Why is it so important for women to understand the origins of the pill?
The combined pill contains two hormones: estrogen and progesterone. These block your ovaries from producing an egg, preventing pregnancy. The NHS website itself claims that the combined pill is not “suitable for everyone”, but what does this mean and how does the pill’s origins make this a controversial topic?
The pill is famously prone to side effects, with complaints from depression to hormonal acne. Personally, I know many friends who had to abandon the pill as they could not overlook the side effects for the purposes of safe sex. Whilst doctors in Britain take blood pressure readings before prescribing the pill, that is not always enough. Reports of worrying symptoms, like blood clots and depression, put many women off from considering the pill as an option. However, this is one of the least invasive forms of contraception and many young girls may not look any further for other forms available.
The Puerto Rican trial
Gregory Pincus was the man behind the first contraceptive pill, Enovid, and unfortunately his motives and clinical trial have since been exposed as unethical. Pincus was known for his interest in population control and finding methods to stop a growing lower class of immigrants from having children.
His clinical trial took place in 1957 on lower class Puerto Rican women who thought the drug was approved and safe to use. Three women died during the study from complications relating to embolisms and heart failure (Cleghorn, 2021). It is obvious that more trialling was needed before these women were used as test subjects for Enovid. However, in 1960, the pill was approved for use by the FDA in the US.
Introduction in Britain and a pill for men
The NHS introduced the pill a year later in 1961, and by 1974, family planning clinics were able to prescribe it to single women. The pill’s creation happened at a time of second-wave feminism when women were rightfully demanding more reproductive freedom. It is therefore a shame that the lack of testing meant that the pill proved fatal for some women and that the first inventor of the pill was a man who did not have women’s rights in mind. There is also discussion over the possibility of a male pill. Trials for contraceptive injections for men have been conducted, but due to side effects, like mood swings, these have never made it to being an approved method of birth control (Behre et al, 2016). This could present a double standard, or, just be a result of the trial for men being conducted in a more ethical environment to that of the first combined female pill.
The pill today
The pill has changed significantly since the Puerto Rican trial and FDA approval in 1960. The type of progesterone being used is different and the dosage of both hormones involved has been reduced, meaning that its use is now considered a lot safer than in 1960. Ethinyl estradiol, the estrogen medication used in the combined pill, has been reduced from 50 to 15 µg over time (Gandhi and Supe, 2024). This does show proactive research to make the pill safer, however there is a long way to go before the NHS no longer needs to disclaim on its website that the pill is not “suitable for everyone”.
Trusting the pill and appreciating what it has done for women.
So, does this suggest that as women, we should never take or trust the pill? The short answer is no. Its primary job as a contraceptive is one that it does well, so if you start taking it and find you are not prone to the side effects, then why not take it? Despite the scary packet inserts that seem a mile long, listing the various side effects, the NHS website claims that only 1 in 1,000 women will be affected by a blood clot when taking the pill. Despite its murky origins and its risks, the effect the pill has had on the freedom of women is revolutionary. It sparked the creation of various contraceptive methods that give today’s women reproductive freedom that is unimaginable to women 100 years ago.
For further reading see Unwell Women by Eleanor Cleghorn (2021) which dives into the different medical prejudices that women have faced throughout history.
Websites and papers consulted:
What is the combined pill? – https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/what-is-it/
Side effects and the risks of the combined pill – https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/side-effects/
How the contraceptive pill changed Britain – https://www.bbc.co.uk/news/uk-15984258
Gandhi and Supe, 2024, Evolution of Oral Contraceptive Pill –https://pmc.ncbi.nlm.nih.gov/articles/PMC11065849/
Behre et al, 2016, Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men – https://doi.org/10.1210/jc.2016-2141
Editor: Ola Jakubowska