America's Favorite Birth Control Method Turns 50

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A world without "the pill" is unimaginable tomany young women who now use it to treat acne, skip periods,improve mood and, of course, prevent pregnancy. They might besurprised to learn that U.S. officials announcing approval of theworld's first oral contraceptive were uncomfortable.

"Our own ideas of morality had nothing to do with the case,"said John Harvey of the Food and Drug Administration in 1960.

The pill was safe, in other words. Don't blame us if you thinkit's wicked.

Sunday, Mother's Day, is the 50th anniversary of thatprovocative announcement that introduced to the world what is nowwidely acknowledged as one of the most important inventions of thelast century.

The world has changed, but it's debatable what part the birthcontrol pill played. Some experts think it gets too much credit orblame for the sexual revolution. After all, sex outside of marriagewasn't new in 1960.

The pill definitely changed sex though, giving women morecontrol over their fertility than they'd ever had before andpermanently putting doctors - who previously didn't seecontraceptives as part of their job - in the birth control picture.

But some things haven't changed. Now as then, a male birthcontrol pill is still on the drawing board.

"There's a joke in this field that a male pill is always fiveto seven years away from the market, and that's what people havebeen saying since 1960," said Andrea Tone, a history professor atMontreal's McGill University and author of "Devices and Desires: AHistory of Contraception in America."

The pill is America's favorite form of reversible birth control.(Sterilization is the leader overall.) Nearly a third of women whowant to prevent unwanted pregnancies use it. "In 2008, Americansspent more than $3.5 billion on birth control pills," Tone said,"and we've gone from the one pill to 40 different brands."

There are Yaz, Yasmin, Seasonale, Seasonique and Lybrel - allwith slightly different packaging, formulations and selling points.Lybrel is the first pill designed to eliminate menstrual periodsentirely, although gynecologists say any generic can do the samething if you skip the placebo and take the active pill every day.

In the 1960s, anthropologist Ashley Montagu thought the birthcontrol pill was as important as the discovery of fire. Turns outit wasn't the answer to overpopulation, war and poverty, as some ofits early advocates had hoped. Nor did it universally savemarriages.

"Married couples could have happier sex with more freedom andless fear. The divorce rate might go down and there would be nomore unwanted pregnancies," said Elaine Tyler May, 62, a

University of Minnesota history professor who wrote "America andthe Pill.

"None of those things happened, not the optimistic hopes or thepessimistic fears of sexual anarchy," she said.

And it didn't eliminate all unwanted pregnancies either. Nearlyhalf of all pregnancies to U.S. women are unintended and nearlyhalf of those end in abortion, according to the GuttmacherInstitute, which has gathered data on abortions for years.

The pill is often associated with the women's movement of the1970s. But the two feminists behind the pill, the ones who providedthe intellectual spark and the financial backing, were born acentury earlier, in the 1870s.

As suffragists worked for the vote, renowned birth controlpioneer Margaret Sanger distributed pamphlets with contraceptiveadvice and dreamed of a magic pill to prevent pregnancy.

Her grandson, Alex Sanger, 62, now chair of the InternationalPlanned Parenthood Council, remembers playing catch as a boy withhis famous grandmother and eating her firehouse-spicy food.

"My grandmother had the idea for the pill back in 1912 when shewas working on the lower East Side of New York," Alex Sanger said."She saw women resorting to back alley, illegal abortions. One toomany of these women died in her arms and she said 'Enough.'

Katharine McCormick, a philanthropist with a science degree fromthe Massachusetts Institute of Technology, bankrolled the work ofGregory Pincus, the man Sanger convinced to develop the pill. "Itwas my grandmother's idea and Katharine McCormick's money," AlexSanger said.

Ironically, when health hazards of the early pill arose - highlevels of hormones caused blood clots in some women - youngfeminists protested that men had invented it and turned women intounwitting guinea pigs.

The FDA's response to the hazards of the pill led to greateraccess to safety information for patients, another less-appreciatedpart of the pill's legacy.

Today's pill, with much lower doses of hormones, is much saferthan the pill of 50 years ago. And it may even be good for you.

"The health benefits are tremendous," said Dr. MelissaGilliam, chief of family planning contraceptive research at the

University of Chicago Medical Center. "It decreases the risk ofovarian cancer and uterine cancer. If we called it 'thecancer-preventing pill,' it would have far better traction. It's areal success story."

The pill divided mothers and daughters in its early days.Married women had clamored for it as soon as it went on the market- within two years of its approval, more than a million women weretaking it. But that didn't mean they wanted their unmarrieddaughters to have it.

"I talk to my daughter about the pill a lot more than I talkedto my mother about the pill," said Jean Elson, 61, a sociologistand expert on women's health at the University of New Hampshire.Elson secretly started taking the pill in college in the late 1960sbefore she was married. Her mother wouldn't have approved.

"The only conversations about sex I remember with my motherwere 'not to.' I remember warnings about tongue kissing. She didn'tdo that until she was engaged," Elson said.

Many parents now discuss birth control with their unmarrieddaughters and sons. They also may discuss condoms to preventdisease, including AIDS. The greatest fear associated withunprotected sex for young people is no longer pregnancy, it'sserious sexually transmitted disease.

Another change is advertising. Women now in their 20s have seenads for the pill nearly their entire lives. The first magazine adsfor the pill ran in 1992. Now TV ads show smiling women liberatedby the ability to limit or even eliminate their menstrual periods.

"The message is your period shouldn't get in the way. It's anappealing message," said Sarah Forbes, 28, curator of the Museumof Sex in New York. Her generation takes the pill for many reasonsand they take it for granted.

"We're so used to it being so freely available," Forbes said."It's almost impossible to think of a world where we didn't haveaccess to it."

The pill is so ubiquitous that young women may have troublelearning about other options. Tone said one doctor said he didn'tremember how to fit a diaphragm, a flexible shield that covers thecervix. The pill is so highly marketed that other methods, likeimplants and IUDs, aren't clearly understood by young women.

"We've got choices, but the information about them isn't alwayswell balanced," said Judy Norsigian, 62, executive director of OurBodies Ourselves, the nonprofit organization that publishes thelong-standing women's health guide of the same name.

Female doctors use IUDs twice as frequently as the generalpopulation of women and many recommend it to their patients.

"The future of birth control is not pills at all," said Dr.Lisa Perriera, 34, of Case Western Reserve School of Medicine inCleveland.

"The best birth control is easy to use, highly effective atpreventing pregnancy and has few side effects," Perriera said."The methods that fit those criteria best are IUDs and implants. Ithink that's where birth control is going."

Others hold out hope for a breakthrough in male-centered birthcontrol. An oral drug called miglustat worked in mice, but not inmen. Researchers are recruiting men for studies of a hormonal gelto suppress sperm production.

"The question is will a single company decide to take this tomarket, to get FDA clearance, a very expensive undertaking, whenit's hard to predict how commercially viable a male pill wouldbe," Tone said. As much as women would like men to be equalpartners in preventing pregnancy, "women at the same time feel alittle bit nervous entrusting men to take a pill or be on apatch."

After all these years, a male equivalent to the birth controlpill is still five to seven years away.

Copyright © 2014, Los Angeles Times
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