What the Pill Gave Birth To

America and the Pill: A History of Promise, Peril, and Liberation by Elaine Tyler May, Basic Books, 224 pages, $25.95

Elaine Tyler May's new book begins by quoting the lyrics to Loretta Lynn's 1975 anthem, "The Pill," an overburdened housewife's audacious cry of reproductive independence. "Promised me if I'd be your wife/ You'd show me the world/ But all I've seen of this old world/ Is a bed and a doctor bill," Lynn croons. "I'm tearin' down your brooder house/ 'Cause now I've got the pill." No feminist theorist could have better captured both the emancipatory power of the pill and the threat it posed to patriarchy. The pill wasn't just a medical breakthrough; it was part of a social revolution, one that was messy, incomplete, sometimes disappointing, but ultimately life-altering for millions of women.

America and the Pill is a brief history of that revolution, timed to coincide with the 50th anniversary of the Food and Drug Administration's approval of the first birth-control pill. The book covers a lot of ground very quickly; reading it is a bit like being a passenger on a bus tour glancing at the passing landmarks without time to explore any of them. It lacks the depth and richness of May's superb 1995 history of childlessness in America, Barren in the Promised Land.

Still, there are worse things one can say about a book than that it should be longer. May's material is fascinating, even when her treatment of it is cursory. Although America and the Pill is sometimes celebratory, it is actually most useful in illuminating some of the darker corners of the pill's history, a history that women's health activists ought to know.

The story begins with Margaret Sanger (1879–1966), a complex heroine who for decades personified the cause of birth control and family planning. A fiery socialist in her early days, Sanger saw the gruesome consequences of unsafe abortion while working as a nurse in New York's immigrant slums and, in defiance of federal law, called for access to birth control. Though genuinely motivated by a passion for women's liberation, Sanger also embraced eugenics, a more respectable cause at the time than sexual freedom or feminist self-determination; indeed, after World War I, as Sanger's biographer Ellen Chesler has written, "eugenics became a popular craze in this country -- promoted in newspapers and magazines as a kind of secular religion." Collaboration with eugenicists provided Sanger with powerful allies, but it wasn't just a matter of convenience for her; she became an ardent advocate of population control for eugenic purposes.

May quotes a letter that Sanger wrote to her friend and patron, the heiress Katharine Dexter McCormick: "I consider that the world and almost our civilization for the next twenty-five years, is going to depend upon a simple, cheap, safe, contraceptive to be used in poverty stricken slums, jungles, and among the most ignorant people." She went on to call for immediate "national sterilization for certain dysgenic types."

One of the central tensions in Sanger's work, then, was between her commitment to reproductive freedom and her willingness to sanction reproductive coercion. A similar tension is at work throughout the history May recounts. McCormick, a brilliant feminist who was the second woman to graduate from the Massachusetts Institute of Technology, bankrolled the pill out of a commitment to women's rights. But as May writes, the scientists and doctors who developed the pill never envisioned it as an agent of female emancipation. Rather, they "hailed it as a miracle drug that would solve the global problem of overpopulation, thereby reducing poverty and human misery, especially in the developing world." They also hoped it would improve marital sex and domestic harmony, strengthening the nuclear family. In other words, they saw it as a tool for preserving existing power relations, not shaking them up.

It's a bleak irony that if the pill's inventors had been more concerned with women's health, they might have taken much longer to develop it. One of the scientists involved, Gregory Pincus, tested a version of the pill on 15 psychiatric patients at the Worcester State Hospital in Massachusetts. Early pills used far higher doses of hormones than modern contraceptives do, and during large-scale clinical trials in Puerto Rico, the side effects were so severe that a female doctor tried to halt the study, to no avail. "Pincus claimed that many of the women's symptoms were psychosomatic," May writes.

As May makes clear, such abuses weren't specific to the testing of the birth-control pill -- they were common to all drug development. "By the standards of the day, the [Puerto Rico] studies were scrupulously conducted," she writes. Furthermore, the women in Puerto Rico were hardly coerced; so many women were so desperate to control their fertility that the scientists had waiting lists of volunteers. Nevertheless, it's undeniable that the creation of the pill often involved a cavalier attitude toward poor or sick women.

May's own father, Dr. Edward Tyler, actually held up federal approval of the pill because of concerns about its safety. The head of the Planned Parenthood Clinic in Los Angeles, he had used the same hormonal compounds found in the pill to treat various gynecological disorders and discovered that they often caused weight gain, abnormal bleeding, swelling, and other problems. But eventually, Tyler assured an official of the Food and Drug Administration "that his earlier concerns had been addressed, and that he was now convinced that Enovid, as the pill was called, 'was safe.'" What changed his mind? May doesn't say.

In one of America and the Pill's most interesting chapters, May asks whether men would tolerate the sorts of side effects that women have regularly experienced. The prospect of a male pill has appeared on the horizon various times over the last 50 years, but the issue of side effects scuttled every effort. Scientists, May reports, "actually discovered an effective vaccine that completely stopped the production of sperm without interfering with sex drive." But it also made users' testicles shrink by a third, so the researchers abandoned it, concluding, "The psychological trauma of shrinking testes just cannot be overcome."

Yet for all this, as May demonstrates, the pill has been a tremendous boon for women, transforming sex and reproduction so thoroughly that it's hard for many to imagine what life was like before it. In the 1960s and 1970s, Black Power leaders denounced the pill as a tool of black genocide -- rhetoric often echoed by today's anti-abortion movement. But female civil-rights activists saw things very differently. "Although they were aware that some white proponents of the birth control pill and other forms of contraception hoped to reduce the numbers of black babies, they wanted the pill and saw it as essential to their reproductive freedom," May writes. For most women, the intentions behind the pill matter much less than its practical effectiveness.

Though May doesn't say it, right-wing opposition to the pill has probably helped temper earlier left-wing objections. As she points out, Our Bodies Ourselves, the feminist health bible, was deeply skeptical of the pill throughout the 1970s and 1980s, but by 2005, with new, low-dose formulations on the market and the culture wars in full swing, the book sang the pill's praises: "The advent of the Pill, probably more than any other event, has enabled women the world over to prevent or delay pregnancy and, in doing so, to complete our educations, choose our careers, and create more egalitarian relationships."

May herself doesn't go quite so far -- she sees the pill as much as a symbol of feminist gains as a cause. "Without the political and cultural upheavals of the last fifty years, particularly those brought about by the feminist movement, the pill would have been just one more contraceptive -- more effective and convenient than those that came before, but not revolutionary," she writes in her conclusion.

She's absolutely right. After all, the pill is widely available in Saudi Arabia, but it hasn't made a dent in that country's brutal patriarchy. Part of the problem with America and the Pill, though, is that it doesn't take the time to delve into the social maelstroms that made the pill so significant. The millions of women who, like Loretta Lynn's narrator, have used the pill to slip the bonds of biology, turning childbearing from an obligation into an option, have utterly reshaped our ideas about sex, marriage, and family. The furious, socially conservative backlash those women have engendered continues to dominate our politics. This slender book can only give us the contours of that tumultuous, still-unfolding story.