Issues and Developments in Birth Control since 1950

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Issues and Developments in Birth Control since 1950

Overview

The conception of the birth control pill in 1956 was the beginning of a social and ethical reproductive revolution as well as the beginning of controversial debates that still continue. While groups throughout history had supported birth control and abortion, it was not until John Rock (1890-1984), Gregory Pincus (1903-1967), and others developed the pill that the era began. In 1961 Jack Lippes devised a flexible plastic intrauterine device (IUD) that ushered in an era of effectiveness as well as some controversy. A defective IUD called the Dalkon Shield clouded the IUD with concerns for safety. Implants were developed around 1990 and are still being researched. The advent of birth control coincided with a period in history of social unrest and the origin of many movements against establishment ideas. The rise of the feminist movement and of equal rights for women was supported by those who sought freedom from being controlled by the reproductive cycle. The whole question of reproductive freedom assisted by legal decisions like Roe v. Wade in 1973 made the issue of abortion or choosing to end pregnancy a hotly contested issue and one that has not gone away. With the advent of RU-486, the French "abortion pill," more fuel was added.

Background

In past centuries even educated women knew very little about the human body and even less about reproduction. Midwives who had served throughout history lost their jobs as male-dominated specialists became obstetricians. In the early 1800s groups of drug- and device-peddlers profited from women's desires for family control. Campaigns to curb the practices, along with the Victorian ideas that these things were wrong and should not be addressed, succeeded in passing groups of laws that criminalized abortion and even contraception information. Anthony Comstock formed a Committee for the Suppression of Vice and fought to get laws passed in 1873 that prohibited making, transporting, and disseminating "obscene, lewd, and lascivious matter." The laws affected all devices and information for preventing conception.

Nonetheless, women—at least in the Western world—did make progress in terms of gaining access to information about contraception. In Great Britain Marie Stopes (1888-1958) opened the first birth control clinic in 1921 to teach working class women about how to prevent unwanted pregnancies. American nurse Margaret Sanger (1883-1966), concerned with how low-income women of New York were devastated by self-induced abortions and unwanted pregnancies, opened up a store-front clinic in 1916. Sanger collided head-on with the groups supporting the Comstock laws but persisted in spite of arrests and threats. Her crusade that began in 1916 gave birth to the group Planned Parenthood and would be instrumental in encouraging the development of the birth control pill, as well as the legal decisions relating to abortions. Sanger in fact coined the term "birth control."

In October 1950 a wealthy 71-year-old widow named Katherine McCormick, heir of the fortune of Cyrus McCormick (1809-1884), inventor of the reaper, wrote a letter to Margaret Sanger. Sanger for all these years had been fighting for the right to disseminate information and had had some success in fighting the Comstock laws. McCormick told Sanger of her interest in contraceptive research and willingness to support the venture financially. Dr. Gregory Pincus, director of the Worcester Foundation of Experimental Biology, was studying the early development of mammalian eggs. The two women by chance met Pincus and revealed their vision of a method of birth control, a contraceptive that could be "swallowed like an aspirin."

The search for such a pill would follow a dramatic path. Russell Marker (1902- ), a chemist, became very interested in the chemical composition of steroids as a possibility for treating arthritis, and he happened to find a corticosteroid called progesterone in the urine of pregnant women. Marker hit upon the idea of finding a plant with the steroid, and after a world-wide search he found the cabeza de nigra, a yucca-like yam in Mexico. Discouraged about setting up production in Mexico, Marker in 1949 destroyed all his papers and disappeared in Mexico.

Back in Massachusetts, Gregory Pincus accepted the challenge of finding that perfect pill. He met John Rock, a scientist working on the opposite problem of fertility. The two teamed up to search for Marker, whose steroid they had heard of. After several months, they found him and persuaded him to let them synthesize the molecule. After several other intriguing battles, they succeeded in making the pill. When they realized there would be a struggle for trials in the U.S., they got permission to clinically test in Puerto Rico and Haiti. The pill proved very effective. The most difficult trials were the religious and political struggles that would follow.

Oral hormones are synthesized compounds of the natural hormones estrogen and progesterone. Early in the menstrual cycle, the growth lining or endometrium of the uterus is controlled by estrogen. Progesterone, made in great quantities in the second half of the cycle, changes the lining of the uterus and causes mucus in the lower part of the reproductive tract to resist sperm. Both of these hormones act on the pituitary glands at the base of the brain. This gland then secretes hormones called gonadatrophins that regulate the estrogen and progesterone produced by the ovaries. Most oral contraceptives have both estrogen and progesterone. When one takes the pill, the presence of the hormones mimics a normal pregnancy and prevents the release of eggs from the ovaries. Different pharmaceutical companies produce pills with varying formulations. A few pills have only a type of progesterone that causes changes in the mucus lining that allows sperm to swim toward the uterus. Several years after the inception, the oral contraceptive was approved by the FDA in 1960.

Impact

The revolution brought by the pill not only enabled women to plan a family but to plan a life and career. The birth control pill was one of the wonders of scientific medicine of the 1960s and 1970s. However, as the years passed, some studies linked use with certain forms of cancer and other problems. Another advance in birth control is the injectable hormone depot mednoxyprogesterone acetate (DMPA). DMPA keeps the ovaries from releasing eggs to implant. A shot is needed every 12 weeks. The contraceptive called Depo-Provera is registered in some countries, but the U.S. FDA rejected it in 1974, 1978, and 1984. The side effects and idea of a shot has not made it very popular; however, it became available in Planned Parenthood clinics.

Intrauterine devices have been used in different forms throughout history to prevent pregnancy. They were invented in the nineteenth century but only became widespread in the late 1950s. Jack Lippes designed a flexible plastic device that was called the Lippes loop. IUDs, available only by prescription, come in varieties of shapes and are fitted into the uterus with a string that remains through the opening in the cervix. The string functions to check the position of the IUD as well as to aid in the removal of the device. IUDs work primarily by preventing fertilization of the egg by affecting the way the egg or sperm move. In 1970 Chilean physician Jaime Zipper added copper to the plastic device, which caused less bleeding and was more effective. However, IUDs were under great scrutiny. The Dalkon Shield was an IUD that sparked controversy because physical problems and infections became prevalent. Questions about the Dalkon Shield reflected on even those devices that were safe. Lawsuits that eventually caused the company A.H. Robbins to go bankrupt also gave all IUDs a bad name. By 1998 only four companies were manufacturing IUDs, and only two types were available in the U.S. One type contains copper and can be left in place for ten years. Another continuously releases a small amount of the hormone progestin and must be replaced every year.

A happening of the late twentieth century was the rise of litigation and prosecution for defective products. When women began to sue A.H. Robbins, the cost of litigation overwhelmed the IUD market with spillover lawsuits. For example, although the Searle CU-7 IUD was never determined defective, it drew more than 2,000 lawsuits.

In the 1990s a device called the Norplant implant began to attract attention. With this device, the physician inserts six thin flexible plastic rods under the skin in the upper arm. Each capsule has a powdered crystal of the hormone levonorgestrol, a progestin (synthetic version of prodesterone). By releasing a small amount, the drug keeps the ovaries from releasing eggs and thickens cervical mucus. Norplant is an effective method of protecting against unwanted pregnancy for five years. Litigation, however, took its toll. The first year sales were $141 million. When lawsuits entered the picture, sales dropped to $3.7 million the next year.

A landmark U.S. Supreme Court decision in 1973 called Roe v. Wade declared a Texas law making abortion a crime unconstitutional. The constitution was interpreted to protect a woman's right to choose to have an abortion during the first three months of pregnancy. State regulations of abortion were acceptable in the last six months. Forces on both sides mobilized. Some groups sought to liberalize this decision. Others determined to overthrow Roe v. Wade. Clinics performing abortion came under fire with picketing and even violence. By the turn of the twenty-first century, the law making abortion legal was as divisive as ever in U.S. society, with many groups still advocating for the repeal of the law.

The story of RU-486, a French abortion pill, is full of subterfuge and intrigue. The drug answers the search of women even from the time of ancient Egypt for a simple and effective way to end pregnancy. In 1982 Group Roussel Uclaf, a subsidiary of Hoechst, Germany, stunned the world with the announcement of the creation of an abortion pill. As the uterus prepares for pregnancy, it receives progesterone by special receptors, but RU-486 binds to the receiving cells and blocks the hormones. Since the uterine lining does not get the hormone, it sloughs off, taking the embryo with it. In 1987 trials indicated a success rate of 95% when used with a second drug. Like a miscarriage, it produced heavy bleeding, which could last up to two weeks; yet, some scientists stated that it was much safer than mechanical abortion. In 1988, in response to serious pressure from anti-abortion advocates, Roussel announced it would no longer market RU-486. Only 48 hours later the French government ordered the company to reverse the position. In 1992, ten years after the discovery, Roussel announced it would not seek to market the drug in the United States because of American anti-abortion forces but would sell only in France, Britain, and Sweden. The Chinese created their own version in 1988 in response to the one child policy—a law mandating that married couples could have no more than one child.

When Bill Clinton became U.S. president in 1993, the FDA sought to have Hoechst market RU-486 in the United States, but the company decided against it but instead donated the rights to the pill to the Population Council, a non-profit research group. The group now had the patent but no one to market it. In 1992 another non-profit group, ARM (Abortion Rights Mobilization), growing tired of Hoechst and the Population Council, found a little-known law that allowed researchers to copy and distribute the drug as long as it was not for profit. Lawrence Lader, a 78-year-old New York writer and head of the group, built a warehouse in Westchester. The group hired a scientist to produce a copy and distributed it through an underground organization. ARM found a manufacturer (although the name is not revealed) and distributes it to clinics in several cities.

Another abortion drug, methotrexate, stops the cells of the embryo from dividing. Like RU-486, it is given with a second drug, misoprostrol. The jury is still out on what will happen to drugs like RU-486. With legal liability and threats of anti-abortion activists to boycott all products made from a company producing the drugs, as of 1997 only five companies were engaged in contraceptive research. Societal forces related to birth control are complex. The interplay of birth control advocates, scientists, the churches and other conservative groups, feminists, drug companies, the courts, trial lawyers, the government, consumers, and consumer advocates made the issues of contraception and abortion as controversial as ever as the twenty-first century dawned.

EVELYN B. KELLY