduced the

risk of unintended pregnancy in the context of

the sexual revolution of the ‘60s and established

family planning as the cultural norm for the U.S.

and in many other countries of the world.

The First Pill

The ﬁrst pill was effective and simple to use. It

extended to millions of women an unheard-of

control over reproduction, for the ﬁrst time allowing

them to truly separate vaginal intercourse from

procreation (Bullough & Bullough, 1990). But it was

far from perfect.

The ﬁrst brand, Enovid, had a lot more hormones

in it than needed to prevent pregnancy. It

contained 10,000 micrograms of progestin and

150 micrograms of estrogen. In comparison,

today’s lower-dose pills are more likely to contain

50–150 micrograms of progestin and 20–50

micrograms of estrogen (Knowles & Ringle,

1998; Tone, 2001).

Side Effects and Adverse Events

The original high doses increased the likeli-

hood and severity of side-effects and the poten-

tial for rare, but very serious risks, such as heart

attack and stroke. Unfortunately, it took scien-

tists more than a decade to recognize the risks

and side effects and to learn that much lower

doses were just as effective as the higher doses

at preventing pregnancy.

Side effects had been very apparent in the ﬁrst

clinical trials. Dr. Edris Rice-Wray, who was in

charge of the ﬁrst trials in Puerto Rico, reported

early on that 17 percent of the women in the ﬁrst

cohort had signiﬁcantly unpleasant side effects,

Birth Control – History of the Pill • 5

including dizziness and nausea, as well as head-

aches and vomiting. In fact, 25 of them withdrew

from the trials because the medication made

them so uncomfortable.

In her ﬁrst report, Rice-Wray concluded that

although the pill provided nearly 100 percent

protection against unintended pregnancy, “it

causes too many side reactions to be acceptable

generally” (Asbell, 1995; Marsh & Ronner, 2008).

Gregory Pincus, the head of the research team,

was delighted with Rice-Wray’s report that the

pill was so effective at preventing pregnancy by

suppressing ovulation. But he ignored Dr. Rice-

Wray’s concerns about side effects. Perhaps

because Pincus was a biologist, not a physi-

cian, he had little clinical empathy for what he

regarded as hypochondria among the women in

the trials (Marsh & Ronner, 2008).

Not only did many women in the ﬁrst clinical

trials in Puerto Rico have distressing side effects,

one woman died of congestive heart failure,

and another developed pulmonary tuberculosis

(Marks, 2001, 107). During medical checkups and

in reports on the women in the trials, however,

researchers were so focused on watching for

carcinogenic effects and damage to the cervix,

endometrium, liver, and ovaries that it did not

occur to them that these adverse events were

related to the pill (Marks, 2001; Marsh & Ronner,

2008).

Early critics of the pill were right that a lot could

be done to improve it. Among the millions of

women using the pill worldwide, there were

disturbing reports of nausea, breast tenderness,

water retention, and weight gain.

Much more alarming was G.D. Searle’s 1961

report to the FDA of 132 incidents of throm-

bosis (blood clots) and embolism (clots moving

through and blocking a blood vessel) among

women using the pill. But the FDA held that

even if the pill caused these adverse events, the

rate of them — 1.3 out of 100,000 users — was

much lower than the rate of women who would

die from pregnancy complications —36.9 out of

100,000 pregnant women (Asbell, 1995; DHS,

N.D.).

The governments of Norway and the Soviet

Union were not reassured, and they banned the

sale of the pill in 1962 (Asbell, 1995).

Barbara Seaman, Gaylord Nelson,

and Hugh Davis

Among the most vocal, and certainly most effec-

tive, critics of the pill in the U.S., was Barbara

Seaman, who published The Doctor’s Case

Against the Pill in 1969. Seaman gave a sensa-

tionalized account of hundreds of women who

suffered side effects and adverse reactions that

she and many others associated with the pill. She

also attacked the American College of Obste-

tricians and Gynecologists and Planned Parent-

hood Federation of America for providing the

pill, which she claimed was dangerous for all

women.

Medical science would prove Seaman right

about some of the adverse events she claimed

were associated with the pill (e.g., blood clots

and strokes), and it would prove her very wrong

about others (e.g., cancer, harmful genetic

effects, and sterility) (Seaman, 1969; Tone, 2001).

Seaman’s book was important because it

prompted Senator Gaylord Nelson (D-WI) to

hold hearings on whether the pill was dangerous

for the human body and whether or not women

who used the pill had enough information

about possible risks and side effects to make

an informed decision to use it (Lehmann-Haupt,

1970; Tone, 2001).

While many who questioned the use of the

pill were entirely motivated by an interest in

women’s health, some were not. Hugh Davis, for

example, was one of the few gynecologists who

spoke at Senator Nelson’s hearings. He was, in

fact, Nelson’s lead speaker, and he had a ﬁnan-

cial stake in the development and success of the

6 • Birth Control – History of the Pill

IUD. He was also one of the important medical

authorities who gave credibility to Seaman’s

attack on the pill in her book.

Davis argued in Seaman’s book and testiﬁed at

the Nelson hearings that women would be safer

using a new IUD instead of the pill. During his

testimony, Davis covered up the fact that he had

a ﬁnancial interest in promoting this new IUD

— the Dalkon Shield, which later proved to be a

health catastrophe for thousands of women and

the cause of bankruptcy, in 1985, for its manu-

facturer, A.H. Robins (Asbell, 1995; Tone, 2001;

Marsh & Ronner, 2008).

The Package Insert

Nelson’s hearings on the safety of the pill ran

from January 14 through March 1970. Feminists

of the day demonstrated against them because

no women were asked to speak about their

experience with the pill. But the hearings did

contribute to the FDA’s eventual decision that pill

packaging must contain an insert with informa-

tion about possible risks and side effects.

Hundreds of women had written letters to the

FDA during the Nelson hearings to demand that

manufacturers be compelled to give them infor-

mation about the possible side effects of the

medication they were taking. And it was during

the Nelson hearings that the FDA announced

that it would compose information on the

possible side effects of the pill for a package

insert that would be included with every

package of pills.

But the American Medical Association (AMA)

opposed the use of a package insert on the

grounds that it would undermine a doctor’s

authority with “his” patients.

The FDA backed off, but did require doctors to

give the information to women whenever they

prescribed the pill. Between 1970 and 1975,

however, doctors distributed only four million

copies of the information to the 10 million

women for whom they prescribed the pill every

year. It wasn’t until 1978 that the FDA required

that the information be inserted into the pill

packages — and it wasn’t until 1980 that the FDA

required that the package insert be intelligible to

the average reader (Marks, 2001; Tone, 2001).

It was during women’s struggle for information

about the beneﬁts and risks of using the pill,

which lasted for two decades during the ‘60s

and ‘70s, that Planned Parenthood earned a

good deal of the respect it enjoys today. During

the information wars between Congress,

the FDA, the AMA, and the women, Planned

Parenthood ﬁlled the gap with its own client

information publications about the pill and

developed its own medical standards and

guidelines to ensure that all women who

came to Planned Parenthood for the pill

would receive balanced information about its

risks and beneﬁts (PPFA, 1976).

Despite the controversies around the pill, in

1970, President Richard M. Nixon signed into law

Title X of the Public Health Services Act, which

provided federal support and funding for family

planning services. Working with Title X grants,

Planned Parenthood was able to provide access

to the pill to hundreds of thousands of low-in-

come women across the United States.

A year later, PPFA established it own interna-

tional program, which was funded largely by

the U.S. Agency for International Development

(USAID). With USAID grants, Planned Parent-

hood was able to bring effective and safe

modern methods of birth control — including the

pill — to millions of women and men around the

world (Feldt and Knowles, 2002).

The cultural ramiﬁcations of the widespread

use of the pill are nearly impossible to measure.

Most women in the ‘70s believed the beneﬁts

of the pill far outweighed the risks. They agreed

with Loretta Lynn that the pill was a key to their

Birth Control – History of the Pill • 7

liberation. As she sang in her hit song of 1975,

“The Pill”

…

All these years I’ve stayed at home

While you had all your fun

And every year that’s gone by

Another baby’s come

There’s a-gonna be some changes made

Right here on nursery hill

You’ve set this chicken your last time

‘Cause now I’ve got the pill

…

This incubator is overused

Because you’ve kept it ﬁlled

The feelin’ good comes easy now

Since I’ve got the pill

It’s gettin’ dark it’s roosting time

Tonight’s too good to be real

Oh but daddy don’t you worry none

‘Cause mama’s got the pill

Oh daddy don’t you worry none

‘Cause mama’s got the pill (McHan, 1973)

Today’s Pill

In 1993, The Economist named the birth control

pill one of the Seven Wonders of the Modern

World because “When the history of the 20

century is written, it may be seen as the ﬁrst

[time] when men and women were truly partners.

Wonderful things can come in small packets”

(May, 2010).

The pill is still America’s most popular reversible

method of contraception. Sixteen percent of all

women between 15 and 44 use the pill (Daniels

et al., 2014). That comes to nearly 30 percent of

all women who use birth control (Guttmacher

Institute, 2014).

Effectiveness

If the pill is used as directed, only three out of

1,000 women will become pregnant in the ﬁrst

year of use. About nine out of 100 less consistent

users will become pregnant in the ﬁrst year of

use (Nelson & Cwiak, 2011).

Mechanism of Action

The pill works by inhibiting ovulation and by

thickening cervical mucus, which prevents sperm

from entering the fallopian tubes where fertiliza-

tion takes place. The theory that the pill inter-

feres with implantation has not been proved

(Nelson & Cwiak, 2011).

Possible Side Effects and Risks

Possible side effects that usually last only the

ﬁrst three months include breast tenderness,

headaches, irregular bleeding, and nausea.

Some women also experience changes in their

sex drive (Nelson & Cwiak, 2011).

Rare but serious health risks include blood clots,

heart attack, stroke, increased blood pressure,

liver tumors, gallstones, and jaundice — women

who are over 35 and smoke are at a greater risk

for some of these problems (Nelson & Cwiak,

2011).

Non-Contraceptive Uses of the Pill

The combined hormone contraceptive pill is

the ﬁrst line of therapy for women who prefer

to have no periods and for otherwise healthy

women who have

• absence of menses due to hyper athleticism

or eating disorders

• anemia due to heavy menses

• certain kinds of recurring ovarian cysts

• emotional challenges that cause fear of

menstrual bleeding

• family histories of cancer of the ovaries

• heavy, infrequent, irregular, or painful

menses

• non-menstrual uterine bleeding

• personal risks for cancer of the

endometrium

• premenstrual dysphoric disorder

8 • Birth Control – History of the Pill

• symptoms of premenstrual syndrome

(Nelson & Cwiak, 2011)

Non-Contraceptive Beneﬁts of the

Pill

Use of combined hormone oral contraceptives

has many non-contraceptive beneﬁts. These

advantages include

• reduced symptoms of endometriosis

• decreased chances of ectopic pregnancy

• less menstrual ﬂow and cramping

• quick return of ability to become pregnant

when use is stopped

• reduced acne

• reduced bone thinning

• reduced iron deﬁciency anemia related to

menstruation

• reduced premenstrual symptoms

• reduced risk of ovarian and endometrial

cancers

• shorter and more regular periods

• (Nelson & Cwiak, 2011))

Safety

In early 2010, a study of 46,112 women in the U.K.

who were observed for up to 39 years showed

that using the pill did not, overall, increase a

woman’s risk of mortality. It showed, in fact, that

pill use among these women may have increased

longevity (Hannaford et al., 2010).

Impact of the Pill

It was just ﬁve years after the pill was approved

for use as a contraceptive in 1960 that birth

control became legal nationwide in the U.S.

That is why the impact of the pill on the health

and lives of women and their families will be

forever intertwined with the 1965 U.S. Supreme

Court decision in Griswold v. Connecticut, which

protected the constitutional right of married

couples in this country to use birth control (Gris-

wold). (It wasn’t until 1972, in its decision in Eisen-

stadt v. Baird, that the Supreme Court found that

unmarried people had the same constitutional

right to obtain contraceptives as married people

[Eisenstadt]).

In the ﬁve decades since these events, profound

and beneﬁcial social changes occurred, in large

part because of women’s relatively new freedom

to effectively control their fertility — maternal and

infant health have improved dramatically, the

infant death rate has plummeted, and women

have been able to fulﬁll increasingly diverse

educational, political, professional, and social

aspirations.

Planning and Spacing Pregnancies

The ability to plan and space pregnancies has

contributed to improved maternal, infant, and

family health:

• In 1965, there were 31.6 maternal deaths per

100,000 live births (NCHS, 1967). By 2007,

the rate had been reduced by 60 percent, to

12.7 maternal deaths per 100,000 live births

(Xu et al., 2010).

• In 1965, 24.7 infants under one year of age

died per 1,000 live births (NCHS, 1967).

Preliminary data for 2011 shows that this

ﬁgure had declined to 6.05 infant deaths

per 1,000 live births, a 76 percent decrease

(MacDorman et al., 2013).

Since 1965, there has been a dramatic decline

in unwanted births — the result of pregnancies

that women wanted neither at the time they were

conceived nor at any future time. This decline is

particularly welcome because unwanted births

are associated with delayed access to prenatal

care and increased child abuse and neglect

Birth Control – History of the Pill • 9

(Piccinino, 1994; Committee on Unintended

Pregnancy, 1995).

• In 1961–1965, 20 percent of births to married

women in the U.S. were unwanted. (Mosher,

1988). By 2006-2010, only 8.9 percent of

births to married women in the U.S. were

unwanted, a 56 percent reduction (Mosher

et al., 2012).

Mistimed births — those that happened sooner

than the woman wanted them — have also

declined markedly.

• In 1961–1965, 45 percent of births to married

American women were mistimed; (Mosher,

1988); in 2006-2010, only 16.4 percent of

births to married women in the U.S. were

mistimed, a reduction of 64 percent (Mosher

et al., 2012).

Education and Employment

By enabling women to control their fertility,

access to contraception broadens their ability to

make other choices about their lives, including

those related to education and employment.

Since 1965, the number of women in the U.S.

labor force more than tripled, and women’s

income now constitutes a growing proportion of

family income:

• In 1965, 26.2 million women participated in

the U.S. labor force; by 2014, the number

had risen to 73 million (U.S. Census Bureau,

2009; BLS, 2015a).

• The labor force participation rate of married

women nearly doubled between 1960

and 2013 — from 31.9 to 58.9 percent (U.S.

Census Bureau, 2009; BLS, 2014).

• By 2012, 29 percent of women in dual-

income families earned more than their

husbands (BLS, 2014).

• In 1960, women represented three percent

of the lawyer population. By 2014, women

represented 33 percent of all lawyers (BLS,

2015b; Epstein, 1981).

• Between 1960 and 2013 the percentage of

women who had completed four or more

years of college increased sixfold — from 5.8

percent to 37 percent (U.S. Department of

Education, 1993; Kena et al., 2014).

• In 1960, only 10 percent of all doctorate

degrees were awarded to women. Today,

women are in parity with men — more

than half (51.4 percent) of doctorates

were awarded to women in 2012–2013

(U.S. Department of Education, 1993; U.S.

Department of Education, 2013).

Publicly Funded Programs

Publicly funded contraception programs have

increased the ability of lower-income women to

exercise the right to control their fertility.

Family planning services available through

Medicaid and Title X of the U.S. Public Health

Service Act help women prevent 2.2 million

unintended pregnancies each year. Without

these family planning services, the number of

unintended pregnancies and abortions would

be nearly two-thirds higher than it is (Frost et al.,

2013).

Worldwide Impact

Women and men no longer need to abstain

from sex for fear of having more children than

they can afford or in terror of endangering a

woman’s health with a high-risk pregnancy.

In 1965, 35 percent of married women in the

U.S. used a safe and effective method of family

planning. Only one out of 10 women in the

developing world did so. Today approximately

56 percent of couples worldwide rely on modern

methods of birth control to maintain the health

10 • Birth Control – History of the Pill

and well-being of their families (PRB, 2014; Ryder

& Westoff, 1971).

As more and more women are able to plan their

families with modern methods of contraception

— the IUD and methods such as the implant and

the shot, which derive from the research that

developed the pill — the number of pregnancies

per woman has decreased worldwide. This

decrease has been identiﬁed as one of the key

factors associated with recently reported and

signiﬁcant reduction in the rate of maternal

mortality around the globe (Hogan et al., 2010).

As former U.S. Secretary of State Hillary Rodham

Clinton pointed out during the G8 Conference

in Gatineau, Quebec, “You cannot have maternal

health without reproductive health, and repro-

ductive health includes contraception and family

planning and access to legal, safe abortions”

(Campion-Smith, 2010).

An Age-Old Need for Birth Control

Having a baby is the least frequent motivator

for most people to have sex (Hill, 1997). This

seems to have been true for all people at all

times throughout history. Contraceptives have

been used in one form or another for thousands

of years — throughout human history and even

prehistory. In fact, family planning has always

been widely practiced, even in societies domi-

nated by social, political, or religious codes that

required people to “be fruitful and multiply” —

from the era of Pericles in ancient Athens to that

of Pope Francis, today (Himes, 1963; Pomeroy,

1975; Blundell, 1995; Wills, 2000).

Of course the methods used before the 20

century were not always as safe or effec-

tive as those available today. Centuries ago,

for example, Chinese women drank lead and

mercury to control fertility, which often resulted

in sterility or death (Skuy, 1995). During the

Middle Ages in Europe, magicians advised

women to wear the testicles of a weasel on their

thighs or hang its amputated foot around their

necks (Lieberman, 1973). Other birth control

amulets of the time included wreaths of herbs,

desiccated cat livers, shards of cat bones (but

only from the pure black ones), ﬂax lint tied in

a cloth and soaked in menstrual blood, or the

anus of a hare. It was also believed that a woman

could avoid pregnancy by walking three times

around the spot where a pregnant wolf had

urinated.

In more recent New Brunswick, Canada, women

drank a potion of dried beaver testicles brewed

in a strong alcohol solution. And as recently as

the 1990s, teens in Australia used candy bar

wrappers as condoms (Skuy, 1995).

Perhaps more surprising than such often bizarre

and totally ineffective methods is that modern

science has revealed many other ancient

methods, especially certain herbal treatments,

to be actually somewhat effective — though not

always safe or practical (Riddle, 1992).

The Pill — The First 2,500 Years

According to ancient Greek myth, Persephone,

the goddess of spring, refused to eat anything

but pomegranate seeds after she was stolen

from her mother, Demeter, raped by the god

of death, and kidnapped to the underworld.

Medical historians now know why Persephone

only ate pomegranate seeds — pomegranate was

one of the ﬁrst oral contraceptives.

Ancients used the myth of Persephone’s abduc-

tion to explain the cause of the world’s ﬁrst

winter — a time when the goddess withheld her

fertility while conﬁned in the underworld. All

the winters that have followed are echoes of her

tribulations, her mother’s search for her, and her

refusal to be pregnant when she didn’t want to

be (Riddle, 1997).

Greek women celebrated the reunion of Perse-

phone and her mother for centuries in festivals

Birth Control – History of the Pill • 11

called Thesmophoria. (All men were banned

from them.) Four plants were central to the

secret rituals of the festival: pomegranate,

pennyroyal, pine, and vitex, also known as

“chaste-tree.” All of these plants are now known

to have contraceptive beneﬁts as well as other

effects (Hawley and Levick, 1995). It now appears

that Greek women gathered in the Thesmo-

phoria to share their contraceptive secrets

(Riddle, 1997).

Herbal Infusions

In the seventh century B.C.E, a brisk contra-

ceptive trade developed in the part of North

Africa that is now known as Libya. That was the

only place in the world that the ﬂowering plant

silphium grew. Silphium was such a reliable

contraceptive that it fetched an exorbitant price

(its weight in silver) in shipping ports all over the

ancient world. Despite its staggering cost, the

demand for silphium was inexhaustible. By the

ﬁrst century C.E., the plant was very scarce from

over-harvesting, and by the fourth century, it was

extinct (Riddle, 1997).

Women all over the world used various herbs

for family planning. Surprisingly, one of the

most comprehensive recipe books for pre- and

post-coital herbal contraception was written by

a man who later became pope. Peter of Spain,

who offered advice on birth control and how to

provoke menstruation in his immensely popular

Thesaurus Pauperam (Treasure of the Poor), was

elected Pope John XXI in 1276 (Riddle, 1992).

Many of Peter’s recipes have been found surpris-

ingly effective by contemporary research, and

it is now thought that women in antiquity had

more control over their reproduction than previ-

ously believed (Riddle, 1994).

Hundreds of generations of women in Africa,

Asia, and the Americas used various fruits and

plants for family planning. Women in tropical

India and Sri Lanka, for example, eat a papaya

a day when they want to prevent pregnancy. It

sounded improbable to scientists in the West,

but in 1993, an English research team found that

an enzyme in the fruit, papain, interacts with the

hormone progesterone in a woman’s body to

prevent pregnancy (Brothers, 1994).

Contraceptive knowledge began to vanish in

Europe after the 15

century. Women who had

the knowledge became fearful about sharing

it because to offer contraceptive information

during these times was to risk being accused of

witchcraft or heresy — the punishments for which

included torture and death (Riddle, 1994).

European women in colonial America were

offered contraceptive information by their

Native-American neighbors and by their Afri-

can-Carribean slaves (Brodie, 1994). Afri-

can-Americans held in slavery became

extremely adroit in the use of contraception,

which was important to them as a way to prevent

the heartbreak of bearing children who could

be sold for the proﬁt of slave owners (Tone,

2001). Some of their formulas, still used in the

rural South, can also be found in Peter of Spain’s

750-year-old recipe book (Riddle, 1992).

12 • Birth Control – History of the Pill

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