The Pill at 50: Sex, Freedom and Paradox

In May 1960, the FDA approved a new oral contraceptive. Somehow we are still fighting about it half a century later — whom it helped, whom it hurt, what it meant and why it mattered

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Combined monophasic early contraception pill, 1960. Pink contraceptive pills (marked 'PD') in a circular blue plastic dispenser.

There's no such thing as the Car or the Shoe or the Laundry Soap. But everyone knows the Pill, whose FDA approval 50 years ago rearranged the furniture of human relations in ways that we've argued about ever since.

Consider the contradictions: It was the first medicine ever designed to be taken regularly by people who were not sick. Its main inventor was a conservative Catholic who was looking for a treatment for infertility and instead found a guarantee of it. It was blamed for unleashing the sexual revolution among suddenly swinging singles, despite the fact that throughout the 1960s, women usually had to be married to get it. Its supporters hoped it would strengthen marriage by easing the strain of unwanted children; its critics still charge that the Pill gave rise to promiscuity, adultery and the breakdown of the family. In 1999 the Economist named it the most important scientific advance of the 20th century, but Gloria Steinem, one of the era's most influential feminists, calls its impact "overrated." One of the world's largest studies of the Pill — 46,000 women followed for nearly 40 years — was released this March. It found that women who take the Pill are less likely to die prematurely from any cause, including cancer and heart disease, yet many women still question whether the health risks outweigh the benefits.

Maybe it's the nature of icons to be both worshipped and stoned, laden with symbolic value beyond their proportions. Because the Pill arrived at a moment of epochal social change, it became a handy explanation for the inexplicable. The 1950s felt so safe and smug, the '60s so raw and raucous, the revolutions stacked one on top of another, in race relations, gender roles, generational conflict, the clash of church and state — so many values and vanities tossed on the bonfire, and no one had a concordance to explain why it was all happening at once. Thus did Woodstock, caked in muddy legend, become much more than a concert, and leaders become martyrs, and the pill become the Pill, the means by which women untied their aprons, scooped up their ambitions and marched eagerly into the new age.

That age has seen changes in social behavior that continue to accelerate. In 1960 the typical American woman had 3.6 children; by 1980 the number had dropped below 2. For the first time, more women identified themselves as workers than as homemakers. "There is a straight line between the Pill and the changes in family structure we now see," says National Organization for Women (NOW) president Terry O'Neill, "with 22% of women earning more than their husbands. In 1970, 70% of women with children under 6 were at home; 30% worked. Now that's roughly reversed."

Today more than 100 million women around the world start their day with this tiny tablet. So small. So powerful. But in surprising ways, so misunderstood.

Improvising Infertility
As long as people have been making little people, they've wanted to know how not to. The ancient Egyptians mixed a paste out of crocodile dung and formed it into a pessary, or vaginal insert. Aristotle proposed cedar oil and frankincense oil as spermicides; Casanova wrote of using half a lemon as a cervical cap. The condom is often credited to one Dr. Condom in the mid-1700s, who was said to have invented a sheath made out of sheep intestines for England's King Charles II to help limit the number of bastards he sired, though such devices had actually been around for centuries.

"The Pill was not at all what separated reproduction and sex among married people," argues Harvard economist Claudia Goldin, who calls that "among the biggest misconceptions" about sexual behavior and the Pill. Long before its introduction, women already knew how to avoid pregnancy, however imperfectly. The typical white American woman in 1800 gave birth seven times; by 1900 the average was down to 3.5.

But well into the modern age, contraception met with unified opposition from across the religious spectrum, Protestants and Catholics, Western and Eastern Orthodox. Sex, even within marriage, was immoral unless aimed at having a baby. Fear of pregnancy was a powerful check on promiscuity — and information about contraception was treated as the equivalent of pornography. In 1873 Congress passed a law banning birth control information as obscene. So women seeking ways to limit the number of children they bore had to know how to read the papers. Through the turn of the century, advertisements for potions to treat "female disorders" or menstrual irregularities carried a bold, bright warning: "Portuguese Female Pills, not to be used during pregnancy for they will cause miscarriage."

The warning, of course, was the ad.

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