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A podcast about how hormones shape our world.

Latest episode:

Risky business: birth control during COVID-19

About Hormonal

Hormones affect everyone and everything: from skin to stress to sports.

But for most of us, they're still a mystery.

Even the way we talk about hormones makes no sense. ("She's hormonal.")

So let's clear some things up. Each week, Rhea Ramjohn is asking scientists, doctors, and experts to break it all down for us.

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Episodes

A Sneak Peek at Season 2

with Rhea Ramjohn

Episode 0, 5 min, August 25, 2020
Listen now

Episode 0

August 25, 2020

A Sneak Peek at Season 2

As we work hard on Season 2 of the Hormonal podcast, we’re dropping into your feed with a special request, and a small behind the...

Hot or not? Birth control & sex drive

with Lynae Brayboy, M.D.

Episode 1, 25 min, October 11, 2020
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Episode 1

October 11, 2020

Hot or not? Birth control & sex drive

How birth control affects your sexual desire, self image, and weight fluctuations.

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The ABC: Abortion & Birth Control

with Stephanie Franzin, M.D.

Episode 2, 34 min, October 19, 2020
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Episode 2

October 19, 2020

The ABC: Abortion & Birth Control

What’s it like to get an abortion and the surprising ways the pandemic is changing abortion access.

The many sides of side effects

with Dr. Gabriela Aguilar

Episode 3, 33 min, October 26, 2020
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Episode 3

October 26, 2020

The many sides of side effects

Hormonal birth control: positive, negative, and neutral effects

Reproductive choice and reproductive justice

with Dr. Loretta Ross

Episode 4, 35 min, November 2, 2020
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Episode 4

November 2, 2020

Reproductive choice and reproductive justice

Accessing birth control against the odds

Happy birthday, birth control

with Jonathan Eig

Episode 5, 42 min, November 9, 2020
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Episode 5

November 9, 2020

Happy birthday, birth control

Controversy and celebration on the 60th anniversary of the pill

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menstrual health together.

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Bringing sexy back

with Imogen Raye Minton & Yasmeen Bruckner

Episode 6, 35 min, November 16, 2020
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Episode 6

November 16, 2020

Bringing sexy back

Birth control after a pregnancy

Risky business: birth control during COVID-19

with Gillian Sealy

Episode 7, 30 min, November 23, 2020
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Episode 7

November 23, 2020

Risky business: birth control during COVID-19

COVID-19 is changing how we access birth control

Credits

Season 2

Executive Producer: Kassandra Sundt
Host: Rhea Ramjohn
Editorial Help from: Amanda Shea, Steph Liao, Nicole Leeds
Clue Design: Marta Pucci & B.J. Scheckenbach
Web Team: Yomi Eluwande, Jane Parr-Burman, Maddie Sheesley

Special Thanks: Trudie Carter, Ryan Duncan, Aubrey Bryan, Claudia Taylor, Léna Calvarin, Lynae Brayboy
Mixing and recording help from: Bose Park Productions & Rekorder Studios in Berlin.

About Clue

Clue is the period tracking app that uses data and science to help you understand your body. It's also an encyclopedia of your menstrual cycle.

Learn more about the Clue app and check out what Clue is doing to advance menstrual health research.

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Rhea Ramjohn,

host of the Hormonal Podcast

Rhea Ramjohn,

host of the Hormonal Podcast

Your Host

The more knowledge we have about our hormones, our medical & menstrual care, and our reproductive rights, the more we empower ourselves and one another.

Hormonal has offered me the true privilege of speaking with people who have the expertise on the scientific knowledge about our hormones and cycles, as well as those sharing their lived experiences, caring for people with menstruation and how, all combined, shapes our lives everyday.

Gathering facts as well as personal stories are so vital to our understanding of our health, our his/herstories, and our cultures. I deem it a privilege because we haven't had many platforms nor opportunities for menstrual health information being broadly accessible.

Episode 5

Happy birthday, birth control

minNovember 9, 2020
min
42 min
November 9, 2020

Happy birthday, birth control

Controversy and celebration on the 60th anniversary of the pill

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About

The birth control pill officially turns 60 years old this year, so we’re telling the story of the pill. Where did this remarkable invention come from? What doors did it open up? Author Jonathan Eig joins us to delve into this fascinating, shadowy story.

Transcript

This transcript and interview were edited for clarity.

On Hormonal we explore the science behind hormones, but we also talk about society and the world around us. We know that there are lots of women who have periods and lots who don’t. We also know that there are people who aren’t women who have periods, too. We also know we have listeners who have never had periods. We hope you feel welcome, even when a term that a guest uses maybe doesn’t apply to you. 

At Clue, we believe that our identities are not determined by our bodies. Thanks for listening to Hormonal. 

Rhea Ramjohn: You're listening to Hormonal, the podcast from Clue: the menstrual health app. I’m Rhea Ramjohn. If you’re just joining us, this season is all about birth control. And it’s a big year for the birth control pill!

2020 marks the 60th anniversary of The Pill. On Hormonal, we wanted to take this opportunity to look at the history of this impactful invention.

I have a really great interview on the  history of the birth control pill, but before we get there, at Hormonal, we were wondering: who were these first users? Our parents and grandparents who took the pill, what was it like? What were their side effects?

So yes, I asked your grandma about her sex life. 

Easy access to birth control, or even the legal right to access birth control, is relatively new. Even after the pill was out on the market, there were laws on the books that prohibited even married couples, in some states in the US for example, from gaining access. 

Trish: It was only in 1965, I think, that the United States Supreme Court prohibited states from having laws against married couples even using birth control pills or birth control in general, for that matter.

Rhea Ramjohn: Today, Trish, is 77 years old. But in the mid 60s, Trish was a newly married biology student, and she said she wanted to go on the pill so that she could,  ahem, enjoy married life but still continue her studies. 

And it worked! For a while at least.

Trish: At the time, the medical wisdom was that after you'd been on the pill for three or certainly six months, you needed to stop for a month to let your body be normal. And then you could start again. So. We did that and used condoms for that month, and I promptly got pregnant. 

Rhea Ramjohn: The science, it seems, was still catching up to the realities. 

Something we noticed when talking to this first generation of birth control pill users is that a lot of them felt kind of isolated. Not talking to their moms or sisters or even peers about it for a whole host of reasons, from religion...

Marguerite: My family were Catholic. 

Rhea Ramjohn: To general teenage awkwardness…

Vivian: I would never ask my parents, you know, for a prescription.

Rhea Ramjohn: I want to introduce you to Vicki. She’s from San Francisco and first went on the pill in the 60s as well. She was self admittedly a little prudish at the time, especially compared to her peers. In fact, it earned her a nickname.

Vicki: It was Iron Pants.

Rhea Ramjohn: Vicki told us that she was so reluctant to talk to an adult about getting the pill at first that she actually stole pills from her mother’s birth control stash. 

Vicki: She had this huge stash of birth control pills. So taking a month’s worth was not a big deal. I don't think she ever said anything. I doubt she ever noticed. 

Rhea Ramjohn: Let’s travel from the sunny streets of San Francisco to Montreal and meet Vivian. 

Vivian: My name is Vivian. I was 17 when I first went on the pill in 1967.  

Rhea Ramjohn: Vivian was working at a big fair called Expo 67 that summer when a coworker made her an offer:

Vivian: She said, oh, I have a prescription and I'm not using it, so you can use it. And somehow I went to a pharmacist, and he gave me the prescription, I guess, without asking too much information.

Rhea Ramjohn: Some of our users had side effects.

Trish: I felt nauseous most of the time. 

Rhea Ramjohn: But most didn’t.

Margeurite: I really had no side effects. It was really wonderful. 

Jen: None. None at all.  

Elaine: I was absolutely fine on it. 

Rhea Ramjohn: Okay, that was the first chapter of our first generation users who all took the pill in the 1960s. Listen at the end of the show for chapter two, when we move from the swinging sixties to the so-called “me decade” of the 1970s. 

We just heard a lot of personal stories about birth control users, but what about the birthday we’re here to celebrate: the birth of the birth control pill. 

The pill opened up a lot of opportunities for people, in a lot of different ways. It offered women and people with periods more flexibility to explore their sexualities, or expand one's career path before becoming a parent, or plan pregnancies in a way that makes the most sense for each individual. 

But there's also a shadow side to this history. With hasty and ethically dubious research and development standards, marginalized women were the ones who bore the brunt of tests to develop this new “miracle pill.”

Here to tell us this story and much more is Jonathan Eigg. He's the author of Birth of the Pill and joins us from Chicago, Illinois. Jonathan, thanks so much for joining us on Hormonal. 

Jonathan Eig: Thanks for having me. It's nice to talk to you. 

Rhea Ramjohn: So tell us, why were you interested in this story? The origins of the birth control pill?

Jonathan Eig: I heard a sermon once from a rabbi who said that he thought the birth control pill was the most important invention of the 20th century, and that it was an example of what the Torah tells us about being partners with God and creating the universe: that we have a responsibility to make the universe, to make change in the world, not to accept the world as we find it. And I thought, “Wow, if the birth control [pill] is the most important invention, or one of the most important inventions of the 20th century, how come we know so little about who invented it and how it was invented and why?” And it just made me curious. I began researching those questions. 

Rhea Ramjohn: Yes, I'm very interested as well. And I'm hoping you'll set the scene for us. I want to know more about what the scientific and cultural landscape was like at that time. So could you read for us a little bit from your book? 

Jonathan Eig: I would love to, I’ll read from the very beginning of the book. It's chapter one called A Winter Night. It takes place in Manhattan in the winter of 1950. 

"She was an old woman who loved sex, and she had spent 40 years seeking a way to make it better. Though her red hair had gone gray and her heart was failing, she had not given up. Her desire, she said, was as strong and simple as ever. She wanted a scientific method of birth control. Something magical that would permit a woman to have sex as often as she liked without becoming pregnant. It struck her as a reasonable wish. Yet through the years, one scientist after another had told her, no, it couldn't be done. Now her time was running out. Which was why she had come to an apartment high above Park Avenue to meet a man who was possibly her last hope. The woman was Margaret Sanger, one of the legendary crusaders of the 20th century. The man was Gregory Goodwin Pincus, a scientist with a genius IQ and a dubious reputation. Pincus was 47 years old, five-feet-ten-and-a-half inches tall, with a bristly mustache and graying hair that shot from his head in every direction. He looked like a cross between Albert Einstein and Groucho Marx. He would speed into a room working a viceroy between his yellowed fingers. And people would huddle close to hear what he had to say. He wasn't famous. He owned no scientific prizes. No world changing inventions were filed under his name. In fact, for a very long stretch of his career, he had been an outcast from the scientific establishment, rejected as a radical by Harvard, humiliated in the press, and left with no choice but to conduct his varied and oftentimes controversial experiments in a converted garage. Yet he radiated confidence as if he knew the world would one day recognize his brilliance.”

Rhea Ramjohn: Wow. You mentioned two very important characters here, Margaret Sanger and Gregory Pincus. Could you tell us a little bit more about them and actually the four main characters that you profile in your book? 

Jonathan Eig: Yes, really the dream of birth control, of oral contraception begins with Margaret Sanger, back around 1915, when she was a young woman working as a nurse in the poorest neighborhoods of New York City. She began to say that what she really needed was effective birth control, that you couldn't teach women about birth control and then leave them with nothing. And what women needed, she felt like, was a miracle tablet. That's what she called it, something that would allow them to turn on and off their reproductive systems. But everybody told her she was crazy, that it was illegal, that even if it weren't illegal, it was scientifically impossible, and that no doctor, no scientist would ever even agree to research such a thing because it would be career suicide. So she continued for decades to ask people, to seek a solution. But it wasn't until 1950, when she met Gregory Pincus, that she finally found a scientist who said there might be a way. And of course, the science had to catch up to her. It was by the 1950s that we were understanding how hormones worked, and when it was beginning to occur to doctors and to scientists that they could manipulate the human body with hormones, that they might be able to fix things like diabetes, that they might be able to cure diseases by using hormones. And Pincus, when confronted by Sanger, said, you know, “It's possible that we could use hormones to trick the body into thinking that it's pregnant, and the woman would not conceive.” So that's really where it began with those two characters. And then two more very important characters came on board. 

Sanger could not get Planned Parenthood to agree to fund this research. So she had to go out and find somebody who would pay for it. Hospitals, universities, drug companies were not the least bit interested. They were afraid to go anywhere near this. So Sanger found a woman named Katherine Dexter McCormick, one of the wealthiest women in America, and she agreed to fund the entire project herself. And then there was one more piece of the puzzle missing: Pincus was a lab guy. He didn't really know how to treat patients. He didn't know how to run experiments on humans, only on rats and rabbits. So he found a gynecologist, a very prominent, very respected gynecologist who worked at Harvard, named John Rock. And John Rock agreed to help him with experiments on women and running clinical trials to see if this idea that progesterone might be an effective contraceptive could be proved. 

Rhea Ramjohn: So what was the state of science at that time, especially in terms of the women's movement and  the idea of sexual liberation at the dawn of this invention? 

Jonathan Eig: I don't think I'm exaggerating when I say that there was no interest whatsoever in the scientific community, in women's reproductive health, in women's sexuality. The only question was fertility really. This was the 1950s. In the postwar boom, women were having bigger and bigger families, and a lot of women were going to their doctors and to their gynecologists if they were infertile, seeking help to try to conceive. But that's about as far as it went. 

Rhea Ramjohn: OK. And as these four characters converge, Rock, McCormick, Pincus, and Sanger, what happens at that point? 

Jonathan Eig: This, to me, is one of the great stories in scientific history, because you have these four outsiders, these four rebels, who really believe that if they can pull this off, they can shake up the world, that they can change the very dynamic of humanity. They can change the very essence of sexuality. But they have to do it all underground. They have to do it with no help from the federal government, no help from universities, no help from corporations. They are completely flying under the radar, and they have no idea. There's no roadmap for this. There's no precedent. So they don't know even if it works, even if their tests show that they can make a birth control pill. Will they be able to get a drug company to manufacture it? Will they be able to get the government to approve it? Will people take it? There has never been a drug that has been approved by the FDA for something that doesn't cure a disease or ease a pain. This is the world's first social drug. Really. 

Rhea Ramjohn: Right. So why exactly was it underground? Could you explain that in more detail for our listeners? 

Jonathan Eig: Yeah, they had to go underground for several reasons. One is that they could never get approval. Much of what they were doing was illegal. It was illegal at the time even to distribute information about birth control. Margaret Sanger was arrested several times for just mailing information, mailing pamphlets about contraception. So they had to be careful that they did not break any laws. And the other issue is that when they started testing it in clinical trials, they had no approval for this. There was no permission. There was no consent. So everything they were doing was meant to prove this thing worked while attracting the least possible attention. 

Rhea Ramjohn: OK, well, what was the process actually like? Can you explain to us what the scene looked like? What were these everyday characters dealing with as they were basically experimenting with the birth of the birth control pill? 

Jonathan Eig: It was, [Laughter], it was a mess, to put it mildly. First, they began in the lab... 

Rhea Ramjohn: I believe that. 

Jonathan Eig: Right. Pincus had a laboratory that he'd built out of a home in Shrewsbury, Massachusetts. And it was a converted home. One of his scientists was actually living there. And they were testing it at first on rats and rabbits, as I mentioned. And then they needed to try to find women who would agree to do this, and that was very challenging. When they began, John Rock had some women who were trying to get pregnant, and they asked these women if they would agree to take injections of progesterone. The theory being that it would “rest” their reproductive systems, they would not have periods, they would not be able to reproduce for a while. And then perhaps when they stopped taking the progesterone, their bodies would rebound. They called it "The Rock Rebound." And then they might have success in getting pregnant. So ironically, the very first attempts at oral contraception were experimented on women who were desperately trying to get pregnant. 

And from there, they needed more women. They needed to show with this that if they were gonna get approval for this from the FDA, they needed to show that it worked on  hundreds, if not thousands, of women. So from there, they moved to an insane asylum in Massachusetts, and they began testing it on women there without the permission of those women. They would just line the women up and say, "We're giving you an injection today. Let us know how you feel." And then they started trying it on men there, too, just to see what would happen. Again, there was very little regard for the side effects or for the safety of these initial guinea pigs. 

Rhea Ramjohn: Ok, this is where we’re starting to get into the really ethically questionable and disturbing part of the pill’s development history. There are other murky parts to this story, but first, going back to Rocks' underground experiments, how long did it take to develop this first pill that went from zero to testing on rabbits to then testing on women?

Jonathan Eig: It was really remarkably fast, when you think about it. Within three or four years of the very first idea occurring to Sanger and Pincus, they've got a prototype and they're testing it on women, as I mentioned, not only in this insane asylum, but people who work for Pincus and Rock. Women in the lab are asking for it because they're so desperate to avoid becoming pregnant. In some cases they have six, seven children already, and they don't want to have more, and they're willing to risk the side effects because this is such an important game changing medical advance. 

Rhea Ramjohn: You mentioned that Rock tested this drug on men and women in an insane asylum. And I understand that Rock also tested it on himself?

Jonathan Eig: Yes, he did. You know, one of the very first important tests was whether this would have fatal side effects, right? It hadn't been tried before. And Rock, to his credit, injected himself to make sure that they were not doing anything that would be horrifyingly dangerous––they didn't think it would be. What they knew about hormones or what they knew about progesterone at the time suggested that it might induce changes in the body, but they didn't think it was likely to be fatal. So, yeah, Rock tried it on himself. They tried it on some of the men in the insane asylum. And this is interesting and important, I think, when Sanger and Katharine McCormick heard that they were testing this on men, they got very upset and they said, "Stop immediately. We are not paying you to create or even experiment on birth control for men."

Rhea Ramjohn: Fair point. 

Jonathan Eig: It's very important. They said it’s their money, and they were afraid that somehow men would hijack this thing. It was very important for them that women gain control of their own bodies, and they wanted a form of birth control that women could take without the involvement of men, without the permission of men, without even the knowledge of men, in some cases. Because history showed that when men controlled access to birth control, when safe sex was dependent on a condom, the men could not be trusted. And that was paramount for them. 

Rhea Ramjohn: Ok. This story and history is really starting to heat up. Let’s pick back up, with more, after this quick break. 

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Alright, back to the show.  

Rhea Ramjohn: You’re listening to Hormonal from Clue. I’m your host, Rhea Ramjohn. 

Ok, Jonathan. Before the break, you were telling us how these two powerful women were angry that some initial tests were being done on men. Now that’s interesting, because now at Clue, we get questions all the time about when men's birth control is coming.

Jonathan Eig: Yes. And that's a really good question, because one of the unfortunate side effects of this birth control pill that Sanger and Pincus developed, Rock and McCormick too, is that it takes men off the hook. Women get the power as they should. Women get control of their own bodies as they should. But one of the side effects is that men can kind of take it for granted. They can assume that the women are handling it. As a result, they don't even feel like they need to be a part of the conversation and they don't take much responsibility in some cases. And that's not fair. It needs to change. And if there were more options for men, if men were willing to endure some of the side effects that these women endured over the years, especially when the birth control pill was new, we would have seen a more just system develop. But right now, that system is skewed toward responsibility for the women. 

Rhea Ramjohn: And speaking of side effects, these first pill prototypes, what was happening with side effects and what level of progesterone are we talking about here? Can you give us a reference for how much of the hormone or how much of the hormones were in these pills? 

Jonathan Eig: The levels were much too high. They were probably five or 10 times higher than they needed to be in the beginning. And that was just a part of the process of experimentation, and the men who were running these experiments were biased. Because they were men, they were not experiencing the side effects. They felt like whatever side effects the women had to endure, it was worth it to make sure this pill was 100 percent effective. So they erred on the side of high doses to make sure that the thing worked, that it was completely reliable, because they knew in order to get FDA approval for this thing, they had to prove that it was as close as possible to 100 percent effective. So women suffered tremendously: nausea, headaches, bloating. All kinds of things, sometimes there were at least a few cases of serious side effects that produced serious illness. 

Rhea Ramjohn: This is all very disturbing, Jonathan. 

Jonathan Eig: Yes. 

Rhea Ramjohn: A disturbing part of our history here. 

Jonathan Eig: It is! And oftentimes this is true when you look back at events that we celebrate as momentous; they were acts that were performed by flawed people who were a product of their times. And I have to say, in their defense, that this is how clinical trials were often done at the time. It was common for people to do scientific experiments without the consent of the people who were participating. It was common for male scientists to ignore the differences between men and women or to take for granted the side effects that women might suffer. Because we lived in a different world, a misogynistic world, a more racist world. And it was easier for white men to experiment on women of color and not suffer any consequences for that.

Rhea Ramjohn: Right. So tell us about the move from Shrewsbury, Massachusetts to trials that happened in Puerto Rico. When exactly did these experiments begin? 

Jonathan Eig: In the mid 50s, when it appeared that the progesterone was working, that it was stopping people from ovulating, they needed more people to experiment on. Margaret Sanger had already been working with a very controversial group of people who supported the eugenics movement, and those eugenicists had already paid to create birth control clinics in Puerto Rico, especially in San Juan, where birth rates were very high, where women were desperate for birth control. And it occurred to Pincus that they could perhaps find doctors and nurses and patients to participate in more clinical trials in Puerto Rico. So they began shifting their operation down there and began offering the pill. In some cases, I think it was injections in the very beginning, but they began offering the progesterone to women in San Juan. And they had finally, for the first time, a reasonable number of women who were enrolled in the study, they could begin to really test it in some larger numbers. 

Rhea Ramjohn: Could you clarify for everyone who's listening, why were these clinics or why were these eugenicists interested in Puerto Rico and opening up clinics in Puerto Rico? 

Jonathan Eig: The eugenics movement was a very popular one in the United States in the early part of the 20th century. Today, we associate it with racism. It was certainly racist to some extent, and some of the people involved were more racist than others. But the belief was that certain people should be encouraged to have more children, and certain people should be discouraged, and certain people should not be allowed to have more children. In particular, the disabled, women who are mentally ill, and some people believed that certain minorities should be discouraged from having more children. This is where the eugenics movement got really controversial. 

In Puerto Rico, the idea was that families were very large and that they could be helped to have fewer children. Some of the eugenicists have different motives. I won't get into who stood for what, because I'm not in a position to judge all of them. But Sanger saw useful allies in the eugenics movement. She saw people who agreed with some of her goals. Sanger was racially progressive in many ways, and by today's standards, you know, racist in some ways. But I think in general, she believed that pragmatically this was a good thing for her to be able to piggyback on and to find a place and find some people who could help her test the birth control pill. So she was able to connect Pincus with some of the people who had already set up clinics in Puerto Rico -- clinics that had been funded and created by the eugenics movement. 

Rhea Ramjohn: So, what happens in Puerto Rico? What exactly goes on? We mentioned earlier that testing moves there, and I don't want to gloss over that. There were 26 cases of severe blood clots and six people died. 

Jonathan Eig: Yes. It was never quite possible to firmly conclude that those were a result of the birth control pill. But there were, as you said, dozens of cases of illness and that it's something that we had to really consider. When you think about the cost of creating this birth control pill, when you consider the human suffering, not to mention the hundreds of thousands of women who suffered severe side effects that were not as medically serious, but nevertheless caused great discomfort. This is the price that was paid for developing a pill that was seen as something that would improve and change countless millions of lives. They talked about it because some of the nurses and doctors who were in the clinics complained to Pincus and said, “You've got to stop. This is wrong.” And again, partly because they're men, partly because they're doctors, they viewed this as a sacrifice worth making. That they were looking at the big picture and they believed that they would be judged on the right side of history.

Rhea Ramjohn: Could you give us a specific example of what the experiment looked like or what the trial looked like? 

Jonathan Eig: Well, there were clinics set up throughout the island, mostly around San Juan. And they would advertise in the newspapers, they would tell people by word of mouth that this new form of birth control was being offered. It was interesting because it was, of course, in violation of the Catholic Church's doctrines. And the priests on Sunday would warn women, you know, "We've heard that there are these experiments going on. We want to remind you that birth control is a sin." And that would only increase the demand. There'd be bigger lines on Monday morning outside these clinics. And women would come in and they would receive it, as I said, at first, they were injections. Then as the pill was improved, they offered them bottles of pills, and the women would take them and come back, be tested, have pap smears, and check to see what kind of side effects they were suffering. But most importantly [they would see] whether the pill was working. And it showed that it was effective -- remarkably so, to a very high degree, but that the side effects were tremendous. 

Rhea Ramjohn: Jonathan, how do you view that part of the history of the birth control pill? I'm not expecting you to justify those times or those people's choices. But frankly, it is disturbing that so many black and brown women were harmed because of the US's colonization of Puerto Rico and the subsequent trials that occurred there. But I'm sure that there are plenty of listeners who know that they have benefited from taking the pill. So stepping back, how do you evaluate this chapter of the pill’s history? 

Jonathan Eig: You know, that's one of those giant, really difficult questions, I feel the same way about this that I feel about American slavery, that, you know, this country, this economy, so much of our comfort today was built on the suffering of others. The same is true for the birth control pill. It changed women's lives. It freed women. It allowed women opportunities that they never would have had before. College, jobs, families, sex. So much came from the pill. And it came because people suffered for it. That women, black and brown women in particular, were treated like second class citizens. And that's a sad part of the world that we live in. 

Rhea Ramjohn: And what happened after the Puerto Rican trials, were they deemed a success? What actually were the results that came out of it? 

Jonathan Eig: The Puertican Rican trials were successful enough that Sanger and Pincus and Rock and McCormick could begin to declare success, to tell the world that they had invented the first hormonal birth control: an oral contraceptive that would change women's lives. And women began clamoring for it even before it was approved by the FDA once the news got out. Women were begging their doctors, "How can I get this? When can I get it? I can't wait because if I have another child, it's going to kill me," or "It's going to deepen the poverty in which I'm already living." And it really became an issue of the demand driving the course of events, it was almost like once they had allowed this genie out of the bottle, they couldn't put it back. So they sought FDA approval. They did not call it birth control. They called it something that would regulate the menstrual cycle, that it would be a pill for women who had irregular cycles. The FDA approved it on those terms, insisting that the bottle would carry a warning that says “This may prevent pregnancy,” which just further fueled demand for it. It was like a great advertisement. And women by the hundreds of thousands, by the millions, began getting prescriptions before it was even called birth control. 

Rhea Ramjohn: Gosh this is so fascinating. I have several more questions for you. So the pill comes back to the U.S. mainland. How does it go from trials and then into our parents or grandparents medicine cabinets? 

Jonathan Eig: Very quickly. It was really remarkable. As soon as the FDA approved this in 1956 for regulating menstrual cycles, the demand for it was enormous. Doctors began calling their patients: women who were desperate not to have more children or who were desperate to delay pregnancy after having just been married; college students on campus began going to the health clinics and asking for this. Everybody knew. Even though it wasn't identified yet as birth control, everyone knew what it did. And it became enormously popular, word of mouth spread. They didn't really have to advertise it at all. And then after a few years, once hundreds of thousands of women in the U.S. and around the world, even more, were using it, it was impossible to stop. And then they were able to go back to the FDA and say, “This also works as birth control. Turns out that, you know, we didn't identify it properly and now we'd like to have it marketed as birth control.” And the FDA approved that, too. 

Rhea Ramjohn: What do you think the legacy of the birth control pill is, especially in this year, the sixtieth anniversary of the pill? Even now we're just calling it the pill, as if it were the only one. 

Jonathan Eig: Yeah, that's remarkable, when you think about it. There's no other product that I can think of that doesn't even need a name, is there? There's not "the car” or “the TV." Right? There's 400 different brands and styles. The pill is just the pill, because it was such a huge game changer, and it was all you needed to know that you're either on the pill or you're not on the pill. Right. It was such a giant force in changing our culture. I think the legacy of the pill is complicated. It is a part of the complicated nature of sexual dynamics. But overall, as I said in the beginning of this interview, it's one of the most important inventions of the 20th century. It's something that really changed the fundamental nature of what it means to be a human being on this planet; it changes the balance of power in the workplace. It changes the dynamics of human relationships. It changes our sexuality. It changes education levels. It changes the economy. You could even argue that it has changed politics and war and allowed women to have far greater control over world events than they previously had. So I think it's one of the most fascinating and powerful innovations of our time. 

Rhea Ramjohn: Jonathan Eigg is the author of The Birth of the Pill. He joined us today from Chicago, Illinois. Jonathan, thanks so much for joining us on Hormonal. 

Jonathan Eig: My pleasure. 

Rhea Ramjohn: And, as promised, Chapter 2 of stories from our generation users:

Jumping a little to the early 1970s, we head to Surrey in the UK.  Elaine went on the pill when she was 15. She wanted help with her painful menstrual cramps. 

Elaine: I was taken to the doctor by my mother, because I think she was so sick of me groaning and moaning every month and put on it. I mean, obviously, it was handy later on as well for obvious reasons. 

Rhea Ramjohn: Elaine’s story was a bit different than some of the others we heard. She told us that she and her peers were actually encouraged to be on the pill.

Elaine: It was a sort of cure-all. They enjoyed giving it out. I think it was quite new at the time, quite novel.  

Rhea Ramjohn: Two women that we spoke to in Australia both got their first birth control pill prescription from a University doctor. 

Jenny: I'm Jenny, and I first took the pill in 1971 when I was 18. I had my boyfriend from the previous year, and we wanted to have sex, and I was very excited about going to university. And I did want to complete my degree. I didn't want to get pregnant.

Rhea Ramjohn: Jenny’s story highlighted a commonality that we saw across our first generation users:

Jenny: I felt empowered. 

Rhea Ramjohn: Marguerite also got her prescription while studying, where stepping into her adulthood opened up a new worldview in many ways:

Marguerite: When I got to university in 1970, it was like the opening up of a whole new situation. It was like a general awakening for me. And not only just the pill, but it was like it was like this sense that the world was changing. Suddenly people were talking about moratoriums and Vietnam, women's rights and abortion on demand and the pill...

Rhea Ramjohn: And this I think is still true today, that when someone first starts to think about a birth control option that works for them, that it’s an opportunity to really take your destiny into your own hands. But now there are more options than in previous decades, and more opportunities to find a birth control solution that works for you. 

But that wouldn’t be the case without these trailblazers who helped make history and later became our teachers, parents, nurses, aunts, cousins and doctors. And for that I, and the whole team here at Hormonal, want to say: Thank you. 

And now… the credits! 

And of course, you can find us on social media. And we really want to hear from more first generation users of the birth control pill. Let us know on social media or send us an email at podcast@helloclue.com

Credits

Rhea Ramjohn: Hormonal is hosted by me, Rhea Ramjohn! Our Executive Producer is Kassandra Sundt. 

Editorial help from:

  • Amanda Shea 

  • Steph Liao 

  • Nicole Leeds

Special thanks to:

  • Marta Pucci

  • Trudie Carter

  • Maddie Sheesley

  • Ryan Duncan

  • Aubrey Bryan

  • Claudia Taylor

  • Léna Calvarin

  • Lynae Brayboy

Mixing and recording help from Bose Park Productions and Rekorder Studios in Berlin. 

Thanks for listening to Hormonal. Please rate and subscribe, and tell a friend! Until next time, I’m Rhea Ramjohn. 

Related links:

  1. https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html

  2. https://helloclue.com/articles/about-clue/how-to-use-clue-if-youre-on-the-hormonal-birth-control-pill

  3. https://helloclue.com/articles/sex/birth-control-pills-101

  4. https://helloclue.com/articles/about-clue/how-we-think-about-birth-control-at-clue

  5. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill 

  6. https://wwnorton.com/books/The-Birth-of-the-Pill

Episode 5

November 9, 2020

Happy birthday, birth control

Controversy and celebration on the 60th anniversary of the pill

minNovember 9, 2020
min

About

The birth control pill officially turns 60 years old this year, so we’re telling the story of the pill. Where did this remarkable invention come from? What doors did it open up? Author Jonathan Eig joins us to delve into this fascinating, shadowy story.

"“There has never been a drug that has been approved by the FDA for something that doesn't cure a disease or ease a pain. This is the world's first social drug. Really.”"

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Transcript

This transcript and interview were edited for clarity.

On Hormonal we explore the science behind hormones, but we also talk about society and the world around us. We know that there are lots of women who have periods and lots who don’t. We also know that there are people who aren’t women who have periods, too. We also know we have listeners who have never had periods. We hope you feel welcome, even when a term that a guest uses maybe doesn’t apply to you. 

At Clue, we believe that our identities are not determined by our bodies. Thanks for listening to Hormonal. 

Rhea Ramjohn: You're listening to Hormonal, the podcast from Clue: the menstrual health app. I’m Rhea Ramjohn. If you’re just joining us, this season is all about birth control. And it’s a big year for the birth control pill!

2020 marks the 60th anniversary of The Pill. On Hormonal, we wanted to take this opportunity to look at the history of this impactful invention.

I have a really great interview on the  history of the birth control pill, but before we get there, at Hormonal, we were wondering: who were these first users? Our parents and grandparents who took the pill, what was it like? What were their side effects?

So yes, I asked your grandma about her sex life. 

Easy access to birth control, or even the legal right to access birth control, is relatively new. Even after the pill was out on the market, there were laws on the books that prohibited even married couples, in some states in the US for example, from gaining access. 

Trish: It was only in 1965, I think, that the United States Supreme Court prohibited states from having laws against married couples even using birth control pills or birth control in general, for that matter.

Rhea Ramjohn: Today, Trish, is 77 years old. But in the mid 60s, Trish was a newly married biology student, and she said she wanted to go on the pill so that she could,  ahem, enjoy married life but still continue her studies. 

And it worked! For a while at least.

Trish: At the time, the medical wisdom was that after you'd been on the pill for three or certainly six months, you needed to stop for a month to let your body be normal. And then you could start again. So. We did that and used condoms for that month, and I promptly got pregnant. 

Rhea Ramjohn: The science, it seems, was still catching up to the realities. 

Something we noticed when talking to this first generation of birth control pill users is that a lot of them felt kind of isolated. Not talking to their moms or sisters or even peers about it for a whole host of reasons, from religion...

Marguerite: My family were Catholic. 

Rhea Ramjohn: To general teenage awkwardness…

Vivian: I would never ask my parents, you know, for a prescription.

Rhea Ramjohn: I want to introduce you to Vicki. She’s from San Francisco and first went on the pill in the 60s as well. She was self admittedly a little prudish at the time, especially compared to her peers. In fact, it earned her a nickname.

Vicki: It was Iron Pants.

Rhea Ramjohn: Vicki told us that she was so reluctant to talk to an adult about getting the pill at first that she actually stole pills from her mother’s birth control stash. 

Vicki: She had this huge stash of birth control pills. So taking a month’s worth was not a big deal. I don't think she ever said anything. I doubt she ever noticed. 

Rhea Ramjohn: Let’s travel from the sunny streets of San Francisco to Montreal and meet Vivian. 

Vivian: My name is Vivian. I was 17 when I first went on the pill in 1967.  

Rhea Ramjohn: Vivian was working at a big fair called Expo 67 that summer when a coworker made her an offer:

Vivian: She said, oh, I have a prescription and I'm not using it, so you can use it. And somehow I went to a pharmacist, and he gave me the prescription, I guess, without asking too much information.

Rhea Ramjohn: Some of our users had side effects.

Trish: I felt nauseous most of the time. 

Rhea Ramjohn: But most didn’t.

Margeurite: I really had no side effects. It was really wonderful. 

Jen: None. None at all.  

Elaine: I was absolutely fine on it. 

Rhea Ramjohn: Okay, that was the first chapter of our first generation users who all took the pill in the 1960s. Listen at the end of the show for chapter two, when we move from the swinging sixties to the so-called “me decade” of the 1970s. 

We just heard a lot of personal stories about birth control users, but what about the birthday we’re here to celebrate: the birth of the birth control pill. 

The pill opened up a lot of opportunities for people, in a lot of different ways. It offered women and people with periods more flexibility to explore their sexualities, or expand one's career path before becoming a parent, or plan pregnancies in a way that makes the most sense for each individual. 

But there's also a shadow side to this history. With hasty and ethically dubious research and development standards, marginalized women were the ones who bore the brunt of tests to develop this new “miracle pill.”

Here to tell us this story and much more is Jonathan Eigg. He's the author of Birth of the Pill and joins us from Chicago, Illinois. Jonathan, thanks so much for joining us on Hormonal. 

Jonathan Eig: Thanks for having me. It's nice to talk to you. 

Rhea Ramjohn: So tell us, why were you interested in this story? The origins of the birth control pill?

Jonathan Eig: I heard a sermon once from a rabbi who said that he thought the birth control pill was the most important invention of the 20th century, and that it was an example of what the Torah tells us about being partners with God and creating the universe: that we have a responsibility to make the universe, to make change in the world, not to accept the world as we find it. And I thought, “Wow, if the birth control [pill] is the most important invention, or one of the most important inventions of the 20th century, how come we know so little about who invented it and how it was invented and why?” And it just made me curious. I began researching those questions. 

Rhea Ramjohn: Yes, I'm very interested as well. And I'm hoping you'll set the scene for us. I want to know more about what the scientific and cultural landscape was like at that time. So could you read for us a little bit from your book? 

Jonathan Eig: I would love to, I’ll read from the very beginning of the book. It's chapter one called A Winter Night. It takes place in Manhattan in the winter of 1950. 

"She was an old woman who loved sex, and she had spent 40 years seeking a way to make it better. Though her red hair had gone gray and her heart was failing, she had not given up. Her desire, she said, was as strong and simple as ever. She wanted a scientific method of birth control. Something magical that would permit a woman to have sex as often as she liked without becoming pregnant. It struck her as a reasonable wish. Yet through the years, one scientist after another had told her, no, it couldn't be done. Now her time was running out. Which was why she had come to an apartment high above Park Avenue to meet a man who was possibly her last hope. The woman was Margaret Sanger, one of the legendary crusaders of the 20th century. The man was Gregory Goodwin Pincus, a scientist with a genius IQ and a dubious reputation. Pincus was 47 years old, five-feet-ten-and-a-half inches tall, with a bristly mustache and graying hair that shot from his head in every direction. He looked like a cross between Albert Einstein and Groucho Marx. He would speed into a room working a viceroy between his yellowed fingers. And people would huddle close to hear what he had to say. He wasn't famous. He owned no scientific prizes. No world changing inventions were filed under his name. In fact, for a very long stretch of his career, he had been an outcast from the scientific establishment, rejected as a radical by Harvard, humiliated in the press, and left with no choice but to conduct his varied and oftentimes controversial experiments in a converted garage. Yet he radiated confidence as if he knew the world would one day recognize his brilliance.”

Rhea Ramjohn: Wow. You mentioned two very important characters here, Margaret Sanger and Gregory Pincus. Could you tell us a little bit more about them and actually the four main characters that you profile in your book? 

Jonathan Eig: Yes, really the dream of birth control, of oral contraception begins with Margaret Sanger, back around 1915, when she was a young woman working as a nurse in the poorest neighborhoods of New York City. She began to say that what she really needed was effective birth control, that you couldn't teach women about birth control and then leave them with nothing. And what women needed, she felt like, was a miracle tablet. That's what she called it, something that would allow them to turn on and off their reproductive systems. But everybody told her she was crazy, that it was illegal, that even if it weren't illegal, it was scientifically impossible, and that no doctor, no scientist would ever even agree to research such a thing because it would be career suicide. So she continued for decades to ask people, to seek a solution. But it wasn't until 1950, when she met Gregory Pincus, that she finally found a scientist who said there might be a way. And of course, the science had to catch up to her. It was by the 1950s that we were understanding how hormones worked, and when it was beginning to occur to doctors and to scientists that they could manipulate the human body with hormones, that they might be able to fix things like diabetes, that they might be able to cure diseases by using hormones. And Pincus, when confronted by Sanger, said, you know, “It's possible that we could use hormones to trick the body into thinking that it's pregnant, and the woman would not conceive.” So that's really where it began with those two characters. And then two more very important characters came on board. 

Sanger could not get Planned Parenthood to agree to fund this research. So she had to go out and find somebody who would pay for it. Hospitals, universities, drug companies were not the least bit interested. They were afraid to go anywhere near this. So Sanger found a woman named Katherine Dexter McCormick, one of the wealthiest women in America, and she agreed to fund the entire project herself. And then there was one more piece of the puzzle missing: Pincus was a lab guy. He didn't really know how to treat patients. He didn't know how to run experiments on humans, only on rats and rabbits. So he found a gynecologist, a very prominent, very respected gynecologist who worked at Harvard, named John Rock. And John Rock agreed to help him with experiments on women and running clinical trials to see if this idea that progesterone might be an effective contraceptive could be proved. 

Rhea Ramjohn: So what was the state of science at that time, especially in terms of the women's movement and  the idea of sexual liberation at the dawn of this invention? 

Jonathan Eig: I don't think I'm exaggerating when I say that there was no interest whatsoever in the scientific community, in women's reproductive health, in women's sexuality. The only question was fertility really. This was the 1950s. In the postwar boom, women were having bigger and bigger families, and a lot of women were going to their doctors and to their gynecologists if they were infertile, seeking help to try to conceive. But that's about as far as it went. 

Rhea Ramjohn: OK. And as these four characters converge, Rock, McCormick, Pincus, and Sanger, what happens at that point? 

Jonathan Eig: This, to me, is one of the great stories in scientific history, because you have these four outsiders, these four rebels, who really believe that if they can pull this off, they can shake up the world, that they can change the very dynamic of humanity. They can change the very essence of sexuality. But they have to do it all underground. They have to do it with no help from the federal government, no help from universities, no help from corporations. They are completely flying under the radar, and they have no idea. There's no roadmap for this. There's no precedent. So they don't know even if it works, even if their tests show that they can make a birth control pill. Will they be able to get a drug company to manufacture it? Will they be able to get the government to approve it? Will people take it? There has never been a drug that has been approved by the FDA for something that doesn't cure a disease or ease a pain. This is the world's first social drug. Really. 

Rhea Ramjohn: Right. So why exactly was it underground? Could you explain that in more detail for our listeners? 

Jonathan Eig: Yeah, they had to go underground for several reasons. One is that they could never get approval. Much of what they were doing was illegal. It was illegal at the time even to distribute information about birth control. Margaret Sanger was arrested several times for just mailing information, mailing pamphlets about contraception. So they had to be careful that they did not break any laws. And the other issue is that when they started testing it in clinical trials, they had no approval for this. There was no permission. There was no consent. So everything they were doing was meant to prove this thing worked while attracting the least possible attention. 

Rhea Ramjohn: OK, well, what was the process actually like? Can you explain to us what the scene looked like? What were these everyday characters dealing with as they were basically experimenting with the birth of the birth control pill? 

Jonathan Eig: It was, [Laughter], it was a mess, to put it mildly. First, they began in the lab... 

Rhea Ramjohn: I believe that. 

Jonathan Eig: Right. Pincus had a laboratory that he'd built out of a home in Shrewsbury, Massachusetts. And it was a converted home. One of his scientists was actually living there. And they were testing it at first on rats and rabbits, as I mentioned. And then they needed to try to find women who would agree to do this, and that was very challenging. When they began, John Rock had some women who were trying to get pregnant, and they asked these women if they would agree to take injections of progesterone. The theory being that it would “rest” their reproductive systems, they would not have periods, they would not be able to reproduce for a while. And then perhaps when they stopped taking the progesterone, their bodies would rebound. They called it "The Rock Rebound." And then they might have success in getting pregnant. So ironically, the very first attempts at oral contraception were experimented on women who were desperately trying to get pregnant. 

And from there, they needed more women. They needed to show with this that if they were gonna get approval for this from the FDA, they needed to show that it worked on  hundreds, if not thousands, of women. So from there, they moved to an insane asylum in Massachusetts, and they began testing it on women there without the permission of those women. They would just line the women up and say, "We're giving you an injection today. Let us know how you feel." And then they started trying it on men there, too, just to see what would happen. Again, there was very little regard for the side effects or for the safety of these initial guinea pigs. 

Rhea Ramjohn: Ok, this is where we’re starting to get into the really ethically questionable and disturbing part of the pill’s development history. There are other murky parts to this story, but first, going back to Rocks' underground experiments, how long did it take to develop this first pill that went from zero to testing on rabbits to then testing on women?

Jonathan Eig: It was really remarkably fast, when you think about it. Within three or four years of the very first idea occurring to Sanger and Pincus, they've got a prototype and they're testing it on women, as I mentioned, not only in this insane asylum, but people who work for Pincus and Rock. Women in the lab are asking for it because they're so desperate to avoid becoming pregnant. In some cases they have six, seven children already, and they don't want to have more, and they're willing to risk the side effects because this is such an important game changing medical advance. 

Rhea Ramjohn: You mentioned that Rock tested this drug on men and women in an insane asylum. And I understand that Rock also tested it on himself?

Jonathan Eig: Yes, he did. You know, one of the very first important tests was whether this would have fatal side effects, right? It hadn't been tried before. And Rock, to his credit, injected himself to make sure that they were not doing anything that would be horrifyingly dangerous––they didn't think it would be. What they knew about hormones or what they knew about progesterone at the time suggested that it might induce changes in the body, but they didn't think it was likely to be fatal. So, yeah, Rock tried it on himself. They tried it on some of the men in the insane asylum. And this is interesting and important, I think, when Sanger and Katharine McCormick heard that they were testing this on men, they got very upset and they said, "Stop immediately. We are not paying you to create or even experiment on birth control for men."

Rhea Ramjohn: Fair point. 

Jonathan Eig: It's very important. They said it’s their money, and they were afraid that somehow men would hijack this thing. It was very important for them that women gain control of their own bodies, and they wanted a form of birth control that women could take without the involvement of men, without the permission of men, without even the knowledge of men, in some cases. Because history showed that when men controlled access to birth control, when safe sex was dependent on a condom, the men could not be trusted. And that was paramount for them. 

Rhea Ramjohn: Ok. This story and history is really starting to heat up. Let’s pick back up, with more, after this quick break. 

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Alright, back to the show.  

Rhea Ramjohn: You’re listening to Hormonal from Clue. I’m your host, Rhea Ramjohn. 

Ok, Jonathan. Before the break, you were telling us how these two powerful women were angry that some initial tests were being done on men. Now that’s interesting, because now at Clue, we get questions all the time about when men's birth control is coming.

Jonathan Eig: Yes. And that's a really good question, because one of the unfortunate side effects of this birth control pill that Sanger and Pincus developed, Rock and McCormick too, is that it takes men off the hook. Women get the power as they should. Women get control of their own bodies as they should. But one of the side effects is that men can kind of take it for granted. They can assume that the women are handling it. As a result, they don't even feel like they need to be a part of the conversation and they don't take much responsibility in some cases. And that's not fair. It needs to change. And if there were more options for men, if men were willing to endure some of the side effects that these women endured over the years, especially when the birth control pill was new, we would have seen a more just system develop. But right now, that system is skewed toward responsibility for the women. 

Rhea Ramjohn: And speaking of side effects, these first pill prototypes, what was happening with side effects and what level of progesterone are we talking about here? Can you give us a reference for how much of the hormone or how much of the hormones were in these pills? 

Jonathan Eig: The levels were much too high. They were probably five or 10 times higher than they needed to be in the beginning. And that was just a part of the process of experimentation, and the men who were running these experiments were biased. Because they were men, they were not experiencing the side effects. They felt like whatever side effects the women had to endure, it was worth it to make sure this pill was 100 percent effective. So they erred on the side of high doses to make sure that the thing worked, that it was completely reliable, because they knew in order to get FDA approval for this thing, they had to prove that it was as close as possible to 100 percent effective. So women suffered tremendously: nausea, headaches, bloating. All kinds of things, sometimes there were at least a few cases of serious side effects that produced serious illness. 

Rhea Ramjohn: This is all very disturbing, Jonathan. 

Jonathan Eig: Yes. 

Rhea Ramjohn: A disturbing part of our history here. 

Jonathan Eig: It is! And oftentimes this is true when you look back at events that we celebrate as momentous; they were acts that were performed by flawed people who were a product of their times. And I have to say, in their defense, that this is how clinical trials were often done at the time. It was common for people to do scientific experiments without the consent of the people who were participating. It was common for male scientists to ignore the differences between men and women or to take for granted the side effects that women might suffer. Because we lived in a different world, a misogynistic world, a more racist world. And it was easier for white men to experiment on women of color and not suffer any consequences for that.

Rhea Ramjohn: Right. So tell us about the move from Shrewsbury, Massachusetts to trials that happened in Puerto Rico. When exactly did these experiments begin? 

Jonathan Eig: In the mid 50s, when it appeared that the progesterone was working, that it was stopping people from ovulating, they needed more people to experiment on. Margaret Sanger had already been working with a very controversial group of people who supported the eugenics movement, and those eugenicists had already paid to create birth control clinics in Puerto Rico, especially in San Juan, where birth rates were very high, where women were desperate for birth control. And it occurred to Pincus that they could perhaps find doctors and nurses and patients to participate in more clinical trials in Puerto Rico. So they began shifting their operation down there and began offering the pill. In some cases, I think it was injections in the very beginning, but they began offering the progesterone to women in San Juan. And they had finally, for the first time, a reasonable number of women who were enrolled in the study, they could begin to really test it in some larger numbers. 

Rhea Ramjohn: Could you clarify for everyone who's listening, why were these clinics or why were these eugenicists interested in Puerto Rico and opening up clinics in Puerto Rico? 

Jonathan Eig: The eugenics movement was a very popular one in the United States in the early part of the 20th century. Today, we associate it with racism. It was certainly racist to some extent, and some of the people involved were more racist than others. But the belief was that certain people should be encouraged to have more children, and certain people should be discouraged, and certain people should not be allowed to have more children. In particular, the disabled, women who are mentally ill, and some people believed that certain minorities should be discouraged from having more children. This is where the eugenics movement got really controversial. 

In Puerto Rico, the idea was that families were very large and that they could be helped to have fewer children. Some of the eugenicists have different motives. I won't get into who stood for what, because I'm not in a position to judge all of them. But Sanger saw useful allies in the eugenics movement. She saw people who agreed with some of her goals. Sanger was racially progressive in many ways, and by today's standards, you know, racist in some ways. But I think in general, she believed that pragmatically this was a good thing for her to be able to piggyback on and to find a place and find some people who could help her test the birth control pill. So she was able to connect Pincus with some of the people who had already set up clinics in Puerto Rico -- clinics that had been funded and created by the eugenics movement. 

Rhea Ramjohn: So, what happens in Puerto Rico? What exactly goes on? We mentioned earlier that testing moves there, and I don't want to gloss over that. There were 26 cases of severe blood clots and six people died. 

Jonathan Eig: Yes. It was never quite possible to firmly conclude that those were a result of the birth control pill. But there were, as you said, dozens of cases of illness and that it's something that we had to really consider. When you think about the cost of creating this birth control pill, when you consider the human suffering, not to mention the hundreds of thousands of women who suffered severe side effects that were not as medically serious, but nevertheless caused great discomfort. This is the price that was paid for developing a pill that was seen as something that would improve and change countless millions of lives. They talked about it because some of the nurses and doctors who were in the clinics complained to Pincus and said, “You've got to stop. This is wrong.” And again, partly because they're men, partly because they're doctors, they viewed this as a sacrifice worth making. That they were looking at the big picture and they believed that they would be judged on the right side of history.

Rhea Ramjohn: Could you give us a specific example of what the experiment looked like or what the trial looked like? 

Jonathan Eig: Well, there were clinics set up throughout the island, mostly around San Juan. And they would advertise in the newspapers, they would tell people by word of mouth that this new form of birth control was being offered. It was interesting because it was, of course, in violation of the Catholic Church's doctrines. And the priests on Sunday would warn women, you know, "We've heard that there are these experiments going on. We want to remind you that birth control is a sin." And that would only increase the demand. There'd be bigger lines on Monday morning outside these clinics. And women would come in and they would receive it, as I said, at first, they were injections. Then as the pill was improved, they offered them bottles of pills, and the women would take them and come back, be tested, have pap smears, and check to see what kind of side effects they were suffering. But most importantly [they would see] whether the pill was working. And it showed that it was effective -- remarkably so, to a very high degree, but that the side effects were tremendous. 

Rhea Ramjohn: Jonathan, how do you view that part of the history of the birth control pill? I'm not expecting you to justify those times or those people's choices. But frankly, it is disturbing that so many black and brown women were harmed because of the US's colonization of Puerto Rico and the subsequent trials that occurred there. But I'm sure that there are plenty of listeners who know that they have benefited from taking the pill. So stepping back, how do you evaluate this chapter of the pill’s history? 

Jonathan Eig: You know, that's one of those giant, really difficult questions, I feel the same way about this that I feel about American slavery, that, you know, this country, this economy, so much of our comfort today was built on the suffering of others. The same is true for the birth control pill. It changed women's lives. It freed women. It allowed women opportunities that they never would have had before. College, jobs, families, sex. So much came from the pill. And it came because people suffered for it. That women, black and brown women in particular, were treated like second class citizens. And that's a sad part of the world that we live in. 

Rhea Ramjohn: And what happened after the Puerto Rican trials, were they deemed a success? What actually were the results that came out of it? 

Jonathan Eig: The Puertican Rican trials were successful enough that Sanger and Pincus and Rock and McCormick could begin to declare success, to tell the world that they had invented the first hormonal birth control: an oral contraceptive that would change women's lives. And women began clamoring for it even before it was approved by the FDA once the news got out. Women were begging their doctors, "How can I get this? When can I get it? I can't wait because if I have another child, it's going to kill me," or "It's going to deepen the poverty in which I'm already living." And it really became an issue of the demand driving the course of events, it was almost like once they had allowed this genie out of the bottle, they couldn't put it back. So they sought FDA approval. They did not call it birth control. They called it something that would regulate the menstrual cycle, that it would be a pill for women who had irregular cycles. The FDA approved it on those terms, insisting that the bottle would carry a warning that says “This may prevent pregnancy,” which just further fueled demand for it. It was like a great advertisement. And women by the hundreds of thousands, by the millions, began getting prescriptions before it was even called birth control. 

Rhea Ramjohn: Gosh this is so fascinating. I have several more questions for you. So the pill comes back to the U.S. mainland. How does it go from trials and then into our parents or grandparents medicine cabinets? 

Jonathan Eig: Very quickly. It was really remarkable. As soon as the FDA approved this in 1956 for regulating menstrual cycles, the demand for it was enormous. Doctors began calling their patients: women who were desperate not to have more children or who were desperate to delay pregnancy after having just been married; college students on campus began going to the health clinics and asking for this. Everybody knew. Even though it wasn't identified yet as birth control, everyone knew what it did. And it became enormously popular, word of mouth spread. They didn't really have to advertise it at all. And then after a few years, once hundreds of thousands of women in the U.S. and around the world, even more, were using it, it was impossible to stop. And then they were able to go back to the FDA and say, “This also works as birth control. Turns out that, you know, we didn't identify it properly and now we'd like to have it marketed as birth control.” And the FDA approved that, too. 

Rhea Ramjohn: What do you think the legacy of the birth control pill is, especially in this year, the sixtieth anniversary of the pill? Even now we're just calling it the pill, as if it were the only one. 

Jonathan Eig: Yeah, that's remarkable, when you think about it. There's no other product that I can think of that doesn't even need a name, is there? There's not "the car” or “the TV." Right? There's 400 different brands and styles. The pill is just the pill, because it was such a huge game changer, and it was all you needed to know that you're either on the pill or you're not on the pill. Right. It was such a giant force in changing our culture. I think the legacy of the pill is complicated. It is a part of the complicated nature of sexual dynamics. But overall, as I said in the beginning of this interview, it's one of the most important inventions of the 20th century. It's something that really changed the fundamental nature of what it means to be a human being on this planet; it changes the balance of power in the workplace. It changes the dynamics of human relationships. It changes our sexuality. It changes education levels. It changes the economy. You could even argue that it has changed politics and war and allowed women to have far greater control over world events than they previously had. So I think it's one of the most fascinating and powerful innovations of our time. 

Rhea Ramjohn: Jonathan Eigg is the author of The Birth of the Pill. He joined us today from Chicago, Illinois. Jonathan, thanks so much for joining us on Hormonal. 

Jonathan Eig: My pleasure. 

Rhea Ramjohn: And, as promised, Chapter 2 of stories from our generation users:

Jumping a little to the early 1970s, we head to Surrey in the UK.  Elaine went on the pill when she was 15. She wanted help with her painful menstrual cramps. 

Elaine: I was taken to the doctor by my mother, because I think she was so sick of me groaning and moaning every month and put on it. I mean, obviously, it was handy later on as well for obvious reasons. 

Rhea Ramjohn: Elaine’s story was a bit different than some of the others we heard. She told us that she and her peers were actually encouraged to be on the pill.

Elaine: It was a sort of cure-all. They enjoyed giving it out. I think it was quite new at the time, quite novel.  

Rhea Ramjohn: Two women that we spoke to in Australia both got their first birth control pill prescription from a University doctor. 

Jenny: I'm Jenny, and I first took the pill in 1971 when I was 18. I had my boyfriend from the previous year, and we wanted to have sex, and I was very excited about going to university. And I did want to complete my degree. I didn't want to get pregnant.

Rhea Ramjohn: Jenny’s story highlighted a commonality that we saw across our first generation users:

Jenny: I felt empowered. 

Rhea Ramjohn: Marguerite also got her prescription while studying, where stepping into her adulthood opened up a new worldview in many ways:

Marguerite: When I got to university in 1970, it was like the opening up of a whole new situation. It was like a general awakening for me. And not only just the pill, but it was like it was like this sense that the world was changing. Suddenly people were talking about moratoriums and Vietnam, women's rights and abortion on demand and the pill...

Rhea Ramjohn: And this I think is still true today, that when someone first starts to think about a birth control option that works for them, that it’s an opportunity to really take your destiny into your own hands. But now there are more options than in previous decades, and more opportunities to find a birth control solution that works for you. 

But that wouldn’t be the case without these trailblazers who helped make history and later became our teachers, parents, nurses, aunts, cousins and doctors. And for that I, and the whole team here at Hormonal, want to say: Thank you. 

And now… the credits! 

And of course, you can find us on social media. And we really want to hear from more first generation users of the birth control pill. Let us know on social media or send us an email at podcast@helloclue.com

Credits

Rhea Ramjohn: Hormonal is hosted by me, Rhea Ramjohn! Our Executive Producer is Kassandra Sundt. 

Editorial help from:

  • Amanda Shea 

  • Steph Liao 

  • Nicole Leeds

Special thanks to:

  • Marta Pucci

  • Trudie Carter

  • Maddie Sheesley

  • Ryan Duncan

  • Aubrey Bryan

  • Claudia Taylor

  • Léna Calvarin

  • Lynae Brayboy

Mixing and recording help from Bose Park Productions and Rekorder Studios in Berlin. 

Thanks for listening to Hormonal. Please rate and subscribe, and tell a friend! Until next time, I’m Rhea Ramjohn. 

Related links:

  1. https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html

  2. https://helloclue.com/articles/about-clue/how-to-use-clue-if-youre-on-the-hormonal-birth-control-pill

  3. https://helloclue.com/articles/sex/birth-control-pills-101

  4. https://helloclue.com/articles/about-clue/how-we-think-about-birth-control-at-clue

  5. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill 

  6. https://wwnorton.com/books/The-Birth-of-the-Pill