The Birth of the Pill
Author: Jonathan Eig
Perhaps no other medical innovation has altered human attitudes and behaviour as much as the contraceptive pill, and this book is a comprehensive exploration of both the health and cultural dimensions of this breakthrough. As the book recounts how the pill became ‘one of the most widely prescribed drugs in the world’, it not only discussed its role in birth control, it also reveals its health benefits in the prevention of heart disease and cancer. The book is set within the social context of the time when ‘sex had become a more casual endeavor’, and women ‘had been exploring their own new moral standards’. Therefore, alongside its chronicle of the scientific advances that led to the pill, the book also narrates the history of the birth control movement, what the author referred to as ‘a human rights campaign that would have world-changing impact, reshaping everything, including family, politics, and the economy‘, and ‘contribute to the spread of divorce, infidelity, single parenthood, abortion, and pornography‘. And the main thread in the book is the joint venture undertaken by Margaret Sanger, ‘one of the legendary crusaders of the twentieth century’, and Gregory Pincus, ‘a scientist with a genius IQ and a dubious reputation’. With themes of the belief in ‘free love‘ and concern for the health and welfare of women on one hand, and the scientific drive to discover on the other, this is a story of how one development cut across the spectrum of society and remodelled healthcare (pages 1-3, 5-6, 39, 55-56 and 320-321).
Gregory Pincus is the scientist who deserves almost all the credit for developing the contraceptive pill, and this book chronicles his detailed life story dating back to his birth into a family in which the author said both genius and instability ran. These traits are indeed reflected in the narrative which charted his enviable and rapid academic progress to professor of biology, becoming ‘perhaps the world’s leading expert on mammalian reproduction‘. Portraying Pincus as a scientist with a ‘reputation as a renegade and creative thinker‘ who ‘inspired his subordinates with his confidence and ingenuity‘, the book maintained that he was driven, not by ‘sex, money, power, or fame‘, but by ‘the quest for greatness‘ – an ambition that spurred his radical experimental reproductive research that provoked professional and public outcry, and led to his dismissal from Harvard. It is remarkable that after his setbacks in the orthodox academic settings, Pincus proceeded to set up an independent research facility, the Worcester Foundation for Experimental Biology, going on to ‘establish a reputation for leadership among his peers’, and becoming ‘an influential player in the scientific community’. It is also notable that, although he was initially ‘interested primarily in the science’ of the contraceptive pill, the author said he was open-minded enough to ‘quickly understood the social change a birth-control pill could effect’ (pages 2, 25, 62-84 and 88-89).
At the heart of the book’s scientific narrative is its discussion of the research which Pincus carried out to develop the contraceptive pill. Stating that he set out to apply his understanding of the biology of progesterone to ‘produce’, ‘modify’, and ‘put it to use’ in tablet form, the author described how Pincus saw this as ‘a solution elegant in its simplicity‘. The book described how Pincus established a dose-effect relationship between progesterone and ovulation; how he tested his birth-control formula by collaborating with John Rock, the gynaecologist who would become ‘the most famous fertility specialist in the country’; and how he carried out what the author portrayed as ‘one of the boldest and most controversial field trials in the history of modern drugs’; this was the study which established the full effectiveness of norethynodrel, the synthetic progestin that was ‘many times more powerful than natural progesterone. It is interesting that Pincus’s formula was initially approved, not for birth control, but as a treatment for menstrual disorders and infertility – a phenomenon the author termed ‘the double effect‘. The author noted that ‘Pincus would dedicate the rest of his life to improving the pill and promoting it around the world’ (pages 9-10, 33, 103-120, 130-134, 161, 191, 252, 256-258, 264-266 and 312-313).
Whilst Pincus was the academic force behind the creation of the pill, the book made it clear that his success would have been near impossible without the drive and support of Margaret Sanger, the woman whose desire ‘for an inexpensive, easy-to-use, and completely foolproof method of contraception’ led to her ‘almost single-handedly’ pioneer ‘the movement for contraceptive rights in the United States’. Asserting that her philosophy was ‘born of a strong libido and a strong mind‘, the author argued that Sanger viewed sex not just as a recreational activity, but as ‘a path of self-improvement, a source of health and happiness, and perhaps even liberation‘. Attributing her worldly outlook to her contact with such radicals as Eugene Debs and Emma Goldman, the author identified her key objectives as how ‘to make sexual freedom a part of a broader social reform‘; how to make motherhood voluntary, and how to bring about ‘a complete change in values and attitudes toward the role of women in society’. Explaining that Sanger ‘had always been good at bending men to her will, exciting them with her energy and ideas, and then leading them into battle – or into bed’, the book nevertheless suggested that she also had altruistic intentions arising from her nursing experience when she witnessed women dying during childbirth ‘because their bodies could not hold up against the strain of producing so many babies in such poor conditions, or because they used primitive birth-control devices that caused infection, or because butchers posing as abortionists botched their jobs’. In its wider portrayal of Sanger, the book also explored her involvement with, and support from, the eugenics movement, noting that she shared their philosophy of sterilization and isolation of the ‘unfit’, but rationalising that she was ‘not necessarily a racist‘ (pages 3, 20, 29-36 and 52-53).
A fascinating theme of the book is its description of the revolutionary activities which Sanger used to build a ‘grassroots movement…with the support of radical feminists, socialists, and sexual freethinkers‘. After she was repeatedly arrested for ‘violating U.S. obscenity laws‘, the book followed her relocation to Europe where she met Henry Ellis, the leading sexual psychologist who the author said ‘educated her on the science of contraception and the economic peril of population growth‘, and who ‘encouraged her to read about eugenics‘. The book also described her activities on returning to the United States where she implemented her concept of contraception as a ‘personal choice‘, and as the determination of ‘who should and should not be giving birth‘. The book showed how, as she ‘grew more sophisticated in her radicalism‘, she avoided ‘challenging society’s conservative views on sex’, but rather promoted the benefits of contraception to public health’, and appealing to ‘doctors, scientists, and corporate leaders to join her crusade‘. The narrative also chronicled the opening of her birth control clinics and how she helped to found the Planned Parenthood Federation of America. The author also highlighted the financial support she got for these and her other activities from her rich businessman husband Noah Slee, the man who provided her ‘all the money she wanted for her cause’, and from her friend Katharine McCormack, ‘one of the world’s wealthiest women’ who was ‘determined to fight for women’s rights’ (pages 11, 39-52 and 90-101).
In its discussion of the history of contraception, the author asserted that ‘for as long as men and women have been making babies they’ve also been trying not to’. On this background, the book described the contraceptive methods that have been used before the discovery of the pill, and these included antiseptic soap, cervical caps, and the douche. The author also narrated the extensive methods by which abortions were obtained, including such extreme methods as swallowing lye and gunpowder, inserting leeches and other foreign bodies, and self-inflicted trauma. The book also explored the evolution of the scientific understanding of how sex hormones control the menstrual cycle going back to 1937 when scientists discovered that ‘injection of the hormone progesterone prevented ovulation in rabbits’. Similarly, the book recounted the history of the changes in social attitudes to sex and family planning; in doing this, the author discussed the key personalities who altered ‘American attitudes toward sex, for example Alfred Kinsey, the man whose surveys of sexual behaviour ‘made Americans feel less shame about sex’, and Wilhelm Reich – ‘the prophet of the orgasm‘ (pages 7, 9, 14-18 and 38-39).
This is an exhaustive account that depicts the medical, social and moral dimensions of what is otherwise a simple innovation. With a skilful narrative that weaves the academic and research work with the sexual and cultural movements that drove it, the book presents a broad perspective of the subject. Although the content is presented with journalistic flair and a rather over-dramatised prose, the content is well researched and the stories very easy to follow. The author also simplified the complex concepts and research that the book addressed, and his excellent storytelling brought out the exciting lives of the major characters in the story. Although a few chapters were dragged out and repetitious, this is compensated by its unique semi-chronological narrative, and by its short, direct and punchy sentences.
This is an enthralling account of one of the most innovative and disruptive medical discoveries, and the book brings out its far-reaching clinical and public health implications. The book emphasises the immense medical applications of the pill, although it shows that its inspiration and core applications are founded in hedonistic roots. The book particularly highlights the social and cultural motives that drove this medical advance, and the fundamental changes that it wrought to individuals, to families, and to society. The narrative documents both the inventive spirit and the serendipitous ingredients that frequently combine to produce scientific breakthroughs. The book demonstrates how the contraceptive pill has become a ubiquitous player in health and disease, and I recommend it to all doctors.
Publisher, Place, Year: Macmillan, London, 2014
Number of chapters: 23
Number of pages: 388
Star rating: 4