Margaret Sanger was one of the most famous proponents of contraceptives in feminist history. Her strong feelings on the subject arose when she witnessed the death of her mother, who died at the young age of fifty, and whose body had endured eleven childbirths and seven miscarriages.
At the time, the Comstock act criminalized the use, sale, and possession of contraceptives and other “obscene” items. Sanger became a nurse and witnessed many women who were unable to obtain contraceptives endure unwanted pregnancies and back-alley abortions. In 1914, she began illegally providing sexual education and contraceptives to women in need, setting off on a crusade to bring safe and effective birth control to American women, winning several legal battles along the way.
In 1951, she met medical expert, Gregory Pincus and convinced him to take on the project of creating a “magic pill” one could take to prevent unwanted pregnancy. Due to legal restrictions on distributing contraceptives and information about them, it would have been difficult to do extensive tests in the United States. After preliminary trials in Boston, the team set out to conduct more extensive testing abroad.
Pincus’ group planned a large trial to be conducted in Puerto Rico. The island was densely populated, contraception was legal, and 67 clinics on the island were already distributing contraceptives as a part of family planning efforts, so he would have a much easier time there than in the United States. Pincus and the rest of the team also felt that birth control would help with population control as a solution to widespread poverty in the territory. Since many subjects were not fluent in verbal English and many were illiterate, the researchers thought testing on them would determine whether the pills could reasonably be used by women all over the world.
The trials in Puerto Rico lasted nine years beginning in 1956 on a population of women mostly living in low-income housing throughout the island. The team distributed a pill called Enovid, the first birth control pill, which contained 10 mg of progesterone and .15 mg of estrogen. That’s about twice the current legal amount of progesterone in birth control pills today. In order to take part, women had to be under forty years old, already have had two children, and be “fertile and in good health.” They also had to agree to give birth if they became pregnant during the trial. The women did not know they were experimental subjects, and from what I can gather, must have thought the study was just another family planning program.
The trials determined that the pill was 100% effective when taken properly, but 17% of the women had serious side effects and three women died. There has never been an investigation into either.
Delia Mestre, a subject in the trials, told the Chicago Tribune :
Women were told this was medicine that would keep them from having children they couldn’t support…The experiments were both good and bad. Why didn’t anyone let us make some decisions for ourselves? I have difficulty explaining that time to my own grown children. I have very mixed feelings about the entire thing.
The FDA approved the pill for menstruation regulation in 1957 noting contraceptive “side effects” on the box’s label. It was later approved specifically for contraceptive use in the United States in 1960, well before the trials in Puerto Rico were concluded.
The Chicago Tribune also interviewed Suzanne White Junod, the U.S. Food and Drug Administration’s historian, who told them:
The FDA cleared the pill as a contraceptive in May 1960 and, almost immediately, issues about safety were being raised and centered on blood clotting. Versions of the pill were tested in Puerto Rico until 1964, largely because women on the U.S. mainland were complaining about side effects… FDA officials say the Humacao tests led to stronger rules and guidelines for future clinical trials and became the underpinning for a law requiring test disclosures for participants.
It was beginning to become unclear whether the “magic pill” was worth its side effects, and it took about a decade for researchers to realize that the amount of progesterone could be lowered significantly without sacrificing contraceptive effects. In 1962, the pill was actually banned in Norway and the Soviet Union.
By 1972, 132 cases of blood clots had been reported in the US, 11 of which resulted in death. When women brought complaints of side effects to their doctors, they were often shrugged off as exaggerations or considered the price women would just have to pay if they wanted to prevent unwanted pregnancy.
By the 1980’s, further trials had been completed around the world and the pill was being taken by millions of women, the 10 mg pill was finally removed from the market and versions with varying smaller amounts of hormones were released. Women today can choose between many different versions of the pill and settle on whichever is best for them.
Personally, I’m a big fan of the pill. I have used a handful of different versions and can tell you that each one affected my menstrual cycle, my weight, and emotional health differently. I can’t imagine how severe those side effects would be if I were taking the scale of doses that were given out 50 years ago.
I love having a pretty regular and low-key menstrual cycle and I really love feeling more confident that I won’t have to confront an unwanted pregnancy. What I don’t love is knowing that the initial phases of a drug I take every single day were conducted pretty damn unethically. Some of the women in the trials may have benefitted from fewer unwanted pregnancies, but they weren’t given the chance to decide for themselves whether or not contraception was worth the potential risk. It’s not ok.