The Pill at 60: why it’s as controversial as ever
Like Twiggy, Beyoncé and Madonna, it only needs one name. It’s been 60 years since the Pill revolutionised life for women in Australia and it’s still controversial.
Anne Summers’ motley history with birth control was much like other Australian women’s prior to the Pill. “There was no birth control as such for we teenagers,” the Aussie trailblazer and author tells The Weekly. “It was ‘withdrawal and hope for the best’, with many days or even weeks of crippling anxiety while we waited for our periods to arrive.
“If they did not arrive, the desperation of a girl in that situation is unimaginable today. The shame was scarifying and there were only three options:
1. A shotgun marriage (I had several friends whose lives changed forever that way);
2. Being bundled off in shame to a ‘home for unmarried mothers’ to have a baby and be forced to give it up for adoption;
3. An abortion, which was illegal, expensive and dangerous.” And prior to which many women had tried even more risky DIY options – hot baths, gin, coathangers, jumping off tables or throwing themselves down flights of stairs.
Anne turned 16 in 1961, the year the Pill arrived in Australia. Yet she found herself with an unwanted pregnancy three years later, as she was about to begin studies at the University of Adelaide. The Pill was still not widely available. It wasn’t legal to advertise it, so word spread slowly. Moreover, it was costly (because it was prohibitively taxed) and most doctors would prescribe it only to married women. Other methods of birth control were still messy and fallible – in Anne’s case devastatingly fallible. Friends rallied around and raised funds for her to travel to Melbourne for what turned out to be a “botched abortion” which she was lucky to survive. It was only after that trauma, when she was referred to a specialist to “repair the damage”, that Anne was finally offered a prescription for the Pill.
In the 60 years since the Pill first landed, it has saved the lives of countless women who might otherwise have died at the hands of backyard abortionists or in childbirth. This is exactly the outcome that its inventors envisaged.
“No woman can call herself free until she can choose consciously whether or not she will be a mother,” wrote Margaret Sanger, the first wave feminist firebrand who dreamed, back in 1912, of a “magic pill” to prevent pregnancy.
Margaret’s own mother had died at age 50 after 18 pregnancies, and Margaret blamed her father. “You caused this,” she said as they stood beside her coffin. “Mother is dead from having too many children.”
Margaret trained as a nurse and opened America’s first family planning clinic. She became lifelong friends with the equally determined Katharine
Dexter McCormick, who was, at the time, one of just a handful of American women to have graduated with a degree in biology. She was also independently wealthy and, with Margaret’s encouragement, invested handsomely in the work of a brilliant young researcher, Gregory Pincus, who was investigating the use of progesterone in birth control. This dynamic trio, in turn, involved an eminent, Harvard-trained fertility specialist, John Rock, who took their experimental pill to human trials.
Testing a hormonal contraceptive was illegal in the United States, so the team took their project to Puerto Rico. There – given hurdles around language and education, perhaps a degree of racism, and the fact that the pills they were testing were far stronger than anything that would be prescribed today – it seems likely that their subjects did not grant full, informed consent. Tragically, two women died during the trial, around 20 per cent experienced side effects,
including dizziness, nausea, headaches and weight gain, and links have been made to an increased incidence of cervical cancer in these and other Latin American women involved in contraceptive testing in the 1950s.
However, only one woman fell pregnant and the trial was deemed a success. So, on May 9, 1960, the US Food and Drug Administration approved the world’s first contraceptive pill.
Appearing in tandem with second wave feminism, the Pill had a profound effect on women’s lives.
“In 1964 I swallowed my first oral contraceptive,” says Wendy McCarthy who went on to become a founding member of the Women’s Electoral Lobby, a CEO, a government advisor, and a vociferous advocate for women’s rights. “It was a seminal moment in my life. I was 22 years old, in love and we had already had one unwanted pregnancy. The idea that I could be in charge of my own fertility by taking a pill which provided total protection against pregnancy and was not related to the sexual moment was breathtaking.”
Women could now choose when, or
“The greatest benefit ... was that it freed women to be in charge of their bodies.”
– Anne Summers
if, they wanted a family and how large that family would be. That decision opened up a world of opportunities.
Women began to marry and have children later, and to study in unprecedented numbers, including subjects like medicine and law that required a view to a career. A pair of Harvard economists, Claudia Goldin and Lawrence Katz, tracked the availability of the Pill across the US and found that, as women achieved greater control over their fertility, their enrolment in professional courses increased and so did their wages. Women made up just 10 per cent of first year law students in 1970. In 1980, that figure had grown to 36 per cent. Today women outnumber men.
“The Pill was more than a contraceptive, it was also a potent symbol of women’s emancipation,” says Anne, who went on to become a journalist, to found Australia’s first women’s refuge, Elsie, and to reframe Australian history with her bestseller,
Damned Whores and God’s Police. “Once women could decide when and if they were going to have babies, that freed them to go into the world and pursue their other dreams. The greatest benefit of the Pill was that it freed women to be in charge of their bodies and their lives. The ramifications of that are still reverberating today.”
Of course there were more factors involved in those changes than this contraceptive. Helen Gurley Brown’s
Sex and the Single Girl was published a year after the Pill arrived in Australia, and the following year Betty Friedan’s
The Feminine Mystique kick-started second wave feminism. But the Pill was, at the very least, an enabler.
And it was adopted with gusto.
Today, more than 151 million women around the world take the Pill, and in Australia it’s the most popular form of contraception.
However, the Pill’s history has not been one glorious march to liberation. The Catholic Church and elements of the religious right objected strenuously, insisting that this little pill interfered with God’s plan (which had apparently been to keep women barefoot and pregnant). A Pontifical Commission into Birth Control was convened between 1963 and ’66. An overwhelming majority of participants recommended liberalising the Church’s position, but Pope Paul VI’s 1968 encyclical remained firmly anti-artificial contraception, and the Church’s official position has not budged to this day.
Meanwhile, conservative media predicted an outbreak of “sexual anarchy”, wife-swapping and
“free love”. The Weekly broke taboos and sales records with an information-packed feature on the Pill in 1966 but responsible reporting was the exception rather than the rule.
As a result of the prevailing atmosphere of moral panic, the Pill’s proponents closed ranks. “There were side effects,” Anne recalls, “and often quite severe ones in those early days of the one-dose-fits-all Pill.” But these were regularly underreported or ignored for fear of returning to backyard abortions and forced adoptions.
In 1969, Barbara Seaman published The Doctor’s Case Against the Pill and exposed a raft of health risks, including heart attack, stroke, cancer and serious depression, of which women had not been informed. As a result, more health information was included, doctors
were advised to discuss side effects with patients, and work proceeded on less hazardous versions of the Pill.
In 1988, “high-dose” Pills were removed from the market and the contraceptive pills available today pose fewer hazards. However, recent assertions that the AstraZeneca vaccine must be safe because the blood clotting risk with oral contraceptives is 250 times higher was reassuring for everyone but women on the Pill.
Blood clots are a real and not uncommon side effect of certain types of contraceptive pill. Most contemporary formulations combine two types of hormone – a progestin, which prevents ovulation, and an estrogen. It is the level of estrogen in the mix that increases the likelihood of life-threatening blood clots.
The blood clot issue made headlines back in 2003, when The Weekly’s medical writer, Professor Kerryn Phelps, was struck down by a life-threatening pulmonary embolism. She had begun taking a birth control tablet to regulate her period. Then in 2017 Labor MP Julian Hill’s daughter, Elanor, developed deep vein thrombosis linked to the combination of a long-haul flight and the Pill. The Therapeutic Goods Administration later released a report confirming that women taking that particular type of Pill were at an increased risk of developing blood clots. It’s now clear that certain formulations can increase clotting risk by two or even four times.
There are more than 30 different brands of the Pill available in Australia and each contains a slightly different mix of estrogen and progestin. You would think the solution would be simple – choose one with a lower dose of estrogen – but it’s not, because it’s the estrogen that tempers another common side effect – mood disorders and depression.
Despite a wealth of anecdotal evidence, there has been little research into the psychological impacts of hormonal contraception, but that is beginning to change. A 2016 Danish study involving one million women found that those on the combined (estrogen plus progestin) pill were 23 per cent more likely to be treated for depression than women who were not taking hormonal contraception. Women on the mini (or progestin-only) pill were 34 per cent more likely to seek treatment for depression. And those results were magnified in adolescents. Teenage girls taking the combined pill were 80 per cent more likely, and those on mini pills more than twice as likely, to be prescribed antidepressants as girls not taking hormonal contraception.
Then, just last year, a Canadian study found that women on the Pill
showed significant changes in both brain activity and physical brain structure in areas related to emotional regulation, stress and memory. And again, the changes were greater in women who began using the Pill during adolescence. In those women, researchers found the type of blunted cortisol (or stress hormone) response that is commonly found in people who have suffered long-term, chronic stress.
“Taken together, all of this research suggests a broad and worrying range of effects on psychological wellbeing,” says Dr Khandis Blake from the University of Melbourne. “And most people taking the Pill have no idea of these effects. Women have a right to know how their medication may affect them so they can make an informed choice.”
In an attempt to rectify that, Khandis and her team have created The Daily Cycle Diary. Women can sign up to track their menstrual cycles and the emotional and psychological fluctuations that accompany them. The data is fed back to the research team, which will provide each volunteer with a personal report.
Meanwhile, across town, Professor Jayashri Kulkarni at the Monash Alfred Psychiatry Research Centre has also been investigating the psychological impacts of the Pill.
“We have now developed a large number of studies and we’ve consistently found that, in women who have vulnerability, the Pill does create a much worse depression in someone who already has depression, or it can in fact create depression in someone who hasn’t had it before. This is where we are now. The next phase is to better understand how the Pill does this, and eventually to develop a new generation of Pills that don’t have mental or physical health issues.”
While both women deal with the fallout from the Pill’s failures, neither Khandis nor Jayashri would dream of going back to the bad old days. Their hope is for a better Pill that is even more widely available. As Wendy McCarthy points out, effective contraception is still scarce throughout much of the developing world, where maternal mortality remains the leading cause of death.
And Margaret Sanger would surely want that rectified. Her vision of a perfect little pill is still, it seems, a work in progress.