The Pill at 40
Although no fewer than five men have been credited as being the “father” of the birth control pill, two women deserve indisputable credit as its mothers: MIT-educated heiress Katherine McCormick and Margaret Sanger, who coined the term “birth control” and founded the International Planned Parenthood Federation.
These two women bullied and cajoled male scientists into creating a female contraceptive that could be swallowed, according to Bernard Asbell, author of “The Pill: A Biography of the Drug That Changed the World.”
Because of their persistence, the first oral contraceptive--a drug combining synthetic estrogen and progestin to prevent ovulation--was approved by the U.S. Food and Drug Administration in 1960, 40 years ago.
For the first time in history, controlling a woman’s fertility safely and effectively was as easy as popping a pill every day (if you remembered). A major medical achievement, the pill profoundly changed--and continues to change--the way women conduct their lives.
Within a year of its introduction, 400,000 American women were using the pill; within five years, 3.8 million were users.
Today, it is one of the two most popular contraceptive methods in the U.S., about on par with female sterilization, with more than 16 million users. Eight out of every 10 American women have used the pill at some point in their lives.
Providing more than 99% effectiveness for women who never miss a pill (“perfect” users) and about 94% for the “typical” users who do, the pill filled a gap in women’s contraceptive needs. In contrast, the diaphragm and the male condom are only 85% to 87% effective with typical use.
The introduction of effective birth control brought enormous social changes. Not only were more women delaying motherhood and entering the work force, but sexual relationships between men and women became more equal.
“Because it allowed women to decide if and when they would have children, the pill provided a tremendous boost to women’s equality,” said Nancy Sasaki, president and chief executive of Planned Parenthood Los Angeles.
By the same token, the pill tied women to the burden of contraception.
“[It] contributed to the decrease in communication about fertility among women and men,” said Jacqueline Darroch, vice president for research at the Alan Guttmacher Institute.
However, a 1996 study by Harvard economists suggests, the advent of female contraception such as the pill and the legalization of abortion led to an increase in out-of-wedlock childbearing in the U.S. as the rate of “shotgun marriages” declined.
The earliest birth control pill contained 10 times the progestin and four times the estrogen found in today’s pills. That high dose caused some women to experience such side effects as headaches, nausea, cramps, irregular menstrual bleeding, breast tenderness and weight gain.
Other women, especially smokers and those over 35, experienced serious or fatal complications such as blood clots, stroke and heart attack.
In response, women’s reproductive health advocates demanded that pharmaceutical companies inform women of the pill’s potential side effects.
Used Mostly by Unmarried Women
According to Linda Gordon, a New York University history professor and author of “Woman’s Body, Woman’s Right: The History of Birth Control in America,” that public health campaign eventually led to the familiar patient insert, chock-full of warnings, side effects and contraindications, that is now included in every drug approved by the FDA.
Today’s low-dose formulations offer the majority of pill users the same level of contraceptive efficacy while minimizing side effects such as breakthrough bleeding.
Women over age 35 who smoke and those who have high blood pressure, however, still should not use the pill.
The pill is most widely used by unmarried women in their 20s, making age the biggest determinant of pill use in the United States, said Darroch. Fifty-two percent of 20- to 24-year-old women using contraception choose the pill, compared with 11% of 35- to 39-year-olds.
With increasing concerns about HIV and other sexually transmitted diseases, U.S. pill use--which does not offer protection against such diseases--decreased between 1988 and 1995. Reliance on condoms has increased, according to a 1998 study in Family Planning Perspectives.
Balanced against the adverse side effects of the pill are several surprising health benefits.
The pill regulates irregular periods, reduces menstrual flow and menstrual cramps, decreases risk of iron-deficiency anemia and protects against ovarian and endometrial cancer, pelvic inflammatory disease and benign breast cysts. One product, Ortho Tri-Cyclen, is FDA-approved to treat mild to moderate acne in girls 15 and older.
Yet misconceptions about the pill still exist.
In a focus group of Vietnamese American women conducted by the National Asian Women’s Health Organization, some women believed that the pill would adversely affect their fertility or cause retardation in children born after they stopped using the pill.
“Language barriers and lack of health information targeted at Asian Americans may be to blame,” said Afton Hirohama, a spokeswoman for the San Francisco-based advocacy group.
Some experts cite the lingering fear of the earlier high-dose pills and their side effects as well as the recent reports that pill use may increase the risk of serious health problems such as breast and cervical cancer and cardiovascular disease.
Among young Latinas who have never been pregnant, religious beliefs may hinder using birth control of any kind.
“Latina women often don’t talk about [birth control] at home, school or church. When they do receive information, it’s [often] incorrect,” said reproductive health counselor America Casillas of County-USC Medical Center.
Some reproductive health specialists feel the pill could do even more.
For example, in cases in which women wish to avoid any menstrual bleeding, they might skip the seven “dummy” or inactive pills that otherwise prompt bleeding once a month.
“For decades, doctors have recommended using the pill to suppress periods for a woman with endometriosis or to occasionally skip the period if it coincided with her honeymoon or other special event,” said Dr. Anita Nelson of the UCLA School of Medicine.
Lack of Knowledge Remains a Problem
Painful menstruation “is the single greatest cause of lost days of work and school for young women,” Nelson said. Endometriosis is a disorder characterized by painful cramps during periods, pain during sex, and heavy or irregular bleeding.
Until recently, however, the choice of continual suppression of the period has never been openly discussed with women.
In fact, more information is needed about the pill overall.
“The No. 1 barrier to pill use is that women don’t know a lot about it, don’t know how it works, what it does to them or the health benefits,” said Vera Zlidar of Population Reports, a publication of the Johns Hopkins University School of Public Health and author of an upcoming report on barriers to pill use. “No one took the time to explain it,” said Zlidar.
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Cathy Pascual can be reached at cathy.pascual@latimes.com.
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Contraceptives Through the Ages
Source: The Contraception Report
