The Pill At 40

By Suzanne White Junod

In a century of astonishing scientific achievements, I imagine that the computer dominates the mind of most people in these (still) lucrative dot com days. And while there may have been impressive singular moments of technological triumph over the last 100 years, few have had as much impact on society as the development of a tiny tablet, the Pill.

This summer marks the 40th anniversary of the day the Food and Drug Administration approved, on June 23, 1960, the first oral contraceptive, Enovid by G.D. Searle. It may not have rocked the ground like the 1945 detonation of the first atomic bomb or energized an industry, like the first time current flowed through a transistor in 1947, but Enovid did more than just provide a technological tour de force. It transformed the very fabric of modern society.

Physiologically, the birth control pill simply prevents ovulation. Though an important scientific achievement, the real revolution began when millions of young women began to use it.

Searle's first marketing campaign showed its understanding of the Pill's revolutionary potential. One marketing logo featured the dramatic, colorful image of a sensuous Greek goddess freed from her bondage. This concept, however, proved too potent for the general public. Marketing for the Pill quickly switched to themes of domestic tranquility, portraying cozy couples, newly married and merely wishing to postpone their children.

Sexual liberation did not appeal to the U.S. government, either. When the Eisenhower administration released a report suggesting that family planning be included in a European aid program, opposition by Catholic bishops killed the plan. The government thereafter said little about the Pill. It was treated as merely another drug, its approval deemed a medical decision best dealt with by the pharmacology experts. So it was sent to the bureaucratic hinterlands, to a smallish agency just refining its scientific foundation: The Food and Drug Administration.

The Pill presented FDA with several dilemmas. Commissioner George Larrick, the last agency commissioner to rise up through the ranks, worried about potentially medicating half the population for something that wasn't a disease. What would its side effects be in healthy women? Some experts feared that it might cause cancers, which might not be seen for decades. This proved not to be the case, and, in fact, the Pill has proven to protect women from certain kinds of reproductive cancers. More significantly, however, some women developed severe blood clots while on the Pill and died. It took a decade to conclusively link the Pill with these adverse events, but early reductions in the drug's estrogen component substantially cut the risk.

Commissioner Larrick pondered the medical pros and cons, and according to witnesses, finally concluded that young couples might benefit from the ability to plan their families more carefully. But, the agency remained cautious. The Pill was the first and only drug approved with an imposed time limit. Women were not to be prescribed the Pill for more than two years until more data came in showing that it was safe to take it for longer periods. Many women, though, skated around the time limit by changing doctors and contraceptive brands. The restriction proved unenforceable.

Whatever its scientific issues, the Pill took the country by storm. Its extreme efficacy in preventing pregnancy opened up many new worlds. Young women with access to the Pill experimented with sex on college campuses. Mothers limited their families, both with and without their husband's approval. Catholics in the United States, who were largely expected to reject the Pill, split with Rome over the issue.

A physician friend credits the Pill, in fact, with paving the way for many of the advances in late 20th century medicine. He vividly recalls that almost all of the physicians in the class ahead of him in medical school already had children by the time they graduated. They hurried into practice to support them. His class, however, was the first whose wives had access to the Pill, and virtually none of them had children at graduation. This allowed some to pursue advanced training and altered the very course of their careers.

New reproductive choices unleashed not only new professional energies, but new social energies as well. The women's movement and even the civil rights movement were fueled by some of these new energies.

But for many, the revolution was more personal, as country-western singer Loretta Lynn crooned in the her musical tribute to the Pill:

This incubator is overused because you kept it filled,
The feeling good comes easy now since I've got the Pill!
It's gettin' dark, it's roosting time,
tonight's too good to be real,
And Daddy, don't you worry none,
'cause Mama's got the Pill.

Suzanne White Junod, Ph.D., is an FDA historian.

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