http://www.guardian.co.uk/society/2010/jun/06/rachel-cooke-fifty-years-the-pill-oral-contraceptive

Fifty years of the pillSince it was introduced in 1960, the pill has
been blamed for promiscuity, hideous side-effects and even destroying
marriage. But the world's most popular oral contraceptive has also
liberated millions of women. Is it time we showed our gratitude?

Rachel Cooke The Observer, Sunday 6 June 2010

Introduced in 1960, the world's most popular oral contraceptive is now
taken for granted.
Last year, Virago republished Mary McCarthy's 1963 novel The Group,
with a new introduction by the author of Sex and the City, Candace
Bushnell. The Group is a novel which some of my dearest friends
consider to be a) seminal and b) as racy, in its way, as Peyton Place,
so I went out and bought the new edition, and read it over the course
of a lazy weekend. Did I like it? Oh yes. The story of eight female
graduates choosing careers and husbands (though not necessarily in
that order) in 1930s New York, it is wonderfully funny, savage and
piercing, with a gossipy kind of a plot that pulls you along rather in
the manner of Carrie Bradshaw on the trail of a fine pair of spike
heels. The travails of its characters – the wife who must shop for
dinner before work in order that she can get straight to the stove
when she comes home – still feel marvellously modern. But something
else struck me about it, too: the detailed and intimate way in which
it deals with the problem of contraception. For all the undoubted
punch of her writing, there are moments down at the family planning
clinic when McCarthy seems to be writing an encouraging manual as much
as a novel.

Let us agree, for a moment, that there is such a thing as the women's
novel. In women's novels of the late 20th and early 21st century, we
see this aspect of women's lives only rarely. Of course characters
still fall in love, and they have sex, plenty of it sometimes. But if
they menstruate, no one ever mentions it; and if they visit a family
planning clinic, they do it off the page, well out of sight of the
gentle reader. In The Group, however, biology, and how to pull a fast
one on it, are centre stage. Early on in the novel, one of the group,
Dottie, goes to bed with a man to whom she is not married, Dick. She
is a virgin – "she had never seen that part of a man, except in
statuary and once, at the age of six, when she had interrupted Daddy
in his bath" – and it shows. Too shy to mention contraception, Dick,
more experienced, employs the oldest method of all, "coitus
interruptus… a horrid nuisance". Afterwards, as Dottie is preparing to
leave, he tells her to get herself a "pessary" (this is American for a
diaphragm). "When you get yourself fixed up, you can bring your things
here and I'll keep them for you," he says, a reference to the fact
that in 1930s America, as in 1930s Britain, diaphragms were not the
kind of thing unmarried women left lying around in their top drawers,
where, depending on their circumstances, their staff, mother or
girlfriends might find them.

Dottie, then, goes to a clinic to pick up her "new device", one
discovered by the birth control pioneer Margaret Sanger in Holland and
imported into the US for the first time. There follows a long and
detailed account of the fitting of the diaphragm. Dottie is gung ho
about getting herself "fixed up", but not so gung ho as to be entirely
unruffled by the experience of squatting girdleless on a surgery floor
in front of a complete stranger, and there is an embarrassing moment
when, observed by both doctor and nurse, the diaphragm, covered in
jelly, flies out of her hand, crossing the room like a tiny bat.
Afterwards, nervously thrilled at the step she has taken, Dottie tries
to call Dick. He isn't home. She leaves a message, telling him that
she is waiting for him in Washington Square. But he doesn't come.
Eventually, as dusk falls, Dottie discreetly places her precious
packages beneath the bench on which she has spent her afternoon, and
heads for Fifth Avenue and a taxi.

McCarthy's novel was published three years after the pill was approved
by the US authorities in 1960, but several years before it was widely
available (well into the 1970s, women in Britain and America were
still pretending to be married in order to get a prescription; some
used to pass around the same battered wedding ring in the doctor's
waiting room). Its explicit descriptions, for the day, of
jelly-covered discs of rubber thus foreshadow the coming openness at
the same time as they reflect the widespread fear, ignorance and shame
which many women, in 1963, still felt when it came to sex. From the
late 1950s until the mid-70s, there were lots of novels like this,
outwardly controversial and racy but also heavy with the misery and
conflict that came with sex before the advent of the pill. Only then,
in fiction as in the world, the anxiety, the unappetising "equipment"
seemed suddenly to disappear. Now, 21st-century women's novels deal
with the IVF clinic, not contraception.

Fifty years after its birth, we take the pill entirely for granted; we
think about what it erased forever not at all. For sure, it is
sometimes the subject of newspaper stories. But less often than of
old, and only when it has been dubiously linked to yet another health
scare. (From time to time, of course, the odd relic will bemoan its
effect on our morals, usually at the behest of the Daily Mail. Last
month it was the turn of Raquel Welch on CNN. The pill has destroyed
marriage, she said: "Seriously, folks, if an ageing sex symbol like me
starts waving the red flag of caution over how low moral standards
have plummeted, you know it's gotta be pretty bad.") We do not talk
about it; we do not celebrate it. In the 20-24 age group, two-thirds
of British women take it every morning, as unthinkingly as they dial
their boyfriends on their mobile phones. It is just another
convenience, and what their grandmothers and great-grandmothers went
through is straight out of the history books.

"Young women don't realise what hell it was [before the arrival of the
pill]," says the fashion designer Mary Quant. "The perpetual anxiety.
It was a real revolution." Was she an early adopter? "Oh yes, it was
quite wonderful. Of course it was hellishly difficult to get hold of
at first. There was a lot of pretending one was married when one went
to the doctor, and a minor disadvantage was that the early pills made
one put on a couple of pounds. But that was nothing! Who cared? The
other forms of contraception were so hellish." She squeals at the
memory. "I remember going to a doctor in Chelsea for a Dutch cap.
'It's quite easy,' she said. 'When you dress for dinner, just pop this
in!'"

The novelist Margaret Drabble, whose 1967 novel Jerusalem the Golden
also features a diaphragm scene, agrees that the pill changed
everything; that the revolution associated with its arrival has not
been mythologised down the years. "The other methods were quite
remarkably unreliable," Drabble recalls, "and fairly repulsive, and
the people who worked in the clinics fitting them were rather
unfriendly and punitive. I remember going to be fitted for a cap, and
I had a child in a pushchair, and the woman asked me why on earth I
was there. By the time the pill was available I already had three
children; I think I would have had a child a year if I hadn't started
taking it. So, yes, it made a very considerable difference to one's
life. You were able to make a choice, you were able to look after
yourself, and I was pleased to do so.

Drabble says her generation had been afraid of getting pregnant.
"People were very afraid of abortion; it threatened you. The pill also
meant people were able to keep the integrity of the family. Of course
people had affairs before the pill, but with more anxiety, and there
were mixed children, and some told, and some didn't tell. Afterwards
that was no longer the case."

In 1960, shame was still a powerful force, pill or no pill. In the
same year, Lynne Reid Banks published her first novel, The L-Shaped
Room. Considered shocking at the time, it tells the story of a failed
actress, Jane Graham, who, having fallen pregnant and been turned out
of the family home by her disgusted father, goes to live in a dingy,
bug-ridden bedsit at the top of a squalid boarding house in Fulham.
"When I wrote it I had never been pregnant," says Reid Banks. "I based
the story on a girl who had the flat next to mine. But my mother was
so worried about my reputation that she begged me to publish under an
assumed name. 'Everyone will think it's you,' she said. I laughed
merrily. But she was right."

Reid Banks never took the pill. By the time it was available she was
married and busy having a family. "However, about the fear of unwanted
pregnancy I can talk. This fear in itself was quite an effective
contraception, even for our boyfriends, who, if they were the right
sort, were as scared as we were of getting us into trouble. It meant
that 'going all the way' was something many of us only did when either
things got out of control, or in the course of what was called 'the
search' – ie, affairs were morally justified when you thought he might
be 'the one' or could deceive yourself into thinking so. We used to
'pet' like mad: by the hour, and very inventively, and inevitably
getting ourselves into a fine old state. I followed the
nothing-below-the-waist rule most of the time." What was that like?
"It was pretty stressful, and probably very bad for us."

The story of the pill's development is well-rehearsed. But still, it
bears repeating. That the scientist most strongly associated with the
project, Gregory Pincus, was able to work on the drug at all was
nothing short of a minor miracle. Among his more powerful enemies were
both the Catholic church – then, as now, implacably opposed to
contraception – and large sections of the political establishment
(thanks to Joe McCarthy's war on communism, birth control was widely
regarded as part of a Bolshevik conspiracy). Nor was the law on his
side. In Massachusetts, where he worked, anyone caught providing
contraception faced a possible prison sentence – a situation which
persisted until 1972. Pincus's major problem, however, was money. The
drug companies considered the idea of a contraceptive pill to be a
(possibly dangerous) shot in the dark, and most universities were
unwilling to risk damaging their reputations by backing such
controversial research.

In 1950, Pincus met Margaret Sanger. Sanger was a Catholic whose
mother had died at 50, after 18 pregnancies. "You caused this," she
told her father, over the coffin. "Mother is dead from having too many
children." After training as a nurse, Sanger began dreaming of a magic
pill that would prevent pregnancy, and it was she who first coined the
term birth control, in 1914. Three years later, at a suffrage meeting,
she met Katharine McCormick, famously only the second woman ever to
graduate from the Massachusetts Institute of Technology. McCormick was
a rich feminist (she was married to the heir to the International
Harvester Co fortune and, when he was declared legally insane, was
awarded control of his estate), and one wholly committed to the cause
of finding a way to help women limit their families, with or without
their husbands' help. Sanger suggested that she bankroll Pincus, and
she agreed. In the course of her lifetime she gave the project the
equivalent of more than $12m.

By the time of his meeting with Sanger, Pincus, an expert on the
process of reproduction, had already attracted attention with his work
to create "fatherless rabbits" (he had succeeded in creating a rabbit
embryo in a Petri dish). Spurred on by Sanger, he now began studying
the effect of the oral administration of progesterone (synthesised by
scientists in Mexico from wild yams) on animals. The results of these
studies suggested that the idea of an oral contraceptive for humans
was feasible, and it was this line of inquiry that McCormick, by now
76 years old, agreed to fund (not only that, but she moved from
California to Massachusetts, the better to keep an eye on
developments: "Freezing in Boston for the pill," she wrote in 1953).

But testing the administration of progesterone on humans would require
someone with clinical experience. Pincus enlisted the help of Dr John
Rock, then the US's leading infertility expert (Rock was a devout
Catholic, with five children and 19 grandchildren). Rock had been
experimenting with progesterone to help women conceive. The
progesterone was used to suppress ovulation for four months. Then it
was suddenly withdrawn, causing a kind of rebound effect. Using
hormones to prevent pregnancy worked on the same lines: the
progesterone prevented the release of an egg, only in this instance it
would be used for a longer time frame.

Some of the clinical trials were carried out, controversially, in poor
countries such as Puerto Rico, and later Haiti. As Lara V Marks points
out in her 2001 history of the pill, Sexual Chemistry, this was
complex work. Much depended on the instruction researchers gave to
their volunteers. In Haiti, many of the women were illiterate and
innumerate. To ensure they remembered their medication, researchers
hit on the idea of giving them rosary beads, which they were to move
individually each day after they had taken it. But even this was not
foolproof: a number of the women wore the beads in the belief that
they alone provided protection against pregnancy. Nevertheless, when
women did remember to take it, the pill proved effective, and in 1957
it was approved for the treatment of "female disorders" (30 states
still had laws forbidding the promotion of birth control, so for a
while it wore a disguise).

In 1959 the pharmaceutical company Searle applied to the FDA for
approval of a pill that would be marketed as a contraceptive called
Enovid – this pill also contained a tiny amount of oestrogen, to
prevent bleeding – and on 9 May 1960 approval was finally granted.
Women were elated, and would not be put off either by its side-effects
or by the rumours of the effect it would have on their long-term
health. The poignant and beseeching letters that Pincus and his
colleagues had received from women while they were still working on
the pill ("I am 30 years old. Have six children, oldest little over
seven… My health don't seem to make it possible to go on this way…")
were replaced by joyful thanks. In Britain, more than one woman
likened being prescribed the pill to winning the pools.

This is not to say that there weren't problems. The early pill was a
blunt instrument and had side-effects including headaches, nausea,
dizziness, bloating, even thrush. Early on, its use was linked to
cancer and to thrombosis. (Over time, hormone levels were refined and
its side-effects reduced. Nowadays the average pill's oestrogen
content is a third of what it used to be, the progesterone a 10th or
less.) Nor was every woman a fan. The American feminist Gloria Steinem
has always insisted that the pill's effect on the wider sexual
revolution was overstated, and perhaps she has a point (social mores
changed for a variety of complex reasons, of which the pill was only
one). Germaine Greer believes its advent meant that "a morally neutral
reason" for refusing penetrative sex had ceased to exist: "Women no
longer had an acceptable reason for refusing the kind of sex that was
most likely to be brutish and short. Once they had made the investment
in sexual activity by taking a daily medication in order to be
available, there was no sense in being unavailable. Having accepted
the idea of themselves as sexually active, they had to be sexually
active or be failures." In other words, she believes that it benefited
men far more than it did women.

Other women note that, in spite of the pill, unwanted pregnancies
still occur. As she revealed in a recent BBC4 documentary series,
Susan Brownmiller, the American feminist and author of Against Our
Will, the classic book about rape, had several illegal abortions
overseas during the 1960s; you might assume she would be strongly on
the side of the pill. But no. "People are still getting pregnant," she
says. "The pill only suits a woman who is on a regimen, who has a
regular sex life. And who does have a regular sex life? Basically that
means the middle classes. The rest [of the population], that's a lot
of women. I just don't think the pill has reached, or will reach,
everybody. I never used it because I was having an irregular sex life.
Some people don't expect to have sex that often. Sex just… comes up
[occasionally]. Those women don't take a pill every day."

For Brownmiller the issue now is increasing the availability of
emergency (ie morning-after) contraception, and of abortion. "The
issue then [in the 1960s] was abortion, and it is now. A lot of people
are still afraid of having an abortion. They're more afraid of that
than they are of having a child. I just don't think that the pill is
the best form of birth control, and that's before we even get on to
the question of STDs [sexually transmitted diseases, against which the
pill is no protection]." Brownmiller feels that it is those who can't
get pregnant who now dominate the media. "This pro-natalism. I haven't
seen anything like it since the 1950s. Everything is baby, baby,
baby." In this context, she believes, abortion rights become more
vulnerable, and abortion itself more taboo.

The fact is, though, that the pill is used by an awful lot of women:
some 3.75 million are currently using it in the UK alone (worldwide,
more than 200 million have used it since it was first approved). Used
properly, it is 99% effective. Most side-effects can be avoided by
changing the type of pill you take. Best of all, in spite of what you
read in certain newspapers, it is extremely safe, its benefits far
outweighing the risks. The pill reduces the risk of cancer of the
ovary, uterus and colon. It may also protect against pelvic
inflammatory disease and reduce the risk of fibroids, ovarian cysts
and non-cancerous breast disease. Last March the Royal College of GPs
published the results of research which studied 46,000 women over
almost 40 years. It found that women who have taken the pill were also
less likely to die from cancer, heart disease or stroke.

"It has so many benefits, from protecting against ovarian cancer to
helping to alleviate painful periods," says Peter Bowen-Simpkins of
the Royal College of Obstetricians and Gynaecologists. "In developing
countries, where anaemia is a huge problem, the pill can help to
reduce blood loss. Only smokers over 35, or the obese – those with a
BMI of over 30 – are at increased risk from coronary heart disease if
they take the pill, but we've known that since 1975."

Why, then, is it still associated, in some women's minds, with risk
and side-effects? "Because the newspapers don't always look at
underlying reasons," says Bowen-Simpkins. "I remember a story when a
mother of seven dropped dead. The headline said: 'Judge blames pill'.
But if you looked behind the story, she was a smoker and she was
obese. Such things are incredibly rare anyway, but 3 million people
read that, and it was bad publicity."

Bowen-Simpkins points out that some newer forms of hormonal
contraception – in essence, the pill in another format – have even
fewer side-effects than the pill because the hormones in them are of a
lower dose. Moreover, because a contraceptive patch releases hormones
straight into the bloodstream, its effectiveness is not reduced if you
vomit or have diarrhoea (the hormones in the pill must be absorbed by
the stomach). Ditto the contraceptive ring, which releases hormones
into the bloodstream via the vaginal wall.

For my own part, when, if, I do stop to think about the pill, I cannot
feel anything but deep gratitude. I started taking it when I went to
university – Marvelon, in a pale blue blister pack – and it was
blissful to be released, overnight, from the monthly dread, from the
sickly, stomach-churning days of waiting and wondering and hoping.
After college, when I was advised to stop taking it, my childhood
migraines having unaccountably returned (there is an increased risk of
deep vein thrombosis in migraine sufferers), I was devastated. This
news ruined all sorts of things which I'd better not go into here. But
then – oh, joy – a new brand of progesterone-only pill came on the
market which was almost as effective as the traditional combined pill
and suitable for migraine sufferers. I take Cerazette to this day, and
thanks to a decade of doing without – the pill, I mean – I have never
got to the point where I take it for granted. I'm not exaggerating.
Popping it actually makes me cheerful.

But I also think about my grandmothers. Both of them came from large
families and, as girls, both had to live with the sometimes harsh
consequences of being, as Hardy put it in Jude the Obscure, "too
many". My maternal grandmother was one of seven and, along the way,
siblings were sometimes, well… lost. A brother went to Canada to seek
his fortune and was never seen again. A sister died as a little girl,
an event then so common my grandmother did not think to mention it for
years and years, not even to her own daughter. My paternal
grandmother, meanwhile, was the eldest of 10. She was clever and would
have liked to have been educated, but her parents, needing her help at
home, insisted that she leave school as soon as she turned 13. She
spent the rest of her childhood dandling babies, stirring pans, and
forcing sodden washing through the family mangle. I wonder: do the
naysayers and doom merchants even know what a mangle is?