Copyright 2000 P.G. Publishing Co.
Pittsburgh
Post-Gazette
May 9, 2000, Tuesday, SOONER EDITION
SECTION: HEALTH, Pg. E-1, COVER STORY
LENGTH: 1881 words
HEADLINE:
THE PILL TURNS 40;
TINY TABLET SIGNALED A REVOLUTIONARY CHANGE IN THE LIVES
OF WOMEN
BYLINE: ELLEN MAZO, POST-GAZETTE STAFF WRITER
BODY:
There are countless pills on the
market, medications designed to either cure or relieve what ails us, even to
prevent us from getting sick in the first place.
But there is only one
tablet known universally as the Pill, the tiny combination of estrogen and
progestin approved by the Food and Drug Administration 40 years ago today as the
first oral contraceptive.
Within five years, the Pill
became the leading reversible contraceptive method in the
United States. It is now the second most popular birth control method behind
sterilization.
After the Pill's approval, Reader's Digest predicted "one
vast, all-pervading sexological spree." Condemned and praised, the Pill became
the symbol of reproductive freedom for women. For young women embarking on new
lives after high school and college, there was now the opportunity to make
choices about sex. That individual freedom became a hallmark of the ' 60s, or so
it seemed.
Deanna Della Vedova, now 52, remembers that several of her
friends were already pregnant in 1966, the year she graduated from high school
in North Huntingdon. Della Vedova's goal, by contrast, was to get an education
before having children.
The word on the street was that there was a
woman doctor who would prescribe the Pill. The doctor asked if you were married,
but all you had to say was that you were engaged.
Della Vedova, single
at the time, with no immediate plans for marriage, walked away with a
prescription.
"She just smiled and said OK," Della Vedova recalled.
"Having the Pill gave me the freedom to go to college, to work, without fear of
becoming pregnant."
This may have been the ' 60s, but there was still
another fear -- that of conservative backlash.
At Planned Parenthood of
Western Pennsylvania, the policy was: No marriage license, no prescription.
Except that proof of imminent marriage was acceptable.
It is said that
at least one woman had engraved wedding invitations printed, complete with a
fictitious bridegroom's name. She got her prescription.
In its first two
years on the market by G.D. Searle Co., the Pill was taken by more than 1.2
million women; today more than 100 million women worldwide rely on oral
contraceptives to prevent ovulation, according to a new report
from the Johns Hopkins School of Public Health.
And, now the FDA is
considering making the Pill available without a doctor's prescription. * * *
While the Pill has been available for 40 years, its history really dates
to 1916 -- long before oral contraception was even considered a possibility
-when Margaret Sanger, a nurse, opened a birth control clinic in Brooklyn, N.Y.,
with her sister, Ethel Byrne.
In the 10 days before the clinic was
closed down, and Sanger and Byrne were arrested, more than 500 women passed
through its doors.
Convinced of the critical need for birth control,
Sanger in 1931 founded the Planned Parenthood Federation. She campaigned for 50
years for a woman's right to birth control, never letting her multiple arrests
on charges of obscenity stop her.
"The moment of conception of the Pill
is most often pinpointed as early as 1951 at a dinner in New York arranged by
Margaret Sanger," according to Bernard Asbell in his book, "The Pill: A
Biography of the Drug That Changed the World," (Random House, 1995).
Among the guests were friends in her birth control movement and Dr.
Gregory Pincus, an authority on women's fertility and director of the Worcester
Foundation for Experimental Biology.
Sanger reportedly asked Pincus what
was needed to "enlist science in finding the perfect answer to contraception?"
Money, he said.
So, Sanger approached her wealthy friend,
Katharine McCormick, the daughter-in-law of Cyrus McCormick, creator of the
mechanical reaper. Katharine McCormick donated the first $ 40,000 toward
Pincus's research -including the work being done by other chemists and
biologists from around the world.
Among those was John Rock, the Harvard
University Medical School graduate who in 1924 started a fertility clinic at the
Free Hospital for Women in Brookline, Mass. His early work focused on women who
could not have children, but with his collaborators, Pincus and Min-Cheuh Chang
(and ultimately millions of dollars of support from McCormick), Rock created the
Pill.
In the early 1950s, the oral contraceptive was
tested on 6,000 women in Puerto Rico and Haiti. The Pill was first introduced in
the United States in 1957 as a treatment for menstrual disorders.
Nora
Ephron, the author and screenwriter, recalls getting the Pill for the first time
at the Margaret Sanger clinic after moving to New York City in 1962. She was
single, but lied to a nurse that she was engaged.
"All I knew about the
Pill was that it had been tested on several thousand Puerto Rican women and not
one of them had had a child in years," she wrote in 1977 in an essay on the '
60s entitled "The Pill and I."
"They contained a larger dose of estrogen
than they do now, and they were also larger pills. Nobody was sure if they
caused blood clots or prevented them, or if they caused breast cancer or
prevented it.... But [that visit to the Sanger clinic] began a long and happy
relationship between me and birth control pills." * * *
Ephron was not
alone. By 1960, 30.5 percent of married women were working outside the home, and
by 1965, 35 percent of the workforce was female. They wanted to decide
themselves when to start their families.
While the Pill was a boon to
working women, there were still understandable fears about its safety, as Ephron
pointed out in her essay.
In the 1950s and early ' 60s, the FDA's
oversight function was not as stringent as it is today. One employee reviewed
the Pill's application.
Soon, however, there was additional research
that found high doses of estrogen led to increased risks of blood clots, heart
attacks and strokes. The early oral contraceptives had 100 to
150 micrograms of estrogen and up to 10 milligrams of progestin -- significantly
higher than doses today of only 30 to 35 micrograms of estrogen and 0.5 to 1
milligram of progestin.
There were other side effects that steered women
away from the Pill: Nausea, breast tenderness, headaches, weight gain, irregular
bleeding and depression. Women who smoked and were 35 and older were considered
at greatest risk.
By 1969, oral contraceptives were
introduced with lower doses of estrogen and progestin to reduce the side effects
without risking pregnancy. Twenty years later, an FDA advisory committee
suggested that women over 40 who don't smoke and are healthy could continue to
take the Pill.
In the 1970s, a minipill was introduced, one that
contained only progestin. While its big sister worked by suppressing ovulation
through a combination of estrogen and progestin, the minipill created changes in
the cervix and uterus, making it difficult for sperm to unite with the egg.
In recent years, Wyeth-Ayerst's new low-dose
contraceptive pills began gaining popularity, and not just for
birth control. Some women took them as a treatment for acne, according to Drug
Store News. * * *
Will the Pill continue to be the most popular
reversible contraceptive method through the 21st century?
John Guillebaud, professor of family planning and reproductive health at
University College in London, says no. In an essay written for the March/April
2000 edition of Family Planning Perspectives, he says the Pill's effectiveness
is still too dependent on sometimes faulty human memory to continue its
predominance.
The search will be on for what he calls
"contraceptive utopia" -reversible methods free of side
effects, that are 100 percent effective, protect against sexually transmitted
diseases and are completely user-friendly.
The history of the Pill
continues. The Pill's legacy
The Pill opened the door to research in all
kinds of contraception for women, and other methods followed: IUDs, or
intra-uterine devices that prevents the fertilized egg from attaching itself to
the lining of the uterus, and Norplant implants, surgical implants that suppress
ovulation for five years, are just two.
Other
contraceptives: A birth control patch, a vaginal ring and an
intrauterine contraceptive designed to release a small dose of
a hormone directly to the uterus. There is also the monthly shot of estrogen and
progestin.
While the patch, which has the same ingredients as the pill,
is considered to be a boon for teen-agers -- the Population Council says that up
to 20 percent of teens on the Pill forget to take the drug at least twice a
month -it is not for women who sweat excessively, or take frequent showers.
There is also the emergency contraceptive kit
containing birth-control progestin pills that must be taken with 72 hours of
unprotected sex.
Research continues on a contraceptive
shot for men, and in addition to the possibility of the Pill becoming an
over-the-counter product, there is also consideration being given to a generic
version.
On the legislative front, lawmakers are pushing in several
states, including Pennsylvania, to require insurance companies
to cover FDA-approved prescription contraceptives, including
the Pill. Only 18 states have some sort of mandated coverage, but the depth of
coverage varies dramatically.
Some local health insurers cover or give
employers the option to buy a rider that includes contraceptive
coverage. Birth control pills cost roughly $ 1 per pill. Pioneer in
contraception
Harvard gynecologist Dr. John Rock, along with Dr. Gregory
Pincus, was one of several people whose work contributed to the development of
the birth control pill, an idea first proposed by two women: Planned Parenthood
founder Margaret Sanger and Katharine McCormick, the daughter-in-law of Cyrus
McCormick, inventor of the mechanical reaper.
Rock, a Catholic whose
work drew harsh criticism from the Vatican on down, is popularly known as "The
Father of the Pill," having shepherded it through clinical trials. Catholic
opposition was so intense that at one point, Monsignor Francis W. Carney of
Cleveland called him "a moral rapist." Ironically, Rock's work with estrogen and
progesterone initially was aimed at helping infertile women become pregnant. He
was born in 1890 in Marlboro, Mass., and died in 1984 in Temple, New Hampshire.
Timeline
* 1960: FDA ON MAY 9 APPROVES THE BIRTH CONTROL PILL FOR
CONTRACEPTIVE USE.
* 1965: THE PILL BECOMES THE LEADING
REVERSIBLE CONTRACEPTIVE METHOD IN THE UNITED STATES.
*
1969: ORAL CONTRACEPTIVES ARE INTRODUCED WITH LOWER DOSES OF
ESTROGEN AND PROGESTIN TO REDUCE SIDE EFFECTS.
* 1998: FDA APPROVES THE
"MORNING AFTER" EMERGENCY BIRTH CONTROL KIT -- A SIMPLE PACKAGE OF BIRTH CONTROL
PILLS.
* 2000 AND BEYOND: THE PUSH IS ON TO MAKE THE PILL AVAILABLE OVER
THE COUNTER. Contraceptives by the numbers
The
contraceptive pill is the most widely used form of birth
control here, according to Planned Parenthood of Western Pennsylvania. Here is
how birth control methods rank:
The Pill -- 61 percent.
Barrier
(condoms) -- 12.8 percent
Depo-Provera -- 11.2 percent
No method
-- 8.3 percent
Sterilization -- 4.1 percent
Other -- 1.6 percent
Norplant -- .2 percent
Intrauterine device -- .2 percent
Diaphragm -- .4 percent
GRAPHIC: PHOTO (2),
PHOTO: (No Caption); PHOTO: Associated Press/1973 photo:
LOAD-DATE: May 10, 2000 
