Enovid, the first birth control pill ushered in a new era of sexual autonomy for women. It was marketed as a safe, clinically tested way to take control of reproductive health. The pill had a bright future, but its past is intertwined with eugenics and colonialism. Its clinical trials took place not in the mainland United States, but in Puerto Rico. Strong women were given a strong formulation of the drug. They were not told they were taking part in a trial or about any of the risks they’d face.
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Opening statement:
Enovid, the world’s first birth control ushered in a new era of sexual autonomy for women. It was marketed as a safe, clinically tested way to take control of reproductive health. The pill had a bright future, but its past is intertwined with eugenics and colonialism. Its clinical trials took place not in the mainland United States, but in Puerto Rico, where strong women were given a strong formulation of the drug without being told they were taking part in a trial or about any of the risks they’d face.
What is going on everyone? this is the LEO podcast… where we talk about various educational topics… especially those impacting the Latin American community.
In today’s episode, we’re going to be talking about…
The first birth control pill and it’s dark past of using Puerto Rican women as Guinea Pigs. These trials are a major component in the history of the development of female oral contraceptives that are not often talked about and today we’re going to go over the history behind the birth control pill, the key figures behind these trials, and the impact it had on Puerto Rican women.
I’m your host kevin muñoz, this is today’s free episode, if you want early access to episodes and bonus episodes you can find that right now on our patreon.com/latinamericaneo and if not then enjoy this one!
Topic 1: The Comstock Laws
In 1873, the United States government passed a series of legislation commonly known as the Comstock Laws. The Comstock Laws not only criminalized the use of the postal service as a means of obtaining or sending anything considered obscene or salacious like books containing sexual language, but it also prevented the usage of contraceptives by the general public.
Legislation, however, did not prevent women or businesses from continuing to explore and attempt different methods of birth control. These unregulated contraceptives and abortive methods often lead to the death and unintentional sterilization of many women.
Topic 2: Margaret Sanger and the first birth control pill
Infuriated by the lengths that many were forced to go to in order to regulate their own fertility, women began to push for legal rights to contraceptive methods and more importantly, the right to govern their own bodies. The movement for public access to birth control started in the early 20th century, propelled by figures like Margaret Sanger.
She became one of the most influential figures in the birth control movement and a key figure in the start of the pill’s history.
In 1916 she opened the nation’s first birth control clinic and was arrested for distributing information on contraception and put on trial for breaking a New York Law. The trial that followed is now considered a watershed moment for birth control in the United States, and inspired physicians and researchers to begin seeking better ways to help women plan and prevent pregnancies.
Sanger thought that women would never be free until they had the ability to control their own bodies. But her views on birth control were also rooted in philosophies that you might not expect from such a key figure in the birth control movement.
Historians contest a longstanding myth that sanger thought non-white people should be prevented from procreating, but they agree that Sanger supported eugenics, a theory that “undesirable” populations could be reduced or eliminated by controlling their breeding.
In Sanger’s case, that “undesirable” group was “the mentally and physically defective.” Using the eugenic language of the era, Sanger argued that birth control could help wipe out “the greatest present menace to civilization” aka people living in extreme poverty and those with mental illnesses and physical disabilities.
The interest to eliminating extreme poverty drove Sanger to look for, and invest in, more modern forms of birth control. She then met controversial biologist Gregory Pincus another key figure in this story who specialized in mammal reproduction. Sanger asked him if his work could be used to create a cheap birth control pill to which he told her he’d try. This led Sanger to introduce Pincus to Katharine Dexter McCormick, a philanthropist who underwrote what would become one of the 20th century’s most ambitious – and risky scientific experiments.
Topic 3: Pincus and John Rocks’ involvement in the first birth control pill
During that time the female reproductive system was still largely a mystery to scientists, and birth control was strongly regulated by state laws that made it effectively illegal to research or distribute. Massachusetts, where Pincus began his work in the 1950s, was one of those states. Pincus and John Rock, an obstetrician, began working in secret to figure out if it was possible to use progesterone, a hormone produced by the body during pregnancy, to prevent pregnancy in women. In the lab, it prevented pregnancy in both rabbits and rats so they thought to themselves if it could also work in women who weren’t yet pregnant as well.
This is the question that led them to begin their trials. But Pincus could have been jailed in Massachusetts if the real nature of his research was discovered. So even before the Puerto Rico trials he first conducted a trial on a small number of women, hiding his research by calling it a “fertility trial”. But if he wanted to get his drug approved then he would need a wider clinical trial.
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Topic 4: Puerto Rico
In the eyes of Pincus and Sanger, Puerto Rico was the perfect place for these trials. During this time, it was the middle of a population boom, and poverty was rampant. But it was also home to birth control clinics that had once been funded by the United States government under New Deal programs. Now, Procter & Gamble’s heir and American eugenicist Clarence Gamble funded and ran many himself.
To give you an idea of their ideology, Gamble believed that Puerto Ricans and others living in poverty should be wiped out to make room for more “fit” members of the population, and birth control was part of that vision. His birth control centers became recruitment grounds for Pincus’s clinical trial. Gamble was even deeply involved in Puerto Rico’s policy of encouraging women to undergo sterilization as a form of birth control. As a result one-third of Puerto Rican women were sterilized-many involuntarily-under policies that pressured women to undergo hysterectomies after their second child’s birth.
What this policy did for Pincus’s trial is help create candidates. Educated women didn’t want to try the new medication, fearing side effects, but less educated women were desperate to avoid both pregnancy and sterilization. Pincus focused on that group of women during the clinical trials that recruited in the poorest areas of San Juan and other cities beginning in 1955.
They purposely recruited women for these trials who were “…the poorest of the poor, had no place to go, and, short of sterilization, no birth control options, and were poorly educated.” Women recounted physicians dispatching their assistants to go door to door throughout the town’s slums, telling women they didn’t have to have another child if they took the pills regularly.
These women were exploited for their use. While these women didn’t know what the drug they were getting would do to them, some also had the responsibility of caring and providing for their families.
Margaret Marsh describes in her work how one woman was 30 years old with ten children, and a husband that “drank heavily and insisted on daily intercourse, but claimed to be too sick to work.” Marsh also described a woman who had five children and a husband who was frequently hospitalized for mental illnesses. This shows these women while trying to provide for their families, were being subjected to this “unknown” treatment, that at many times, left them unable to work or even care for their families and children.
The women were only told that they would have the opportunity to make sure they would no longer get pregnant and that their families would not be growing anymore, which for these poor, and uneducated women, was what they felt they needed at the time.
Topic 5: Side Effects
Women who took the drug knew that it prevented pregnancy, but had no idea it was experimental or even that they were participating in a clinical trial. And according to physicians Pamela Verma Liao and Janet Dolin, they weren’t given safety information on the product, either, and women experienced serious side effects like blood clots and nausea.
The drug Enovid used in this trial was a much higher dosage than oral contraceptive pills prescribed today. Modern health practices facilitate prescriptions for birth control, averaging about 0.75 milligrams per dose. The original dosing of 10 milligrams is more than 100 times the acceptable concentration of hormones in contraceptive pills today.
It was noted that the “women who stepped forward to describe side effects…were discounted as unreliable”. So despite the substantial positive effect of the pill, its history is marked by a lack of consent, a lack of full disclosure, a lack of true informed choice, and a lack of clinically relevant research regarding risk.”
And the risk was very real. However, Pincus didn’t feel that side effects like nausea or depression warranted a reformulation of the pill. Their only concern was proving its efficacy. Meanwhile, three women died during the clinical trials, but autopsies were not performed on their bodies. And it remains unclear whether those fatalities were linked to the pill.
By modern standards, the secretive trials were both unethical and unsafe. Women who agreed to take the drug did out of desperation, but without full disclosure of what might be at stake. But for Pincus, the trial was a success: The high dose of hormones ensured trial participants wouldn’t get pregnant, and in the field trials, the pill was nearly 100 percent effective. Pincus didn’t stop testing: A second trial was funded by Gamble, and the pills were also tested on women and men in mental asylums without consent.
As for the original dosage from the trials, it was eventually dropped to 5 milligrams after severe side effects were observed including dizziness, headaches, and blood clots, along with the death of the 3 women in Puerto Rico. Despite strong circumstantial evidence that the pill was causing these unexpected deaths, they were not reported for two reasons. Firstly, those conducting the trial considered the deaths to be coincidental. Secondly, autopsies were never conducted on the bodies of the three women.
Topic 6: Approval
On May 9, 1960, the pill was first approved by the FDA as a contraceptive method in the U.S., the demand was immediate. Within four years, more than four million women had used what was then marketed under the name Enovid. Now, more than half a century later, the pill is the most common birth control method used by women of reproductive age. In recent years, a social media campaign has even formed around the hashtag #ThxBirthControl.
Topic 7: Ethics and controversy
Even though the contents of the original birth control pills were modified after trials due to the dangerous levels of hormones in its contents, the discovery and the authorization of the pill made a profound impact on women’s reproductive rights in the United States. Women were now able to directly control their own fertility because of the legalization of the pill and the studies that aided in the authorization of the pill. Instead of having to deal with an accidental pregnancy, women were provided the opportunity to delay having children allowing them to pursue higher educational goals or seek employment. Based on statistics, the pill was considered “… one of the most transformational developments in the business sector in the last 85 years. Fully one-third of the wage gains women have made since the 1960s are the result of access to oral contraceptives.”
Despite the benefits that the birth control pill has given global feminism, it is important to understand the trail of negative impacts of the pill that is less talked about. A Puerto Rican woman named Delia Mestre who participated in the trial unknowingly was able to shed light on these issues describing that it was difficult to understand that the experiments, in which she and other hundreds of women served as guinea pigs, would ultimately benefit white women of higher socioeconomic status on the mainland of the United States. When questioned about her participation in the experiments, Mestre explains that “the experiments were both good and bad. Why didn’t anyone let us make some decisions for ourselves?” With tears in her eyes, Mestre also states “I have difficulty explaining that time to my own grown children. I have very mixed feelings about the entire thing”
Unfortunately, Mestre and other women who participated in the trials were not given the choice to decide whether or not they wanted to serve as participants in the sexual revolution that had been occurring within the United States. Instead, the bodies and welfare of impoverished women were sacrificed for the benefits of white women and male scientists who considered the pill a milestone in the fields of science and healthcare.
Closing remarks:
Lastly, to close off this episode let’s read off the response to the trials from Feminist activists
Alice Wolfson is among the many advocates that critiqued and condemned the contraceptive trials conducted on Puerto Rican women. Not only were advocates challenging the anti-feminist outlooks of both liberal and conservatives within the United States, but also the systematic inferiorization of women through colonial, racial and gendered structures.
Feminist scholar and activist, Antonia Darder analyzed the various degrading policies that were enforced following World War II. As explained, women were seen as the means towards the advancement of imperialistic interests held by philanthropists and foreign policy makers. Notoriously, it was the exploitation of poor and working-class women’s sexuality and reproduction in which forged the crude occupation of the United States in Puerto Rico. Furthermore, feminist Catherine MacKinnon scrutinized the hierarchy of power between men and women as a key component in their encroached subjection. Such disparities within Puerto Rico constrained their advancement and rendered them as inferior citizens.
In addition, native Puerto Rican women were constantly targeted and discriminated based on derogatory stereotypes. Considered incapable of socio-economic achievement, they were often deemed as prostitutes, welfare abusers and incompetent mothers. This stigma enforced the idea that low socio-economic communities had the moral obligation to limit and restrict the growth of families with inadequate capability to sustain themselves. This ideology was cultivated by the fears and biases of white pro-birth control groups in the United States who wanted to prevent abusive dependency on social welfare services by poor familial units.
Among those culpable in supporting this race-suicide discourse as explained by political activist, Angela Yvonne Davis, were white pro-birth control women like Margaret Sanger. Her public statement in support for the implementation of forced contraceptive trials in Puerto Rico is a direct example of the negative rhetoric that harmed minority women. As she argued, “morons, mental defectives, epileptics, illiterates, paupers, unemployables, criminals and prostitutes” should be forcibly sterilized or given contraception to limit their reproductive capabilities.
As Kimberlé Crenshaw would argue through the theory of intersectionality, which discusses knowledge as the mixture of situation, context, relationship, and a reflection of political and economic standing, Sanger exclusively includes women in her remarks since women are also victims of multiple conditions and societal strains at the same time. Due to this discourse, minority women from Puerto Rico were coerced to undergo clinical treatments. In her film, La Operación, Ana Maria Garcia provides these women a platform to denounce the practices. Some women as seen in the film, were inadequately advised on procedures, and others argued that they did not have other choices due to the constant coercion.
THE END
That’s all for today on the LEO podcast. I’m Kevin Muñoz and as always feel free to send me a message with your thoughts or with any interesting topic that you’d like to see covered.
and for those of you on Patreon, I’ll see you there.
Otherwise, I’ll see you all in next week’s episode!
Sources:
https://www.washingtonpost.com
