The Birth Control Pill
In the middle of the 20th century, an age-old
quest for safe and effective oral contraception
was realized. The woman who made that happen
was Margaret Sanger (1879–1966), the founder
of the American Birth Control League, the forerunner of Planned Parenthood Federation of
America (Chesler, 1992).
Planned Parenthood has played and continues
to play a central role in making safe and effective
family planning, including the pill, available to
women and men around the world:
• from 1916, when Margaret Sanger opened
the first birth control clinic in America
• to 1950, when Planned Parenthood
underwrote the initial search for a
superlative oral contraceptive
• to 1952 when Planned Parenthood
helped found the International Planned
• to 1965, when Planned Parenthood of
Connecticut won the U.S. Supreme Court
victory, Griswold v. Connecticut (Griswold),
that finally and completely rolled back state
and local laws that had outlawed the use of
contraception by married couples
• to today, when Planned Parenthood
continues leading the family planning
movement by successfully defending and
expanding women’s reproductive rights and
options against those who would diminish
them (Chesler, 1992; Feldt & Knowles, 2002).
Margaret Sanger’s Brainchild
In her 70s, and years after most people retire,
Sanger achieved one of the greatest accomplishments of her career. As honorary president
and chair of Planned Parenthood Federation of
America, she drove the research and development of the century’s most revolutionary medical
breakthrough — after penicillin — the pill. Sanger
had won for most women in the U.S. the right to
use contraception. Now she would develop a
method that was nearly 100 percent effective.
Birth Control – History of the Pill • 1
Katharine Dexter McCormick
In the 1940s and 1950s, Sanger closely followed
scientific research on birth control and personally funded some of it. Planned Parenthood
Federation of America also made support for
new birth control technology a major focus of its
advocacy efforts. The turning point came when
Sanger’s longtime friend — Katharine Dexter
McCormick — threw her financial support behind
research to produce an oral contraceptive
McCormick was Sanger’s closest collaborator
during her career. She was an avid crusader
for women’s rights, had been a leader in the
suffrage movement (Fields, 2003), had helped
establish the League of Women Voters (Fields,
2003), and was the second woman to graduate
from the Massachusetts Institute of Technology
(Fields, 2003), where she studied biology.
McCormick was also heir to the International
Harvester fortune. In 1950, following the death
of her husband, Stanley, McCormick wrote to
Sanger to ask how she could use her inheritance
to contribute to contraceptive research (Chesler,
1992). This helped Sanger shift her search for an
oral contraceptive into high gear during 1951
In 1953, Sanger took McCormick on a personal
visit to the Worcester Foundation for Experimental Biology in Massachusetts, where
research scientists Gregory Pincus and Min
Chueh Chang were conducting experiments that
Sanger considered promising — at her behest,
they were trying to produce an oral contraceptive based on synthetic progesterone.
Inspired by the visit, McCormick — also in her 70s
— used her scientific knowledge to watch over
the research process. As Gregory Pincus said,
“she knew the field” (Fields, 2003). And she used
her inheritance to supply the financial backing
that was so desperately needed.
2 • Birth Control – History of the Pill
McCormick first pledged $10,000 toward the
research. Soon after, she began contributing
$150,000 to $180,000 a year, funneling a portion
of the money through Planned Parenthood’s
research grant program. (Planned Parenthood
had supported Pincus’ early studies on mammalian eggs that led him to the work he would do
on the development of the pill.) The total of
McCormick’s gifts to the research was $2 million,
which would be more than $18 million in today’s
dollars (Asbell, 1995; Chesler, 1992; Grimes,
All in all, McCormick donated the lion’s share of
the financial resources needed for the research
that enabled the fulfillment of the dream she
shared with Sanger — making birth control safe,
dependable, affordable, and controlled by
women (Chesler, 1992).
The efforts to develop an oral contraceptive would have been for naught, however, if it
hadn’t been for the medical folk traditions of the
descendants of the Aztecs. The basic research
for the pill became possible when Russell
Marker discovered that generations of Mexican
women had been eating a certain wild yam —
the Barbasco root, also called cabeza de negro
— for contraception (Asbell, 1995). It was from
these yams that Marker was able to extract the
progestin that Gregory Pincus combined with
estrogen to formulate the first birth control pill
Dr. John Rock (1890–1984)
McCormick also funded the first clinical trials
of the pill, which were conducted by Dr. John
Rock, an eminent gynecologist and a Roman
Catholic, with patients in his private practice.
Rock, who came to be regarded as a co-developer of the pill, worked with Planned Parenthood
staff on a closely reasoned book, The Time Has
Come: A Catholic Doctor’s Proposals to End the
Battle over Birth Control, in which he argued —
unsuccessfully — that the Catholic church should
accept the oral contraceptive as a natural extension of the “rhythm method” (Chesler, 1992).
But distributing contraceptives or information
about contraceptives was illegal in Massachusetts, so Rock had to find another venue for
wider clinical trials, or pay a $1,000 fine each
time he or one of his staff gave a contraceptive
or contraceptive advice to one of the women in
the trial (or spend five years in prison) (Marks,
2001). Holding yearlong, large-scale trials in
other states where contraception was legal was
also challenging because, after World War II,
American women of reproductive age became
highly mobile. Keeping a trial cohort together for
up to three years was absolutely necessary, so
less mobile populations of women were sought
After also considering Japan, Hawaii, India,
Mexico, and New York, Rock and his colleagues
settled on Puerto Rico as the best place to hold
the trials (Marks, 2001). From the very beginning,
this decision opened them to fallacious charges of
racism (Tone, 2001; Marsh & Ronner, 2008). In fact,
they settled on Puerto Rico for several reasons:
• It had no laws against contraception.
• It had a well-established network of birth
• It was close enough to the U.S. to allow easy
visits from the research team.
• Many medical practitioners on the island
had been trained in the U.S., and Pincus
knew and trusted them.
• Many of the women were semi-literate or
illiterate, which allowed the researchers
to test whether or not the pill could
also be used by women around the
world, regardless of their educational
• Puerto Rico was an island with a relatively
stable population that could be followed for
the full length of the trial.
• Many Puerto Rican women were eager to
have more effective methods of reversible
birth control than those that were available
to them (Marks, 2001; Tone, 2001; Marsh &
Participants had to meet four criteria: They had
to be in good health. They had to be under 40.
They had to have had at least two children — to
prove they were fertile. And they had to agree to
have a child if they became pregnant during the
study (Tone, 2001).
Critiques of the Clinical Trials for the
Critics of the early pill trials point out retrospectively that the women involved did not give
informed consent with their signatures. In the
late ‘50s and early ‘60s, however, having subjects
sign informed consent documents to participate
in clinical trials was not a common procedure.
In the 1980s, Dr. Luigi Mastroianni, one of John
Rock’s colleagues, recalled that
The concept of informed consent that is so
talked about now, and is a legal requirement
of any research project involving human
volunteers, didn’t exist then. But Rock practiced it [informed consent] before it was
ever defined. There were always long and
large discussions of the risk factors. It didn’t
matter that Rock had no formal guidelines,
he set his own, and they were high standards
indeed (Marks, 2001).
Retrospective critics have been concerned that
the clinical trials did not meet today’s standards.
But the pill was thoroughly tested by the standards of the day. Today, the numbers of women
in the trial and the amount of time they were
observed would not be acceptable. Before the
Food and Drug Administration (FDA) approved
the pill in 1960, 221 women in Puerto Rico had
taken it in two clinical trials. More than 130 of
them had used it for between one and three
years. Thousands more in Australia, Britain,
Birth Control – History of the Pill • 3
Ceylon, Chicago, Haiti, Hong Kong, Japan, Los
Angeles, Mexico City, Seattle, and Tennessee
were involved in clinical trials of various formulations of the pill. Another 500,000 women had
used the first brand — Enovid — for up to three
years for menstrual regulation. But in the end,
Searle submitted reports on only 897 women in
its application for FDA approval (Asbell, 1995;
Marks, 2001; Marsh & Ronner, 2008).
By today’s standards, these were small clinical
trials, but small trials were not unusual at that
time. For example, the 1960 approval of Librium
to treat anxiety was based on the experience of
only 570 psychiatric patients, although 593 other
patients used it for a wide range of conditions
that included ezcema, “frigidity,” heroin addiction, and spastic colon (Junod & Marks, 2002;
History of Psychology, 2010).
A Smashing Success
The clinical trials began in April 1956 (Marsh
& Ronner, 2008). That same year, the journal
Science announced their ongoing success. In
1957, the FDA approved the use of the pill to
regulate menstruation. By 1959, 500,000 women
were ostensibly using it to keep their periods
regular, while enjoying its contraceptive “side
effects.” They knew the medication had contraceptive effects because every package had a
warning about its “contraceptive activity” on the
label (Asbell, 1995).
On June 23, 1960, the FDA approved the sale
of Enovid for use as an oral contraceptive. It was
manufactured by G.D. Searle and Company, a
firm that had also supported Gregory Pincus’
research for many years (Chesler, 1992; FDA,
2000, Grimes, 2000; Lange, 2007).
By 1965, one out of every four married women
in America under 45 had used the pill. By 1967,
nearly 13 million women in the world were
using it. And by 1984 that number would reach
50–80 million (Asbell, 1995). Today more than
4 • Birth Control – History of the Pill
100 million women use the pill (Christin-Maitre,
Sanger’s tenacious efforts, even as her health
declined, brought about the advent of safe and
effective oral contraception and changed the
human sexual landscape forever. It reduced the
risk of unintended pregnancy in the context of
the sexual revolution of the ‘60s and established
family planning as the cultural norm for the U.S.
and in many other countries of the world.
The First Pill
The first pill was effective and simple to use. It
extended to millions of women an unheard-of
control over reproduction, for the first time allowing
them to truly separate vaginal intercourse from
procreation (Bullough & Bullough, 1990). But it was
far from perfect.
The first brand, Enovid, had a lot more hormones
in it than needed to prevent pregnancy. It
contained 10,000 micrograms of progestin and
150 micrograms of estrogen. In comparison,
today’s lower-dose pills are more likely to contain
50–150 micrograms of progestin and 20–50
micrograms of estrogen (Knowles & Ringle,
1998; Tone, 2001).
Side Effects and Adverse Events
The original high doses increased the likelihood and severity of side-effects and the potential for rare, but very serious risks, such as heart
attack and stroke. Unfortunately, it took scientists more than a decade to recognize the risks
and side effects and to learn that much lower
doses were just as effective as the higher doses
at preventing pregnancy.
Side effects had been very apparent in the first
clinical trials. Dr. Edris Rice-Wray, who was in
charge of the first trials in Puerto Rico, reported
early on that 17 percent of the women in the first
cohort had significantly unpleasant side effects,
including dizziness and nausea, as well as headaches and vomiting. In fact, 25 of them withdrew
from the trials because the medication made
them so uncomfortable.
In her first report, Rice-Wray concluded that
although the pill provided nearly 100 percent
protection against unintended pregnancy, “it
causes too many side reactions to be acceptable
generally” (Asbell, 1995; Marsh & Ronner, 2008).
Gregory Pincus, the head of the research team,
was delighted with Rice-Wray’s report that the
pill was so effective at preventing pregnancy by
suppressing ovulation. But he ignored Dr. RiceWray’s concerns about side effects. Perhaps
because Pincus was a biologist, not a physician, he had little clinical empathy for what he
regarded as hypochondria among the women in
the trials (Marsh & Ronner, 2008).
Not only did many women in the first clinical
trials in Puerto Rico have distressing side effects,
one woman died of congestive heart failure,
and another developed pulmonary tuberculosis
(Marks, 2001, 107). During medical checkups and
in reports on the women in the trials, however,
researchers were so focused on watching for
carcinogenic effects and damage to the cervix,
endometrium, liver, and ovaries that it did not
occur to them that these adverse events were
related to the pill (Marks, 2001; Marsh & Ronner,
Early critics of the pill were right that a lot could
be done to improve it. Among the millions of
women using the pill worldwide, there were
disturbing reports of nausea, breast tenderness,
water retention, and weight gain.
Much more alarming was G.D. Searle’s 1961
report to the FDA of 132 incidents of thrombosis (blood clots) and embolism (clots moving
through and blocking a blood vessel) among
women using the pill. But the FDA held that
even if the pill caused these adverse events, the
rate of them — 1.3 out of 100,000 users — was
much lower than the rate of women who would
die from pregnancy complications —36.9 out of
100,000 pregnant women (Asbell, 1995; DHS,
The governments of Norway and the Soviet
Union were not reassured, and they banned the
sale of the pill in 1962 (Asbell, 1995).
Barbara Seaman, Gaylord Nelson,
and Hugh Davis
Among the most vocal, and certainly most effective, critics of the pill in the U.S., was Barbara
Seaman, who published The Doctor’s Case
Against the Pill in 1969. Seaman gave a sensationalized account of hundreds of women who
suffered side effects and adverse reactions that
she and many others associated with the pill. She
also attacked the American College of Obstetricians and Gynecologists and Planned Parenthood Federation of America for providing the
pill, which she claimed was dangerous for all
Medical science would prove Seaman right
about some of the adverse events she claimed
were associated with the pill (e.g., blood clots
and strokes), and it would prove her very wrong
about others (e.g., cancer, harmful genetic
effects, and sterility) (Seaman, 1969; Tone, 2001).
Seaman’s book was important because it
prompted Senator Gaylord Nelson (D-WI) to
hold hearings on whether the pill was dangerous
for the human body and whether or not women
who used the pill had enough information
about possible risks and side effects to make
an informed decision to use it (Lehmann-Haupt,
1970; Tone, 2001).
While many who questioned the use of the
pill were entirely motivated by an interest in
women’s health, some were not. Hugh Davis, for
example, was one of the few gynecologists who
spoke at Senator Nelson’s hearings. He was, in
fact, Nelson’s lead speaker, and he had a financial stake in the development and success of the
Birth Control – History of the Pill • 5
IUD. He was also one of the important medical
authorities who gave credibility to Seaman’s
attack on the pill in her book.
Davis argued in Seaman’s book and testified at
the Nelson hearings that women would be safer
using a new IUD instead of the pill. During his
testimony, Davis covered up the fact that he had
a financial interest in promoting this new IUD
— the Dalkon Shield, which later proved to be a
health catastrophe for thousands of women and
the cause of bankruptcy, in 1985, for its manufacturer, A.H. Robins (Asbell, 1995; Tone, 2001;
Marsh & Ronner, 2008).
The Package Insert
Nelson’s hearings on the safety of the pill ran
from January 14 through March 1970. Feminists
of the day demonstrated against them because
no women were asked to speak about their
experience with the pill. But the hearings did
contribute to the FDA’s eventual decision that pill
packaging must contain an insert with information about possible risks and side effects.
Hundreds of women had written letters to the
FDA during the Nelson hearings to demand that
manufacturers be compelled to give them information about the possible side effects of the
medication they were taking. And it was during
the Nelson hearings that the FDA announced
that it would compose information on the
possible side effects of the pill for a package
insert that would be included with every
package of pills.
But the American Medical Association (AMA)
opposed the use of a package insert on the
grounds that it would undermine a doctor’s
authority with “his” patients.
The FDA backed off, but did require doctors to
give the information to women whenever they
prescribed the pill. Between 1970 and 1975,
however, doctors distributed only four million
6 • Birth Control – History of the Pill
copies of the information to the 10 million
women for whom they prescribed the pill every
year. It wasn’t until 1978 that the FDA required
that the information be inserted into the pill
packages — and it wasn’t until 1980 that the FDA
required that the package insert be intelligible to
the average reader (Marks, 2001; Tone, 2001).
It was during women’s struggle for information
about the benefits and risks of using the pill,
which lasted for two decades during the ‘60s
and ‘70s, that Planned Parenthood earned a
good deal of the respect it enjoys today. During
the information wars between Congress,
the FDA, the AMA, and the women, Planned
Parenthood filled the gap with its own client
information publications about the pill and
developed its own medical standards and
guidelines to ensure that all women who
came to Planned Parenthood for the pill
would receive balanced information about its
risks and benefits (PPFA, 1976).
Despite the controversies around the pill, in
1970, President Richard M. Nixon signed into law
Title X of the Public Health Services Act, which
provided federal support and funding for family
planning services. Working with Title X grants,
Planned Parenthood was able to provide access
to the pill to hundreds of thousands of low-income women across the United States.
A year later, PPFA established it own international program, which was funded largely by
the U.S. Agency for International Development
(USAID). With USAID grants, Planned Parenthood was able to bring effective and safe
modern methods of birth control — including the
pill — to millions of women and men around the
world (Feldt and Knowles, 2002).
The cultural ramifications of the widespread
use of the pill are nearly impossible to measure.
Most women in the ‘70s believed the benefits
of the pill far outweighed the risks. They agreed
with Loretta Lynn that the pill was a key to their
liberation. As she sang in her hit song of 1975,
All these years I’ve stayed at home
While you had all your fun
And every year that’s gone by
Another baby’s come
There’s a-gonna be some changes made
Right here on nursery hill
You’ve set this chicken your last time
‘Cause now I’ve got the pill
This incubator is overused
Because you’ve kept it filled
The feelin’ 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
Oh but daddy don’t you worry none
‘Cause mama’s got the pill
Oh daddy don’t you worry none
‘Cause mama’s got the pill (McHan, 1973)
Mechanism of Action
Non-Contraceptive Uses of the Pill
In 1993, The Economist named the birth control
pill one of the Seven Wonders of the Modern
World because “When the history of the 20th
century is written, it may be seen as the first
[time] when men and women were truly partners.
Wonderful things can come in small packets”
The combined hormone contraceptive pill is
the first line of therapy for women who prefer
to have no periods and for otherwise healthy
women who have
The pill is still America’s most popular reversible
method of contraception. Sixteen percent of all
women between 15 and 44 use the pill (Daniels
et al., 2014). That comes to nearly 30 percent of
all women who use birth control (Guttmacher
If the pill is used as directed, only three out of
1,000 women will become pregnant in the first
year of use. About nine out of 100 less consistent
users will become pregnant in the first year of
use (Nelson & Cwiak, 2011).
The pill works by inhibiting ovulation and by
thickening cervical mucus, which prevents sperm
from entering the fallopian tubes where fertilization takes place. The theory that the pill interferes with implantation has not been proved
(Nelson & Cwiak, 2011).
Possible Side Effects and Risks
Possible side effects that usually last only the
first three months include breast tenderness,
headaches, irregular bleeding, and nausea.
Some women also experience changes in their
sex drive (Nelson & Cwiak, 2011).
Rare but serious health risks include blood clots,
heart attack, stroke, increased blood pressure,
liver tumors, gallstones, and jaundice — women
who are over 35 and smoke are at a greater risk
for some of these problems (Nelson & Cwiak,
• absence of menses due to hyper athleticism
or eating disorders
• anemia due to heavy menses
• certain kinds of recurring ovarian cysts
• emotional challenges that cause fear of
• family histories of cancer of the ovaries
• heavy, infrequent, irregular, or painful
• non-menstrual uterine bleeding
• personal risks for cancer of the
• premenstrual dysphoric disorder
Birth Control – History of the Pill • 7
• symptoms of premenstrual syndrome
(Nelson & Cwiak, 2011)
Non-Contraceptive Benefits of the
Use of combined hormone oral contraceptives
has many non-contraceptive benefits. These
• reduced symptoms of endometriosis
• decreased chances of ectopic pregnancy
• less menstrual flow and cramping
• quick return of ability to become pregnant
when use is stopped
• reduced acne
• reduced bone thinning
• reduced iron deficiency anemia related to
• reduced premenstrual symptoms
• reduced risk of ovarian and endometrial
• shorter and more regular periods
• (Nelson & Cwiak, 2011))
In early 2010, a study of 46,112 women in the U.K.
who were observed for up to 39 years showed
that using the pill did not, overall, increase a
woman’s risk of mortality. It showed, in fact, that
pill use among these women may have increased
longevity (Hannaford et al., 2010).
Impact of the Pill
It was just five years after the pill was approved
for use as a contraceptive in 1960 that birth
control became legal nationwide in the U.S.
That is why the impact of the pill on the health
and lives of women and their families will be
8 • Birth Control – History of the Pill
forever intertwined with the 1965 U.S. Supreme
Court decision in Griswold v. Connecticut, which
protected the constitutional right of married
couples in this country to use birth control (Griswold). (It wasn’t until 1972, in its decision in Eisenstadt v. Baird, that the Supreme Court found that
unmarried people had the same constitutional
right to obtain contraceptives as married people
In the five decades since these events, profound
and beneficial social changes occurred, in large
part because of women’s relatively new freedom
to effectively control their fertility — maternal and
infant health have improved dramatically, the
infant death rate has plummeted, and women
have been able to fulfill increasingly diverse
educational, political, professional, and social
Planning and Spacing Pregnancies
The ability to plan and space pregnancies has
contributed to improved maternal, infant, and
• In 1965, there were 31.6 maternal deaths per
100,000 live births (NCHS, 1967). By 2007,
the rate had been reduced by 60 percent, to
12.7 maternal deaths per 100,000 live births
(Xu et al., 2010).
• In 1965, 24.7 infants under one year of age
died per 1,000 live births (NCHS, 1967).
Preliminary data for 2011 shows that this
figure had declined to 6.05 infant deaths
per 1,000 live births, a 76 percent decrease
(MacDorman et al., 2013).
Since 1965, there has been a dramatic decline
in unwanted births — the result of pregnancies
that women wanted neither at the time they were
conceived nor at any future time. This decline is
particularly welcome because unwanted births
are associated with delayed access to prenatal
care and increased child abuse and neglect
(Piccinino, 1994; Committee on Unintended
• In 1961–1965, 20 percent of births to married
women in the U.S. were unwanted. (Mosher,
1988). By 2006-2010, only 8.9 percent of
births to married women in the U.S. were
unwanted, a 56 percent reduction (Mosher
et al., 2012).
Mistimed births — those that happened sooner
than the woman wanted them — have also
• In 1961–1965, 45 percent of births to married
American women were mistimed; (Mosher,
1988); in 2006-2010, only 16.4 percent of
births to married women in the U.S. were
mistimed, a reduction of 64 percent (Mosher
et al., 2012).
Education and Employment
By enabling women to control their fertility,
access to contraception broadens their ability to
make other choices about their lives, including
those related to education and employment.
Since 1965, the number of women in the U.S.
labor force more than tripled, and women’s
income now constitutes a growing proportion of
• In 1965, 26.2 million women participated in
the U.S. labor force; by 2014, the number
had risen to 73 million (U.S. Census Bureau,
2009; BLS, 2015a).
• The labor force participation rate of married
women nearly doubled between 1960
and 2013 — from 31.9 to 58.9 percent (U.S.
Census Bureau, 2009; BLS, 2014).
• By 2012, 29 percent of women in dualincome families earned more than their
husbands (BLS, 2014).
• In 1960, women represented three percent
of the lawyer population. By 2014, women
represented 33 percent of all lawyers (BLS,
2015b; Epstein, 1981).
• Between 1960 and 2013 the percentage of
women who had completed four or more
years of college increased sixfold — from 5.8
percent to 37 percent (U.S. Department of
Education, 1993; Kena et al., 2014).
• In 1960, only 10 percent of all doctorate
degrees were awarded to women. Today,
women are in parity with men — more
than half (51.4 percent) of doctorates
were awarded to women in 2012–2013
(U.S. Department of Education, 1993; U.S.
Department of Education, 2013).
Publicly Funded Programs
Publicly funded contraception programs have
increased the ability of lower-income women to
exercise the right to control their fertility.
Family planning services available through
Medicaid and Title X of the U.S. Public Health
Service Act help women prevent 2.2 million
unintended pregnancies each year. Without
these family planning services, the number of
unintended pregnancies and abortions would
be nearly two-thirds higher than it is (Frost et al.,
Women and men no longer need to abstain
from sex for fear of having more children than
they can afford or in terror of endangering a
woman’s health with a high-risk pregnancy.
In 1965, 35 percent of married women in the
U.S. used a safe and effective method of family
planning. Only one out of 10 women in the
developing world did so. Today approximately
56 percent of couples worldwide rely on modern
methods of birth control to maintain the health
Birth Control – History of the Pill • 9
and well-being of their families (PRB, 2014; Ryder
& Westoff, 1971).
As more and more women are able to plan their
families with modern methods of contraception
— the IUD and methods such as the implant and
the shot, which derive from the research that
developed the pill — the number of pregnancies
per woman has decreased worldwide. This
decrease has been identified as one of the key
factors associated with recently reported and
significant reduction in the rate of maternal
mortality around the globe (Hogan et al., 2010).
As former U.S. Secretary of State Hillary Rodham
Clinton pointed out during the G8 Conference
in Gatineau, Quebec, “You cannot have maternal
health without reproductive health, and reproductive health includes contraception and family
planning and access to legal, safe abortions”
An Age-Old Need for Birth Control
Having a baby is the least frequent motivator
for most people to have sex (Hill, 1997). This
seems to have been true for all people at all
times throughout history. Contraceptives have
been used in one form or another for thousands
of years — throughout human history and even
prehistory. In fact, family planning has always
been widely practiced, even in societies dominated by social, political, or religious codes that
required people to “be fruitful and multiply” —
from the era of Pericles in ancient Athens to that
of Pope Francis, today (Himes, 1963; Pomeroy,
1975; Blundell, 1995; Wills, 2000).
Of course the methods used before the 20th
century were not always as safe or effective as those available today. Centuries ago,
for example, Chinese women drank lead and
mercury to control fertility, which often resulted
in sterility or death (Skuy, 1995). During the
Middle Ages in Europe, magicians advised
women to wear the testicles of a weasel on their
10 • Birth Control – History of the Pill
thighs or hang its amputated foot around their
necks (Lieberman, 1973). Other birth control
amulets of the time included wreaths of herbs,
desiccated cat livers, shards of cat bones (but
only from the pure black ones), flax lint tied in
a cloth and soaked in menstrual blood, or the
anus of a hare. It was also believed that a woman
could avoid pregnancy by walking three times
around the spot where a pregnant wolf had
In more recent New Brunswick, Canada, women
drank a potion of dried beaver testicles brewed
in a strong alcohol solution. And as recently as
the 1990s, teens in Australia used candy bar
wrappers as condoms (Skuy, 1995).
Perhaps more surprising than such often bizarre
and totally ineffective methods is that modern
science has revealed many other ancient
methods, especially certain herbal treatments,
to be actually somewhat effective — though not
always safe or practical (Riddle, 1992).
The Pill — The First 2,500 Years
According to ancient Greek myth, Persephone,
the goddess of spring, refused to eat anything
but pomegranate seeds after she was stolen
from her mother, Demeter, raped by the god
of death, and kidnapped to the underworld.
Medical historians now know why Persephone
only ate pomegranate seeds — pomegranate was
one of the first oral contraceptives.
Ancients used the myth of Persephone’s abduction to explain the cause of the world’s first
winter — a time when the goddess withheld her
fertility while confined in the underworld. All
the winters that have followed are echoes of her
tribulations, her mother’s search for her, and her
refusal to be pregnant when she didn’t want to
be (Riddle, 1997).
Greek women celebrated the reunion of Persephone and her mother for centuries in festivals
called Thesmophoria. (All men were banned
from them.) Four plants were central to the
secret rituals of the festival: pomegranate,
pennyroyal, pine, and vitex, also known as
“chaste-tree.” All of these plants are now known
to have contraceptive benefits as well as other
effects (Hawley and Levick, 1995). It now appears
that Greek women gathered in the Thesmophoria to share their contraceptive secrets
In the seventh century B.C.E, a brisk contraceptive trade developed in the part of North
Africa that is now known as Libya. That was the
only place in the world that the flowering plant
silphium grew. Silphium was such a reliable
contraceptive that it fetched an exorbitant price
(its weight in silver) in shipping ports all over the
ancient world. Despite its staggering cost, the
demand for silphium was inexhaustible. By the
first century C.E., the plant was very scarce from
over-harvesting, and by the fourth century, it was
extinct (Riddle, 1997).
but in 1993, an English research team found that
an enzyme in the fruit, papain, interacts with the
hormone progesterone in a woman’s body to
prevent pregnancy (Brothers, 1994).
Contraceptive knowledge began to vanish in
Europe after the 15th century. Women who had
the knowledge became fearful about sharing
it because to offer contraceptive information
during these times was to risk being accused of
witchcraft or heresy — the punishments for which
included torture and death (Riddle, 1994).
European women in colonial America were
offered contraceptive information by their
Native-American neighbors and by their African-Carribean slaves (Brodie, 1994). African-Americans held in slavery became
extremely adroit in the use of contraception,
which was important to them as a way to prevent
the heartbreak of bearing children who could
be sold for the profit of slave owners (Tone,
2001). Some of their formulas, still used in the
rural South, can also be found in Peter of Spain’s
750-year-old recipe book (Riddle, 1992).
Women all over the world used various herbs
for family planning. Surprisingly, one of the
most comprehensive recipe books for pre- and
post-coital herbal contraception was written by
a man who later became pope. Peter of Spain,
who offered advice on birth control and how to
provoke menstruation in his immensely popular
Thesaurus Pauperam (Treasure of the Poor), was
elected Pope John XXI in 1276 (Riddle, 1992).
Many of Peter’s recipes have been found surprisingly effective by contemporary research, and
it is now thought that women in antiquity had
more control over their reproduction than previously believed (Riddle, 1994).
Hundreds of generations of women in Africa,
Asia, and the Americas used various fruits and
plants for family planning. Women in tropical
India and Sri Lanka, for example, eat a papaya
a day when they want to prevent pregnancy. It
sounded improbable to scientists in the West,
Birth Control – History of the Pill • 11
Asbell, Bernard. (1995). The Pill: A Biography of
the Drug that Changed the World. New York:
Blundell, Susan. (1995). Women in Ancient
Greece. Cambridge, MA: Harvard University
Brothers, Caroline. (1994, February 17). “Papayas
Work as Powerful Contraceptives — A Study.”
Brodie, Janet Farrell. (1994). Contraception and
Abortion in Nineteenth-Century America.
Ithaca, NY: Cornell University Press.
Bullough, Vern L. & Bonnie Bullough. (1990).
Contraception: A Guide to Birth Control
Methods. Buffalo, NY: Prometheus Books.
BLS — Bureau of Labor Statistics. (2014,
December). BLS Reports: Women in the
Labor Force: A Databook. Washington, DC:
Bureau of Labor Statistics. [Online]. http://
accessed May 14, 2015.
_____. (2015a, February 12). “Table 2:
Employment Status of the Civilian
Noninstitutional Population 16 Years and
over by Sex, 1974 to Date.” Labor Force
Statistics from the Current Population Survey.
Washington, DC: Bureau of Labor Statistics.
accessed May 14, 2015.
_____. (2015b, February 12). “Table 11: Employed
Persons by Detailed Occupation, Sex, Race,
and Hispanic or Latino Ethnicity,” Labor Force
Statistics from the Current Population Survey.
Washington, DC: Bureau of Labor Statistics.
accessed May 14, 2015.
Campion-Smith, Bruce (2010). “Hillary Clinton
Stirs the Pot on Afghanistan, Abortion, and
the Arctic.” The Toronto Star, March 30.
canada/article/787841--hillary-clinton-stirsthe-pot-on-afghanistan-abortion-and-thearctic accessed April, 22, 2010.
12 • Birth Control – History of the Pill
Chesler, Ellen. (1992). Woman of Valor: Margaret
Sanger and the Birth Control Movement in
America. New York: Simon and Schuster.
Christin-Maitre, Sophie. (2013). “History of
Oral Contraceptive Drugs and Their Use
Worldwide.” Best Practice & Research Clinical
Endocrinology & Metabolism. 27(1): 3-12.
Committee on Unintended Pregnancy. Institute
of Medicine, National Academy of Sciences.
(1995). The Best Intentions: Unintended
Pregnancy and the Well-Being of Children
and Families. Washington, DC: National
Daniels Kimberly, et al. (2014, December).
“Current Contraceptive Status among
Women aged 15–44: United States, 2011–
2013.” NCHS Data Brief, no 173. Hyattsville,
MD: National Center for Health Statistics.
2014. [Online]. http://www.cdc.gov/nchs/
data/databriefs/db173.pdf, accessed May 18,
DHS — U.S. Department of Health Statistics (N.D).
“Table 5-1. Deaths, Maternal Deaths, Infant
Deaths, Neonatal Deaths, and Fetal Deaths,
U.S., 1945–2005. [Online].” http://www.dhs.
chapter5/5-01.pdf accessed February 26,
Eisenstadt v. Baird, 405 U.S. 438 (1972).
FDA — U.S. Food and Drug Administration.
(2000). “The Pill at 40.”, FDA Consumer, 34(4),
36 [Online]. http://findarticles.com/p/articles/
February 18, 2010.
Epstein, Cynthia Fuchs, (1981). Women in Law.
New York: Basic Books.
Feldt, Gloria & Jon Knowles. (2002). Creating
Hope for Humanity — Planned Parenthood:
Our Story and Vision for the Future. New
York: Planned Parenthood Federation of
Fields, Armond. (2003). Katharine Dexter
McCormick: Pioneer for Women’s Rights.
Westport, Connecticut: Praeger.
Frost, Jennifer J., et al. (2013, July). Contraceptive
Needs and Services, 2010. New York:
Guttmacher Institute. [Online]. http://www.
guttmacher.org/pubs/win/contraceptiveneeds-2010.pdf, accessed May 14, 2015.
Grimes, David A, ed. (2000). “History and Future
of Contraception: Developments over Time.”
The Contraception Report, 10(6), 15–25.
Griswold v. Connecticut, 381 U.S. 479 (1965).
Guttmacher Institute. (2014). Contraceptive Use
in the United States New York: Guttmacher
Institute. [Online]. http://www.guttmacher.
org/pubs/fb_contr_use.pdf, accessed May
Hannaford, Philip C., et al. (2010) “Mortality
among Contraceptive Pill Users: Cohort
Evidence from Royal College of General
Practitioners’ Oral Contraception Study.”
BMJ, 340, c927. [Online]. doi:10.1136/bmj.
Hawley, Richard & Barbara Levick, eds. (1995).
Women in Antiquity: New Assessments.
London, UK: Routledge.
Hill, Craig A. (1997). “The Distinctiveness of
Sexual Motives in Relation to Sexual Desire
and Desirable Partner Attributes.” The
Journal of Sex Research, 34(2), 139–53.
Himes, Norman E. (1963). Medical History of
Contraception. New York: Gamut Press, Inc.
History of Psychology. (2010). 1960 — FDA
Approves Librium. [Online]. http://www.
history_nonflash.html accessed March 16,
Hogan, Margaret C., et al. (2010). “Maternal
Mortality for 181 Countries, 1980–2008: a
Systematic Analysis of Progress Towards
Millennium Development Goal 5.” The
Lancet [Online]. DOI:10.1016/501406736(10)60518-1, accessed April, 21, 2010.
Junod, Suzanne W. & Lara Marks. (2002).
“Women’s Trials: The Approval of the First
Oral Contraceptive Pill in the United States
and Great Britain.” Journal of the History of
Medicine and Allied Sciences, 57(2), 117–160.
Kena, Grace, et al. (2014). The Condition of
Education 2014 (NCES 2014-083). Washington, DC: U.S. Department of Education.
accessed May 14, 2015.
Knowles, Jon & Marcia Ringel. (1998). All About
Birth Control. New York: Three Rivers Press.
Lange, Gregg. (2007). “Food and Drug
Administration Approves Birth Control Pill
on May 9, 1960.” [Online]. HistoryLink.org,
accessed March 17, 2006.
Lehmann-Haupt, Christopher. (1970). “Pill Talk.”
Books of The Times, The New York Times,
Lieberman, Janet J. (1973). “A Short History of
Birth Control.” The American Biology Teacher,
MacDorman, Marian F., et al. (2013). “Recent
Declines in Infant Mortality in the United
States, 2005–2011.” NCHS Data Brief, (120).
Hyattsville, MD: National Center for Health
databriefs/db120.htm, accessed May 16,
Marks, Lara V. (2001). Sexual Chemistry: A History
of the Contraceptive Pill. New Haven: Yale
Marsh, Margaret & Wanda Ronner. (2008). The
Fertility Doctor: John Rock and the Reproductive Revolution. Baltimore: Johns Hopkins
May, Elaine Tyler. (2010). America and the Pill — A
History of Promise, Peril, and Liberation. New
York: Basic Books.
McHan, et al. (1973, 2001). “Since I’ve Got the
Pill.” Guaranty Music/BMI/Coal Miners Music,
Inc. BMI in May, 2010).
Mosher, William D. (1988). “Fertility and Family
Planning in the United States: Insights from
the National Survey of Family Growth.” Family
Planning Perspectives, 20(5), 207–17.
Mosher, William D. et al (2012). “Intended and
Unintended Births in the United States: 1982–
2010.” National Health Statistics Report, 55.
Hyattsville, MD: National Center for Health
Statistics. [Online]. http://www.cdc.gov/
nchs/data/nhsr/nhsr055.pdf, accessed 2013,
NCHS — National Center for Health Statistics.
(1967). Vital Statistics of the United States,
1965: Vol. II — Mortality, Part A. Washington,
D.C.: U.S. Government Printing Office (GPO).
Birth Control – History of the Pill • 13
Nelson, Anita L. & Carrie Cwiak. (2011).
“Combined Oral Contraceptives (COCs).” In
Hatcher, Robert A., et al., 2011, Contraceptive
Technology — 20 th Revised Edition, New York:
Ardent Media, 249–341.
Piccinino, Linda J. (1994). “Unintended
Pregnancy and Childbearing.” From Data to
Action: CDC’s Public Health Surveillance for
Women, Infants, and Children. Hyattsville,
MD: CDC, 73–82.
Pomeroy, Sarah B. (1975). Goddesses, Whores,
Wives, and Slaves: Women in Classical Antiquity. New York: Schocken Books.
PPFA — Planned Parenthood Federation of
America (1976). You and the Pill. New York:
PRB – Population Reference Bureau. (2014). 2014
World Population Data Sheet. Washington,
DC: Population Reference Bureau. [Online].
May 14, 2015.
Riddle, John M. (1992). Contraception and Abortion: From the Ancient World to the Renaissance. Cambridge, MA: Harvard University
_____. (1994). “Ever Since Eve … Birth Control
in the Ancient World.” Archaeology, 47(2),
_____. (1997). Eve’s Herbs: A History of
Contraception and Abortion in the West.
Cambridge, MA: Harvard University Press.
Ryder, Norman B. & Charles F. Westoff. (1971).
Reproduction in the United States 1965.
Princeton, NJ: Princeton University Press.
Seaman, Barbara. (1969). The Doctor’s Case
Against the Pill. New York: Peter H. Wyden,
Skuy, Percy. (1995). Tales of Contraception.
Toronto, Canada: Janssen-Ortho Inc.
Tone, Andrea. (2001). Devices and Desires — A
History of Contraceptives in America. New
York: Hill and Wang.
U.S. Census Bureau. (2009). Statistical Abstract
of the United States, 2010: The National Data
Book, 129th edition. Washington, DC: U.S.
U.S. Department of Education, National Center
for Education Statistics. (1993). 120 Years of
American Education: A Statistical Portrait.
Washington, DC: U.S. Department of Education. [Online]. http://0-nces.ed.gov.opac.
2013, March 12.
_____. (2013). Integrated Postsecondary
Education Data System (IPEDS), Fall 2013,
Completions component. (This table was
prepared September 2014.) Washington,
DC: U.S. Department of Education. [Online].
tables/dt14_318.30.asp, accessed May 14,
Wills, Garry. (2000). Papal Sin — Structures of
Deceit. New York: Doubleday.
Xu, Jiaquan, et al. (2010, May 20). “Deaths:
Final Data for 2007.” National Vital Statistics
Reports, 58(19). Hyattsville, MD: National
Center for Health Statistics. [Online]. http://
nvsr58_19.pdf, accessed 2013, March 6.
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14 • Birth Control – History of the Pill