By Abby Neiser
According to a 2015-2017 study, the birth control pill is the second most common form of contraception in the United States, with 12.6% of women aged 15 to 49 using it to prevent pregnancy (Daniels and Abma, 2018). This finding is unsurprising. Discreet, affordable, and easy to access, it has empowered women by allowing them to take control of their own bodies. Because of this, many consider it to be a symbol of female liberation. However, rarely do we consider the history of how this revolutionary medication came to be. This story is little known, particularly in the United States, but is important nonetheless, as it underscores the troubling history of violence against women in American efforts to make medical advancements and the consequences of not trusting women’s accounts of what goes on in their own bodies.
Margaret Sanger is known as the mother of birth control and an important figure in the feminist movement of the first half of the 20th century, but this reputation has a dark side. Sanger subscribed to eugenicist ideas, specifically against people with disabilities and poor people (Blakemore, 2019). The goal of eradicating poverty might seem like a good idea if not for the fact that she wanted to do so by exterminating poor people themselves rather than the concept of poverty (Blakemore, 2019). Birth control was her solution to accomplish this. Sanger worked with biologist Gregory Pincus, who had developed an contraceptive medication that worked well in female animals (Blakemore, 2019). With this success in animal trials, the pair needed to find human subjects to further test its efficacy (Blakemore, 2019). The activist and biologist chose Puerto Rico to do the trials for three main reasons. First, laws in the continental United States regarding medical trials and birth control were very restrictive (Blakemore, 2019). Second, Puerto Rico was densely populated, and the population was continuing to increase (Blakemore, 2019). Third, and perhaps most importantly, Puerto Rico had a high poverty rate (Blakemore, 2019). These last two factors combined, in effect, meant that the population of poor people was growing in Puerto Rico, something that Sanger and likeminded Pincus wanted to avoid. Thus, doing the trials in Puerto Rico could kill two birds with one stone—they could test the pill without legal restrictions and prevent poor people from reproducing.
Not only were the trials grounded in immoral principles, but they were also conducted immorally. The women in the trials knew the basic contraceptive function of the pill but did not know anything about potential side effects (Blakemore, 2019). As a result, many women left the trials after experiencing these side effects, and rich and educated women did not participate because they were worried about the consequences (Blakemore, 2019; BBC Mundo, 2018). In short, Pincus preyed on the vulnerability and desperation of poor Puerto Rican women to promote a twisted ideology. Although the pill may have been effective in achieving the women’s goal of not having children, this benefit does not overshadow the huge ethical issue of providing incomplete information to trial participants about what could happen to them on this medication. These side effects were not insignificant either. Blood clots were common, and three women died during the trial (Blakemore, 2019). Whether or not these deaths were a result of the pill is still unknown because no autopsies were performed (Blakemore, 2019). The trials represent a passive form of medical violence. Pincus may not have been violent in the traditional sense of the word, but rather he left the women to suffer without having any idea what was happening inside their own bodies. This negligence resulted in many avoidable consequences, possibly up to and including death.
Pincus’s negligence extended to the way that he and his fellow scientists evaluated the results of the trials, as they disregarded most of the women’s complaints about side effects (Blakemore, 2019). According to Pincus, the majority of the side effects were merely psychosomatic (BBC Mundo, 2018). In this way, he invalidated the women’s lived experiences, which harmed not just the women in the trials but every woman who has taken—and continues to take—the pill since.
Even to this day, we do not talk much about the side effects of birth control pills, and women often suffer in silence because it is one of the only options to ensure pregnancy prevention on the woman’s end. These side effects range from mild to severe, and a non-exhaustive list of symptoms includes acne, bloating, fatigue, headaches, insomnia, nausea, increased blood pressure, mood swings, and dizziness (Gotter, 2018). The pill also can increase risk of much more serious conditions such as blood clots, heart attacks, liver cancer, and strokes (Gotter, 2018). Further, one 2016 study found that the pill may increases the risk of depression (How risky is the contraceptive pill?, 2016). While the more serious side effects may be rare, even the milder ones can be harmful and should be talked about more.
In my own experience, the pill has greatly affected my mental health. I went through long stretches of time when I did not feel like myself but simply wrote it off to stress from school because I had received no warning about side effects. After noticing a pattern that these symptoms got worse during a certain portion of the pill pack, I called my doctor’s office and received a call back with a prescription for a different pill without even speaking directly to a physician. The same thing happened again when the second pill did not resolve the problem. Months and months of suffering from anxiety later, I finally realized that the pill was the source of most of my woes after I made the decision to get off the pill and get an IUD. The worst part of this is that even surrounded by open, relatively liberal people and having the privilege of good insurance and living in an area saturated with doctors, I still thought that this was normal and simply something I would have to deal with because it is such a taboo topic in our society.
I have no doubt that the dismissal of the Puerto Rican women’s complaints in the initial trial are at least partly responsible for the modern stigma around birth control pill symptoms that I experienced firsthand. These side effects were never taken seriously from the beginning, and nowadays birth control pills are handed out like candy to young women with little to no warning. While they may be a good option for some—and have applications outside of contraception—the carelessness with which they are prescribed creates a problematic amount of avoidable suffering. The birth control trials and the use of the pill since highlight the detriment of mistreating, doubting, and stigmatizing women in medical settings, up to the point that they question their own bodily reality.
While the idea of allowing women to take control of the decision to have children was quite progressive, especially in such a Catholic place during the 1950s, it is important to recognize and remember the unethical conditions under which the pill was created. Beyond the actual conduct within the trial, the researchers never paid the women, and for a long time, the pill was unaffordable for most Puerto Rican women (BBC Mundo, 2018). Many of these women were also forcibly sterilized without their consent (Blakemore, 2019). This was so widespread that a 1965 survey found that 34% of mothers aged 20 to 49 had been sterilized (Presser, 1965). The pattern of sterilization in Puerto Rico continues to this day and has been marred by desperation due to a lack of options and misinformation (Onyekweli, 2020). The legacy of Sanger’s eugenic ideas and Pincus’s unethical trial is still alive and well.
Nonetheless, the dark side of the pill’s history does not mean that it should be outlawed or that we should not praise its benefits. We still can—and should—advocate for the pill as a form of female empowerment. For many, it may be the best option for preventing pregnancy or as an effective treatment for other conditions, and this is worth applauding. At the same time, however, we must not forget about the women who were affected by the initial trials. Their suffering and mistreatment live with us today and are a call to action for us to take the side effects of birth control seriously, talk about them openly, and push for medical professionals to do a better job informing patients about birth control options. Abandoning these women to be lost in history would be antithetical to the supposedly feminist position that the celebration of the pill implies.
Abby Neiser is a senior at the University of Pittsburgh majoring in Political Science and Spanish with a minor in Portuguese and a Certificate in Latin American Studies. During the summer of 2019, she studied abroad in Cuba as part of the Pitt in Cuba program. She is also the President of the Luso-Brazilian Student Association at Pitt. Abby is primarily interested in Latin American politics, international relations, social movements, and the intersection between politics and artistic expression. Upon graduating, she plans to pursue a career in public service or international relations.
BBC Mundo. (2018, January 7). Cómo América Latina fue clave en la historia de la píldora anticonceptiva (y por qué nadie lo celebra). BBC News. https://www.bbc.com/mundo/noticias-42274170
Blakemore, E. (2019, March 11). The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs. History. https://www.history.com/news/birth-control-pill-history-puerto-rico-enovid
Daniels, K. and J. Abma. (2018, December). Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db327.htm#:~:text=In%202015...(8.7%25).
Gotter, A. (2018, August 3). What Are the Side Effects of Birth Control Pills? Healthline. https://www.healthline.com/health/birth-control-side-effects
How risky is the contraceptive pill? (2016, December 12). BBC News. https://www.bbc.com/news/magazine-38265865
Onyekweli, N. (2020, October 28). Reports of Forced Sterilizations Have Prompted America to Reckon With Its Past. Shondaland. https://www.shondaland.com/act/news-politics/a34497969/ice-forced-steril...
Presser, H. (1969). The Role of Sterilization in Controlling Puerto Rican Fertility. Population Studies, 23(3), 343-361. doi:10.2307/2172875