THE BIRTH OF THE PILL:How Four Crusaders Reinvented Sex and Launched a Revolution

by Jonathan Eig (Norton, 2014)

I asked Jonathan Eig why he wrote this book, as his other biographies are about Al Capone, Lou Gehrig, and Jackie Robinson. “My wife said I should write a book women would read,” he told me. “I heard a rabbi say the birth-control pill was the most important invention of the 20th century and I got curious.”

A curious person who does solid research and presents facts with objectivity can produce an honest examination of his subject and make complicated matters understandable. Eig has done all this in his new book; he has also made it a good read.

The Birth of the Pill tells the story of the eccentric individuals who brought the oral contraceptive into existence: two women, Margaret Sanger and Katharine Dexter McCormick, and two men, Gregory Pincus and John Rock.

The lives of the women were marked by anger (Sanger) and sorrow (McCormick). Sanger, who considered marriage akin to suicide, loved sex more than people. When her 10-year-old son wrote to her, begging to come home for Thanksgiving, she told him he could come—the maid would fix him dinner. When her first husband protested her love affairs, she told him to have some of his own. She hated the Catholic Church with special passion.

McCormick, who had been born to wealth, funded the contraceptive project. One of the first women to graduate from MIT, in 1904 she married Stanley McCormick, the youngest son of Cyrus McCormick, one of the richest men in America. Soon after their wedding, Stanley sank into insanity. She cared for him for 40 years and fruitlessly sought cures—a search that led her to endocrinology, just as the field was taking its modern shape. She was grateful she had not conceived a child, as both her husband and an older sister of his suffered from schizophrenia.

McCormick’s support of the suffrage movement brought her into Sanger’s orbit. In 1921, she collaborated with Sanger on the first American Birth Control Congress; she later funded Sanger’s monthly “Birth Control Review” and her clinic. After her husband’s death in 1947, McCormick, then age 72, found herself with more than 35 million dollars and no family attachments. She knew exactly what she wanted to achieve: the liberation of all women, married or single, from their fertility.

Scientific History Is Made by Scientists 

Today, Gregory Pincus would be the nerd from Central Casting: wild ideas and wild hair. In 1934 (!) he performed IVF on rabbits, transplanting embryos into the mother’s uterus and bringing them to term. But after a story in Collier’s magazine in 1937 suggested he intended to apply his revolutionary idea to human beings, he was denied tenure at Harvard.

In 1945, Pincus did something else that was revolutionary: He started his own research center, the Worcester Foundation for Experimental Biology. This allowed him to be accountable to no one. At the start, he begged door-to-door for funding to continue his biological experiments, and at one point housed his family in an insane asylum because he couldn’t afford rent anywhere else. But by 1953, the pharmaceutical company G.D. Searle was giving him $62,400 a year.

Dr. John Rock was also from Central Casting; however, as Eig puts it, he was a “walking advertisement” for the controversial work he undertook with Pincus. A Harvard-educated, handsome, diplomatic, highly respected, universally trusted physician, Rock was a well-known infertility specialist, devoting himself to helping women become pregnant—and he was a Catholic, faithful, at least at the beginning, to his church’s teaching on contraception. His very presence helped neutralize the strongest opposition the project faced.

Pincus and Rock both tinkered with female reproductive hormones; Sanger and McCormick brought them together to develop a pill that would keep women from getting pregnant. G.D. Searle would market it.

Once Pincus and Rock had created a chemical mix that worked in rabbits, women became their guinea pigs: medical students who were told their grades would be affected if they dropped out of the study; inmates of an insane asylum; impoverished Puerto Ricans who may have feared they would lose their government housing if they said no.

Nobody was asked for consent. Nobody was told the nature of what they were testing. Nobody was told they were helping to bring to market a drug that would make Searle’s stockholders (of which Gregory Pincus was one) fabulously wealthy.

Getting Government Approval

The data G.D. Searle presented to the FDA in 1957 was meagre even by the standards of the day. Rock himself pointed out that 20% of the women in the trials reported nausea or breast pain. Among 221 women in one study, 25 simply withdrew because of negative reactions, and there were 29 complaints of dizziness, 26 of nausea, 18 of headaches, 17 for vomiting, 9 for abdominal pain, 7 for weakness, and 1 for diarrhea. Other women complained of bleeding between their periods, but doubling the dosage solved that problem.

Nonetheless, that year Enovid was approved by the FDA for treatment of “menstrual disorders.”  Since contraception was still illegal in many states, that was code language for what would later be marketed as an “oral contraceptive.” But everybody already knew what it was, and the drug was a huge success.

Two years later, Searle asked the FDA to approve Enovid for the purpose of birth control. FDA Medical Director William Kessenich noted that evidence for the pill’s safety was thin: “Only 66 patients have continued medication for 24 cycles or more.”

Pasquale DeFelice, the FDA official in charge of Enovid’s relabeling as a contraceptive, wasn’t convinced of its safety. The pill, he claimed, treated a normal biological process as if it were a disease. He feared it might cause permanent changes in women’s uteruses, noting that female newborns whose mothers had been on the pill had abnormalities of the labia and clitoris.

Despite his qualms, Enovid was approved for contraceptive use on April 7, 1960, but with a warning that patients should not stay on it longer than two years.

Before two years had passed, reports of women suffering blood clots and strokes came to the FDA. Even today, redesigned oral contraceptives cause fatal blood clots (can you spell Yaz?).  Just earlier this month, a new study from Harvard and Massachusetts General Hospital found that long-term use of birth-control pills causes a thinning of the lateral orbitofrontal cortex and posterior singulate cortex of women’s brains.

Larry Cahill, a professor of Neurobiology and Behavior at the University of California-Irvine, co-authored that study of brain thickness. The lack of research on the long-term effects of the pill astonishes him. “You might think after 50 years and hundreds of millions of women taking various incarnations of the pill, there would be a large and cohesive and impressive body of evidence on it,” he told Catholic World Report, “but there’s next to nothing.”

Timing Is Everything

At the same time DeFelice was acquiescing in Enovid’s approval, elsewhere in the FDA another new hire, Dr. Frances Kelsey, stood up to her bosses and the pharmaceutical company involved, and refused to approve a European drug until it could be proven safe. She held out long enough for the devastating side effects of the sleeping pill Kevadon—medical name: Thalidomide—to become known around the world.

A year later Congress enacted the Kefauver-Harris Drug Act of 1962, which required pharmaceutical companies to provide the FDA with proven records of safety and efficacy before approval of any new drug. It also mandated that informed consent be obtained from participants in clinical trials, and that the FDA be notified of any adverse reactions to drugs being tested.

If DeFelice had held out a little longer, or if Sanger and Pincus had met a little later, or if Stanley McCormick had lived a little longer and the flow of cash to Pincus had begun a little later . . . would the Pill have been approved by the FDA when it was? Most likely not, if Kefauver-Harris had been in force.

Thalidomide, by the way, finally won FDA approval in 1998—as a drug to treat leprosy. Thirty years of research unearthed something good.

Margaret Sanger died eight months after the Supreme Court ruled, in Griswold v. Connecticut (1965), a constitutional “right to privacy” protected married couples’ access to contraceptives (extended to unmarried couples in Eisenstadt v. Baird in 1972). The Court’s “privacy” reasoning later became the foundation for Roe v. Wade.

The legal gymnastics required to make the Pill universally available paved the road to legalized abortion in the United States. The contraceptive mindset that disconnects sex from consequences made it inevitable: If the goal is pleasure with no baby, there has to be a backup when birth control fails, doesn’t there?

Jonathan Eig’s assessment is clear-eyed: Sanger had hoped her pill would allow people to enjoy more sex, but for many it lowers libido. She thought it would make married couples happier: In fact, divorce rates have skyrocketed since it was introduced. She hoped it would lift women out of poverty, but its usage rate is much higher in affluent countries than in poor ones. “Neither she nor anyone else could have imagined how birth control would also contribute to the spread of divorce, infidelity, single parenthood, abortion, and pornography,” Eig says. “Like any revolutionary, she was willing to tolerate a certain degree of chaos.”

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Connie Marshner organized her first pro-life meeting in 1971, among Capitol Hill staffers who sensed a drift toward legalizing abortion.  She’s worked in the movement in one capacity or another ever since.