UNRAVELLING THE LIE BEHIND THE

More than 100 million women use this form of contraception. So why, as a recent report shows, have they all been misinformed?

SINCE the contraceptive pill was launched in late 1950s America, generations of women all over the world have religiously taken the tiny daily tablets that have proved to be one of the most effective ways to prevent an unwanted pregnancy.

An instant hit when it was first released in 1957 as a drug that could help ‘menstrual disorders’, the Pill was fully approved for contraceptive use in the US by the Food and Drug Administration (FDA) in June 1960.

Naturally it took a little longer for it to be formally introduced in Ireland. Available as a ‘menstrual cycle regulator’ since 1963, it was officially legalised in 1979 for ‘bona-fide family planning purposes’ at the discretion of a doctor, usually just for married women. The Pill was fully legalised, without discrimination, in 1993.

Today, more than 100 million women around the world depend on it. So when it was announced recently that the way women have been taking the Pill could be very different, the news was greeted with astonishment and even anger from some quarters, especially when it was revealed that a Pope was possibly to blame for this misinformation.

Up until now, it had been assumed by the vast majority of users that it was important to take a seven-day break from the Pill each month. Indeed, blister packs of the drugs traditionally consist of 21 real pills and seven placebos. However new guidelines from the UK’s Faculty of Sexual and Reproductive Healthcare (FSRH), who set key national guidelines for the safe prescription of contraceptives, say there is no health benefit to the week-long hiatus.

In fact, scientists believe taking the Pill continuously will actually prevent more unwanted pregnancies. It’s a fairly massive revelation, to learn there is no reason to suffer the period-like symptoms, including headaches and bleeding, which can go with the seven-day break.

When the experts were asked why this method of taking the Pill was introduced, some of them blamed the Catholic Church.

‘The gynaecologist John Rock devised [the break] because he hoped that the Pope would accept the Pill and make it acceptable for Catholics to use,’ Professor John Guillebaud, who has spent his career researching contraception methods, explained. ‘Rock thought if it [the Pill] did imitate the natural cycle then the Pope would accept it.’

OTHERS, however, have insisted Rock’s effort to get the Pill past the Pope is only part of the reason a break was introduced.

‘The background to the seven-day break with the Pill is actually multifactorial,’ insisted Jane Dickson, Vice President of the FSRH. ‘It wasn’t just about appeasing the Catholic Church.

‘There were many reasons why there was a break when the Pill was introduced. One of the most important reasons is that the Pill which was used 60 years ago, some of the hormones in that Pill were 100 times greater in dose than in those we have now. Quite often, women actually felt quite dreadful when they took it, so part of the reason for the seven-day break was as a break from the massive amount of hormones.

‘Also, it led to a period, even though we know now that it’s not a proper period, just a withdrawal bleed. Because contraception was new at the time, there was a lot of anxiety about how it affected your body.

‘One of the other reasons for the break was to reassure women that they weren’t pregnant.

‘What we’ve seen over the years is that the Pill has been modernised. We have much lower dose versions now [and they are] much better tolerated. Research over the past ten years or so has demonstrated that there is actually no medical reason to have a break.

‘It’s a guidance for health professionals,’ she added. ‘It’s not a [UK] Department of Health ruling, or an NHS ruling. We’re a professional organisation that makes clinical recommendations to health professionals who provide contraception.’

The fact still remains, however, that trying to get a contraceptive pill approved by not just the Church but the US medical authorities, took enormous effort. And according to American author Jonathan Eig, who wrote the book The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, which was released in 2014, making the new drug seem as natural as possible was imperative to getting it past the post.

‘When they were developing the Pill they wanted to create the illusion of a menstrual period,’ he told the Irish Daily Mail. ‘They wanted to make it seem as natural as possible. They thought if women

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Despite his devotion to Catholicism, he believed the Church was wrong to oppose contraception and tried his best to help change their stance. But it wasn’t just Rock’s devotion that made the developers of the Pill anxious to get the Church on side.

‘The Catholic Church provided one of the biggest obstacles to getting a new form of birth control on the market,’ explains Eig. ‘They were seen as the strongest, most influential group that would oppose getting access to birth control.

‘So they [the developers] thought if they could present this to the Vatican as something natural, like the rhythm method, perhaps the Vatican would go along with it.

‘Women at the time could not control their fertility; the only way was abstinence to be sure you weren’t going to get pregnant. The only [form of birth control] that the Vatican approved of was the rhythm method, which was highly unreliable, so women were having more children than they wanted.

‘Women were often forced to consider abortions because they couldn’t afford to support another child if they got pregnant.

‘The Pill was seen as a way of giving women some control over their lives. The idea was developed by Margaret Sanger [who would go on to establish the organisations that evolved into the Planned Parenthood Federation of America].

‘Around 1914, she started the idea that if women had access to a ‘miracle tablet’, as she called it, a pill that allowed them to turn their reproductive systems on and off, then they would be able to take more control of their bodies and lives and would have a chance to compete equally with men in things like education and careers.

‘It was a radical notion, to create a birth control pill and to get the government to approve it, so they needed to think about how they could make it seem more acceptable to the government bodies who were going to authorise it.

‘The idea was that it would seem more palatable to them, and indeed the public, if it had this period where the pills were actually placebos and women were actually able to menstruate, and they were probably right about that.

‘You also have to remember, it was men who were making these scientific choices, it was Gregory Pincus and John Rock primarily. Rock, as a Catholic, was particularly sensitive to how this was going to be perceived by Catholics and the Vatican.’

Was Eig surprised to hear the FSRH’s recent announcement about their new guidelines regarding how to take the Pill?

‘No, I wasn’t, because I know there had been some movement in that direction, that women who were on the Pill and doctors had been talking a lot about that question lately,’ he says.

‘I actually think the scientists had an idea all along that you didn’t need the break.

‘It was just never really tested. They just had this idea that it [the break method] was the best way to do it, so they included it in the instructions that you should take it every day and that some of the pills were placebos.

‘They wanted you to take a pill every day so you would get into the habit. They figured if you just stopped instead of taking the placebos, you might forget.

So it was seen as the most effective way of getting women comfortable with taking it and making sure they were well protected. It was another throw-back really to men being in charge. They felt it was too complicated to explain to women that the placebo period might not be necessary.

‘At that time I don’t think anyone really tested what would happen if you gave women the real Pill every day instead of taking a placebo, that wasn’t their [the developers’] first choice. They saw it worked this way and I don’t think they tested it the other way.

‘I do think it’s surprising it has taken so long [to change the guidelines about how to take the Pill] given that it’s a medication so many millions of women have been using for so long. It raises the question of why this wasn’t explored sooner. Maybe it’s because women always get short-shift when it comes to research, especially around birth control.’

The introduction of the contraceptive pill, however, did mark a significant moment in history for women, regardless of how it was taken.

‘Almost immediately, when you saw the Pill introduced, you saw big changes in pregnancy rates and the age that women were marrying, big differences in the number of women finishing college and going on to graduate school,’ explains Eig. ‘The impact was tremendous and immediate.

‘It’s still tremendous. It’s not just birth control, it’s one of the great advances in public health, allowing women to control their reproductive systems, and have babies when it’s safe and when they are ready to have them.’

Does he think Margaret Sanger would have been disappointed or surprised to know that the sevenday break was possibly not necessary?

‘I don’t think so, she knew everything she had to fight for was difficult,’ he says. ‘There was push back every step of the way. She was also very pragmatic — if this was the way to get it on the market, if you had to make compromises, find a way to make it acceptable to the men who controlled the world of science, then that’s what she would do.’

AS for John Rock, he continued trying to persuade his beloved Church that the Pill was a good thing for women. In 1963 he wrote The Time Has Come: A Catholic Doctor’s Proposals to End the Battle over Birth Control.

He was crushed, however, when the Pope officially banned the Pill in the encyclical Humanae vitae in 1968, an official church policy on contraception that still stands today. It’s believed, in his later years, Rock lost his faith and stopped going to church altogether.

‘Rock lived a long time [he died in 1984 at the age of 94]; he lived to see birth control flourish in America,’ says Eig. ‘And throughout the rest of his life he continued to complain that the Church had got it wrong and blew a great opportunity.

‘If the Vatican had accepted birth control pills as a legitimate form of contraception, maybe women would have been more respectful of the Church’s policies. But the Vatican, ultimately, could not control the behaviour of women.

‘I think women decided in very large numbers that this was one Vatican order they could ignore, they were willing to break with the Church on this. And it’s around this time when you begin to hear people talking about “cafeteria Catholicism — I’ll follow one rule but I won’t follow the other.”

‘I think the Pill was a big moment in that evolution. It was a huge advance in modern medicine too big to ignore.’