50th Anniversary of The Pill

It was almost Christmas in London, 1956. Elvis Presley's "Love Me Tender" was playing on the jukeboxes in Soho and a young Gloria Steinem was waiting to collect her visa so she could fly on to India to study. She was just 22, an American graduate student with a precious, hard-won scholarship.

Two decades later, she would be one of the world's most high-profile and glamorous feminists, but right now, pretty Steinem, with her brown eyes and high spirits, was fancy-free and it had taken some daring to achieve that. Just weeks before, she had broken off her engagement to a handsome pilot back in the US. Now, an exotic adventure lay ahead. Then, to her horror, she discovered she was pregnant.

In the mid '50s, abortion was still illegal, and women only had a few ways to stop getting pregnant: withdrawal, condoms, the rhythm method, spermicides and the barrier method of the diaphragm. Or, they could just leave it to luck. Unbelievably, Steinem had done the last. She had been using the diaphragm (although she had to lie to her American doctor that she was almost married to get hold of one), but she had discarded it after the break-up. Then, she had not been able to resist a last bout of farewell sex with her ex-fiance.

Now she was in London, on her own, with her heart in her mouth, a baby on the way, and her scholarship in jeopardy. As she panicked over her condition, a friend confided how she could get an abortion. It cost her half the $1000 she had saved for her trip. But Steinem had never been so relieved.

Years later, she remembered: "My own [abortion] had taken place in a time of such isolation, illegality and fear that afterwards, I did my best just to forget."

In that, she was like millions of other women whose bodies got in the way of their dreams, their futures and their safety. There was very little they could do about it. But, just over three years after Steinem's abortion, the world for women shifted on its axis.

In May 1960, the US government's Food and Drug Administration (FDA) gave conditional approval to a new drug. It was a tiny tablet, stuffed with powerful female hormones, and it stopped a woman ovulating. Without ovulation, a woman couldn't get pregnant. All she had to do was swallow the tablet once a day. It sounded like something out of a fairytale. The drug was quickly nick-named the pill.

"It was an unbelievably wonderful gift to women," remembers Australian feminist and educator Wendy McCarthy who, as a young teacher, had suffered through her own terrifying termination at an illegal abortion clinic in Sydney's La Perouse in the early '60s.

The Economist, the serious, high-minded magazine, called the pill, which was more than 99 per cent effective, "the greatest advance in science and technology in the 20th century". It meant women could make love without making babies. Better still, they could plan their lives and make choices. It meant freedom.

That was certainly the case for New York housewife and former secretary Betsy Webster. She had had four children - two of them unplanned - by the time she was 32.

"Young women today don't know what it was like not to be able to plan from month to month. You just never knew," she recalls. "There was always angst about whether or not you'd get your period. And if you did, it was like, 'Phew! I have another month when my life isn't going to change.' Even with the very best contraceptives available at the time, like a diaphragm and [spermicidal] jelly, women got pregnant at a very high rate," says Webster.

"You could never think, 'When I'm going to be a neurosurgeon ...' We didn't have the opportunity to be anything but teachers, nurses and secretaries. They were female jobs; they could be worked around a family."

The pill changed all that. Within three years of it being getting FDA approval, more than two million women were taking it. By 1970, the figure was more than eight million. The drug was approved in Australia in 1961 and it is still the most popular method of birth control here, with between 22 and 40 per cent of contracepting women taking a version of it.

Today - 50 years later - more than 200 million women around the world have taken the pill, and 100 million women are taking it right now.

The impact was immediate. In Australia, the number of married women in the workplace soared after 1970. In 1961, only 17 per cent of married women worked; 10 years later, it was 33 per cent and, by 1981, 42 per cent. Similarly, the percentage of female students at Australian universities doubled between 1961 and 1981. Other social factors were at work, but birth control was crucial.

But it wasn't all easy and the pill wasn't all miracle. The story of this drug is one of euphoria, new freedoms and breakthroughs, but it's also a tale of cover-up and old-fashioned male high-handedness towards women's concerns.

For a start, although the pill was legally available to all women in Australia from 1961, in practice, doctors - who were still mostly male - were often loath to prescribe it to single women.

Jill Michelson, now national clinical advisor to Marie Stopes International, the sex and reproductive healthcare provider, remembers when she asked her Adelaide family doctor for a prescription, he said he was going to tell her mother.

"I was over 21," she exclaims. "But I was unmarried. I felt disgusting, revolting."

When Wendy McCarthy, alarmed after her abortion, visited a middle-aged gynaecologist in Macquarie Street in Sydney in June 1964 to get the pill, he postdated her prescription to December, six months later, the date she'd told him she was getting married.

"I was so timid, I just said, 'Oh, OK,'" McCarthy remembers with a disbelieving laugh. "Then I went and told my married friend and she said that it was alright, she'd tell her doctor she'd lost her prescription and I could have hers!"

Those pills had four times or more the oestrogen and 10 times the progestogen of today's pills. "You couldn't give them to a racehorse now," says McCarthy, who was so grateful for the freedom from worry, she has never minded.

But even if she had, it wouldn't have made much difference. So long as doctors thought a patient was married - or were happy with sighting the hastily bought ring on her finger - few bothered to give women careful physical checks before handing out the pill. They didn't even ask the most basic question, which all
doctors ask now: were they smokers? "We all smoked!" says McCarthy.

Nobody had yet realised the potentially dangerous impact of the magic pill.

Erica Jong, the woman whose liberated novel Fear Of Flying has sold more than 20 million copies, took the pill for only a year or so in her 20s. It gave her acne and made her feel nauseous. Then she learnt there were bigger problems.

"That early pill was dangerous. It produced breast cancer and clots in some people, especially in smokers. We forget that women were guinea pigs for the use of oestrogen."

High-powered lawyer Alice Wolfson was a long-haired college graduate living in Washington DC in 1970. Wolfson had moved in with her boyfriend some years before and had started taking the pill then. ("My mother didn't talk to me for a year," she quips.)

Like her friends, she had been on the original high-dose pill, Enovid, with its 150mcg of oestrogen and 10mg of progestogen. (For comparison, a popular pill of today like Yaz has 20mcg of oestrogen.) After a while she noticed her hair was falling out, her breasts were swollen and she had heavy periods.

Her friends noticed similar side effects. They were all early radicals and when they heard there was a US Senate hearing into the pill, they decided to go and listen. The hearings had been called because, a year earlier, an explosive book called The Doctors' Case Against the Pill, by journalist Barbara Seaman, had documented links between the pill and thrombosis (blood-clotting), stroke, cancer, heart disease and a litany of other side effects.

By 1961, Enovid's manufacturer, Searle, had knowledge of at least 11 deaths.

"None of us went there having any idea of what we were going to hear," says Wolfson. "We're sitting there and we hear all these male researchers talking about the dangers they knew about."

But to the shock of Wolfson and her friends, there were no women giving evidence. No women researchers; no women pill-takers. "Nobody had been given any idea that there could be something the matter with the pill. One of the men testifying said that oestrogen is to cancer what fertiliser is to wheat," says Wolfson in appalled wonder.

"We raised our hands, and you just don't do that in the Senate, and when nobody called on us, we started to stand up and shout out questions. We were so brave and angry. And then all the cameras turned from the senators to us!" After that, women were called to give evidence and, as a result of the hearings, manufacturers had to include patient warning leaflets - the first ever such inserts - into pill packets. Sales dropped about 20 per cent temporarily, but the pill's popularity returned with the production of new lower-dosage formulations.

Women had discovered they didn't just need control of their wombs; they had to have control of their bodies.

That had always been the intention of Margaret Sanger and without her, and her vision, there may never have been a pill. She was a petite Irish-Catholic, born into a family of 11 children in one of New York's poorest areas in 1879. She had first dreamt of a "magic pill" in 1912 after her worn-out mother - who'd had 18 pregnancies - died at 50. At the time, anti-obscenity laws criminalised birth control and Sanger's life became one of protests and arrests, as she opened birth control clinics. Serendipity led her to a benefactor, Katharine McCormick, who was prepared to put money into the search for a birth control pill that could be "swallowed like an aspirin" as Sanger put it.

In 1951, Sanger, then 71, met biologist and world expert on female fertility Gregory Pincus at a dinner party in New York, and promptly introduced him to McCormick. A year later, the fourth crucial person came along, gynaecologist John Rock who dreamt of a contraceptive method for married women that would satisfy the Catholic church. (It didn't, in the end.) Only nine years after that dinner party, the pill was on the market.

Today, the contraceptive pill has evolved into many forms: there are pills with low doses of oestrogen; progestogen-only pills, and hormonal implants and intrauterine devices plus a vaginal ring that releases hormones into the blood stream. There are also inroads into new non-hormonal contraceptives that rely on blocking egg implantation and even the male "pill".

Despite such progress, contraception continues to be a problem. Research by Marie Stopes International reveals that 51 per cent of surveyed Australian women had had an unplanned pregnancy and 43 per cent of the 60 per cent using birth control were on the pill.

A spokesperson for the agency says, "There's a real lack of public health education about birth control, where to go to get it, and how to use it properly. It's totally the government's responsibility."

There are other paradoxes, concerning cost. While the older types of the pill are on the Pharmaceutical Benefits Scheme, which makes them cheaper to buy, newer contraceptives aren't. As Dr Sally Cockburn, aka Melbourne radio host and columnist Dr Feelgood, asks: "How come contraception isn't free anyhow? It's not a girlie cosmetic thing."

Betsy Webster puts the pill in its rightful historic place. "I really believe the pill was the impetus behind the women's movement because the women who took it could plan their lives. It gave women the freedom that was essential for women to become all they could become."

Once that had happened - pill, or no pill - there was no going back.