This is the true history behind the development of hormonal contraceptives that now provide hope to billions of women. Photo credit: Reproductive Health Supplies Coalition via Unsplash
Note: Throughout this article, I use the term ‘women’ to include anyone who may use hormonal contraceptives to regulate their menstrual cycle. The Oxford Scientist acknowledges that this term encompasses many different identities and is not an accurate representation of various physiologies.
In the UK, approximately 26% of women between 18 and 49 use some form of hormonal contraception, ranging from the combined oral contraceptive pill, to the progestogen-only pill, to the hormonal IUD. These forms of contraception are generally hailed as having changed women’s lives since their rollout in the 1960s, providing financial liberation, reproductive autonomy, and sexual freedom. Nonetheless, despite their immense popularity nowadays, the story of the development of hormonal contraceptives is distinctly darker. Despite providing hope for billions of women across the globe, the history of these ‘miracle pills’ is rooted in eugenics, and the systemic control of impoverished women, POC, and Indigenous communities.
…the history of these ‘miracle pills’ is rooted in eugenics, and the systemic control of impoverished women, POC, and Indigenous communities.
In 1947, Katherine Dexter McCormick inherited US$ 35 million after the death of her husband. A lifelong women’s rights campaigner, birth control advocate, and biological scientist, McCormick generously donated this fund to her friend Margaret Sanger. Sanger, now well-known as the founder of Planned Parenthood, was on the hunt for a ‘simple, cheap contraceptive’. The search for an effective hormonal contraceptive was the pinnacle of Sanger’s work, believing that this contraceptive would have the potential to free women from enforced marriages through childbirth. Sanger, in turn, chose to gift this grant to Professor Gregory Pincus, a Harvard endocrinologist who had been working with his colleague John Rock on finding a female steroid hormone despite being ‘against women having sexual freedom’. Based on the work and findings of G.D. Searle, Pincus and Rock had been able to isolate and create a pill from progestin, a synthetic form of progesterone.
In 1954, after discovering the possible tranquillising effects of their pill, Pincus launched a trial on 16 female patients at the state mental health hospital in Worcester, Massachusetts. (Or as McCormick described it, ‘their cage of ovulating females to experiment with’.) These women, believed to be chronic psychosis patients, were fed birth control prototypes before Pincus sliced into their uteruses in an attempt to understand their effect on ovulation. After continued experiments on the patients of the Worcester State Hospital with increasingly worrying side effects, Pincus and Rock continued to explain all side effects as ‘largely psychogenic’.
…easier birth control for ‘slum dwellers’ in order to limit and discourage the fertility of the mentally and physically defective
Despite this, the first trial of this new birth control, Enovid, was launched in some of the most densely populated, impoverished, US-incorporated slum areas of Puerto Rico in 1956. Choosing to experiment on poverty-stricken women in a political conflict zone was not without reason. Margaret Sanger was of the firm belief that contraceptive pills would provide easier birth control for ‘slum dwellers’ in order to limit and discourage the fertility of the mentally and physically defective—or, as John Rock argued, to control the reproduction of ‘primitive peoples’ in line with his goals of curbing population growth. Existing eugenicist legislation in these US-controlled regions had already led to the forced sterilisation of 16.5% of Puerto Rican women of childbearing age, with 16% reporting that they had not made this decision for themselves. Elinor Cleghorn, author of Unwell Women, argues that the researchers saw these women as ‘submissive enough to be coerced continuously into taking an unchartered drug’. The first reports of the pill, released in 1957, illustrated that of the 221 involved, 17% had symptoms including nausea, dizziness, gastrointestinal symptoms, vomiting, bleeding, and headaches. Pincus and Rock argued that these symptoms were a product of the ‘emotional super-activity of Puerto Rican women’. In 1957, synthetic oestrogen was introduced to the progestin mix, meaning that Enovid contained 3 times as much oestrogen, and 10 times as much progestin as current combined birth control pills. In 1959, Enovid gained FDA approval for rollout in the USA.
In 1961, reports from Britain, New Jersey, and Los Angeles uncovered rising cases of pulmonary embolisms and thrombosis—both serious conditions involving the blockage of blood flow—as a potential product of the high hormone levels in these pills. 272 cases of thrombosis and 30 deaths as a result of the pills were reported by 1963. At least 3 women in the Puerto Rican trial tragically died of sudden heart failure and pulmonary embolisms, and their deaths were not reported in the trial findings. Despite this, Enovid was still approved for long-term use, and thrombophlebitis and pulmonary embolisms were only listed on the side of the packaging as ‘occasional occurrences’ with ‘no cause and effect relationship’.
Unfortunately, this is not where the story ends. Depo-Provera, a form of long-term hormonal contraceptive injection, was given disproportionately to African, Caribbean and Asian women in Britain in the 1970s. The Secretary of State for Social Services, Keith Joseph, argued that Depo-Provera was needed to ‘balance the human stock’ in order to prevent the birth of ‘problem children, the future citizens of our borstals, subnormal establishments, and prisons’. In 1979, Neelim Zabit, a member of the Campaign Against Depo -Provera, astutely argued that this contraception was being unfairly distributed ‘if you are seen by your doctor as either promiscuous, stupid, inadequate, working-class, Black, or with additional needs’. It is, by these standards, unsurprising that the introduction of Depo-Provera was coupled with a lack of scientific research and concerns surrounding short-term side effects including heavy bleeding, amenorrhoea (stopped periods), weight gain, and depression. American manufacturers of Depo-Provera, Upjohn, had also raised concerns about the potential carcinogenic nature of the drug, leading to its rejection by the FDA in America. Despite revisions of the drug and re-rollout since then, the National Institute of Health and Care Excellence (NICE) in the UK still lists cervical cancer, breast cancer, decreasing bone mineral density, and cardiac issues as risks associated with long-term use.
A dark coda to the story of Depo-Provera came in 2012, when an Israeli documentary team uncovered that thousands of Ethiopian women were non-consensually given courses of Depo-Provera contraceptive jabs whilst in refugee camps. Many of these women were not informed that these injections were contraceptive medication, nor were they given any indication of potential side effects. Dr. Mushira Aboodia, a gynaecologist working at a medical centre in Jerusalem, reported that the majority of Ethiopian women she had met had received Depo-Provera injections. Israel’s health ministry has since strongly denied that any injections were part of a policy to control the growth of this community. But, once again, we see the distribution of a poorly researched and dangerous drug to vulnerable women as a form of eugenics-motivated population control.
But, once again, we see the distribution of a poorly researched and dangerous drug to vulnerable women as a form of eugenics-motivated population control.
It is not just hormonal pills and injectables that have been the source of ethical controversies. During the 1960s and 1970s, doctors in Denmark were responsible for placing hormonal IUDs in Greenlandic Inuit women without their knowledge or consent. These coils were fitted during routine medical procedures, such as abortions, health check-ups, and surgery, under the jurisdiction of government officials. The results were devastating, with thousands of women and girls, some as young as 12, left with severe abdominal pain, bleeding, cramping, conception issues, amenorrhoea, and in some cases, punctured uteruses. A BBC article by Elaine Jung, published in 2022, highlights that this issue does not appear to have stopped in the 1960s–70s and may still be ongoing today, with some young women having had coils found inside them within the last decade. In Greenland, Inuit women continue to push for an apology from the Danish government, alongside a court case demanding compensation that is expected to conclude this year.
Birth control methods are often poorly researched, poorly funded, and all too frequently used to control the bodies of women that governments deign undesirable.
Perhaps, given its dark history, it is unsurprising that there is a growing movement of people anxious about the effects of hormonal contraceptives and choosing to opt for less effective non-hormonal methods. Studies continue to show that the pill is linked to physical side effects such as increasing the risk of breast and endometrial cancer, as well as emotional side effects, such as depression, suicidality, low libido, and dysregulated sleep. Birth control methods are often poorly researched, poorly funded, and all too frequently used to control the bodies of women that governments deign undesirable. It is essential that the women hurt by these programmes are given appropriate reparations, and that increased research funding and regulations are in place before hormonal contraceptives are rolled out to the general population—only then can birth control completely represent liberation.
