Birth control pill's legacy coloured by coercion and oppression, says researcher

From family planning to sexual freedom, the birth control pill was groundbreaking when it first hit the market, but what many didn't expect was the far-reaching reverberations it would have over time, beyond pregnancy prevention.

'People around the world have increasingly been told that their fertility is a problem'

A one-month pack of birth control pills against a white background.
The invention of this tiny pill had a tremendous impact on society. (Rae Alexander / Shutterstock)

When someone mentions "the pill," we know exactly what they're referring to.

That's a testament to the impact the oral contraceptive has had since its invention — but its origins are nested in the politics of inequity.

A purple graphic of a pack of birth control pills inside of a butterfly against a white background.
This story is part of The Butterfly Effect, a special Spark series about small inventions that have gone on to change the world. (CBC)

For as long as people have been having sex, they have also been trying to avoid pregnancy, to varying degrees of success. But the combined oral contraceptive, approved in 1960, proved to be a major technological leap forward. Since then, millions have embraced it as their birth control method of choice, and a tool to manage menstruation.

"You can argue that it was one of the most important inventions of the last century that not only gave women power and control, [but also] changed the dynamics of marriage," Jonathan Eig, a biographer and author of The Birth of the Pill, told Spark host Nora Young.

"It changed the dynamics of sex. It changed the way we look at our society … and who gets to tell women what they can and can't do with their bodies and with their lives."

When the first pill came out, under the trade name Enovid, it was marketed in a way that was palatable to the evolving sexual mores of the day: a treatment for severe menstrual disorders.

"The bottles at the time came with a warning 'may prevent pregnancy.' So it really wasn't much of a subterfuge," said Eig.

Birth control itself wasn't legalized until five years later, and was only available to married women — which only changed through the courts in 1972.

A bald man is smiling and staring directly into the camera while standing on a city street that is blurred in the background.
Journalist and author Jonathan Eig's fourth book, The Birth of the Pill, looks at the social history of the contraceptive. (Courtesy of W.W. Norton )

"At the time … there wasn't much of a constituency for single women who wanted to have sex," Eig said.

"It was considered such an unmentionable act, something people didn't talk about openly."

"I think a really important change was thinking about sex as something that could be decoupled from fertility and from having children," said Krystale Littlejohn, an associate professor of sociology at the University of Oregon and author of Just Get On The Pill: The Uneven Burden of Reproductive Politics.

The birth control pill itself evolved in the years that followed.

It contains progestin, which mimics progesterone — a hormone that controls much of the reproductive cycle — and a synthetic estrogen. It signals to the ovary that pregnancy has occurred, which stops it from releasing a new egg each month. And at the end of the cycle, the uterine wall sheds and the cycle starts again.

The concentration of both hormones in the first pills was ten times what it is now. While that meant the pill was very effective in preventing pregnancy, the side effects were unpleasant. Among the most serious were deep vein thrombosis and pulmonary embolism, more commonly known as blood clots. The dosage was eventually lowered as a result.

The societal effects were immediate. The pill afforded people the ability to plan their careers and future families, said Diana Blithe, chief of the contraceptive development program at the National Institute of Child Health and Human Development at the National Institutes of Health.

A smiling woman with short straight hair wears a bright blue shirt against a brown background.
Diana Blithe is the program chief for the National Health Institute's Contraceptive Development Program. (Submitted by Diana Blithe)

Eig points to a number of stats that went up in the years following the pill's release, including the increased number of women enrolling in four-year college, completing their degrees, enrolling in graduate programs, and the age at which people married and had children.

Complicated roots

Sex educator and activist Margaret Sanger, philanthropist Katharine Dexter McCormick, a gynaecologist named John Rock and biologist Gregory Pincus pioneered the development of the pill.

"It was really just four or five people at the core of this thing with no government funding, no corporate funding, really on their own," said Eig.

But early days of the pill's development involved questionable testing practices and other controversies. Sanger herself is a divisive figure, particularly for aligning herself with the eugenics movement that was gaining momentum at the time.

While discussing finding test subjects, McCormick, who bankrolled much of the research into the pill, is documented saying, "How can we get a cage of ovulating females to experiment with?"

Before the approval of the pill, Eig said testing was done on non-consenting women and men in psychiatric institutions, and then on low-income women in Puerto Rico and Haiti — some of whom could not read or write. While some knew that the pill was meant to prevent pregnancies, they weren't aware that it was an experimental drug.

Littlejohn says this case is emblematic of the continued use of birth control for oppressive means. "[Some] people around the world have increasingly been told that their fertility is a problem and that they need to limit their fertility," she said.

When it comes to what's considered an "undesired" pregnancy, it can have less to do with people's feelings about having children and more to do with assumptions and circumstances, according to Littlejohn. For instance, people of colour from lower socioeconomic backgrounds are more likely to have pregnancies deemed "undesired," she said.

A woman with long straightened hair is wearing a black blazer and smiling against a leafy green blurred background. Floating beside her is the cover of her book, Just Get On The Pill, in yellow lettering against an orange background with a large brown graphic of a uterus holding scales of justice.
Krystale Littlejohn's work focuses on reproductive justice and the gendered politics of pregnancy prevention. (UC Press)

"Some people would like to have children, but they can't," she said. "They don't feel like a child could be desired at that point in time because structurally, for example, they don't have enough money to be able to take care of children."

The solution might be to prescribe birth control so that they can stop a pregnancy from happening, she said, "but in reality, what that person needs is support with housing, so that they could feel like their pregnancy could be desired. The solution is rethinking our social policy."

Uneven burden of responsibility

The pill is what Littlejohn refers to as "gendered compulsory birth control."

"[It's] the idea that women and people who can get pregnant are really channelled into accepting primary responsibility for preventing pregnancy, specifically using methods that are designed for their bodies," Littlejohn said. It's an idea that she says is enforced by their partners, parents, friends and even medical providers.

In addition to side effects, the tedium of taking it every day can also be a source of dissatisfaction. But Littlejohn says the pressure and sole responsibility to prevent pregnancy is why people continue to stay on it.

"My study shows there were lots of women who wanted to prevent pregnancy, but they wanted to do it by having their partners wear condoms," said Littlejohn. 

The pill could be a tool for liberation, she says, if people who are trying to prevent pregnancy have free and unbridled access to the methods that they want without pressure from their partners or anyone else.

Future of birth control

When it comes to evening the burden of responsibility around birth control, one of the hurdles has been research funding. But, Littlejohn says, that's been changing in recent years, with significant progress in prescription contraceptives that target sperm.

The experimental sperm-targeting contraceptive, which uses the same principles as hormonal birth control for women and birthing people, comes in the form of a gel that is applied onto the shoulders and contains both progesterone and testosterone.

The development of such a drug, Blithe says, has been about 80 years in the making.

"We're building on the 60 years of data we have [on] women about how this works in them and we're applying this to men," she said.