The Story Of The Pill

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In the early popular controversy, while women by the million applied to their doctors for the prescription needed for their use of the Pill, its safety was assumed: the vehemently argued questions were religious, moral, social. Religious people, especially Roman Catholics, asked whether the Pill was a manifestation or a violation of the Divine Plan. A typical answer was that of John Rock, himself a devout Catholic. The prevention of pregnancy by hormones was, said he, far more “natural” than the hierarchy-approved but notoriously unreliable “rhythm method.” Sociologists asked what effect the Pill would have on sex mores. Would it loose a flood of licentious sexuality, fatally weakening the family as basic social unit? To this question there could be no certain answer. The most that can now be said is that the Pill’s introduction coincided with a radical shift toward sexual “freedom” on the part of the young in the 1960’s and that there was probably some causal connection between the two phenomena.

It was not until the latter part of the decade, by which time several rivals of Enovid-10 had appeared in the marketplace, that questions about the Pill’s safety became the center of popular controversy. In 1966, elaborate statistical studies by Britain’s Medical Research Council revealed Pill users to be far more susceptible than nonusers to thromboembolism (blood clotting which can do great and even fatal injury to lungs or heart or brain). Statistically, according to this study, a Pill user is about nine times more likely to be hospitalized for blood clotting, and about seven times more likely to die of it, than a nonuser. Yet the percentage risk, this same study showed, is very small—smaller than for many widely used drugs. Of 100,000 Pill users, aged twenty to thirty, 1.3 will die of thromboembolism in a given year, say the statistics; of 100,000 aged thirty-five to forty-four, 3.4 will die. Incidentally, this compares with 30 deaths per 100,000 per year from thromboembolism caused by pregnancy itself.

Another seeming and dangerous effect of the Pill, according to many medical scientists, including Edward Klaiber, an endocrinologist M.D. now on the staff of the Worcester Foundation, is its encouragement of certain kinds of mental illness, notably depression. And it is worth noting that sex therapists Masters and Johnson, when women come to them with problems of anxiety and depression centered on sex, immediately order these women off the Pill if they have been on it. Often this solves the problem. But here again the percentage risk seems small (there are no firm statistical data from which to draw conclusions); and one must bear in mind that anxiety, depression, irritability (the “middle-ofthe-month blues”) are a common accompaniment of the menstrual cycle, whether a woman is on the Pill or not.

Recently there has been an increase in popular fears that the Pill is carcinogenic, due in part to a highly publicized court case in which a judge ruled in favor of a plaintiff who claimed that the spread of her breast cancer, ultimately fatal, was due to the estrogen in the Pill. This fearful belief may be effecting a considerable reduction in mass Pill usage as this is written. No support for it is provided, however, by the numerous statistical studies of cancer vis-à-vis the Pill conducted in the last few years. It would appear that on this score, too, where the initial risk was perhaps greatest, the FDA has won the gamble it made when it approved this means of birth control.

Such, at least, is the conclusion suggested by staff members of the department of medical and public affairs in the George Washington University Medical Center, Washington, D.C., who have made detailed studies of the immense volume of available statistics on the question. Although the heading for a May, 1977, report dealing exclusively with statistical studies of oral contraceptives and neoplasia (that is, tumors) is “Answers Remain Elusive,” the report itself observes: “Oral contraceptives have brought millions of women relief from the burdens of childbearing and the fear of unwanted pregnancy and have contributed to happier family and sexual lives, better health, and an improved standard of living. Oral contraceptives have helped reduce illness and death due to childbearing and, in many places, have facilitated the slowing of population growth. These benefits are clear and large. No known adverse effects on the incidence of neoplasia outweigh these benefits or argue for restricting the availability of orals.”