The story of hormonal contraceptives in the United States is, as it is usually told, largely a story of triumph for women. The ability to easily control one’s fertility opened many opportunities for American women to plan their families, have careers outside the home, and to pursue more liberated forms of sexuality within and without the context of marriage. For many women, the Pill mitigates the premenstrual discomfort or even allows them to control their menstruation. But there are a number of important consequences associated with the Pill that call for careful reflection on the part of historians. The introduction of the Pill marked a long period of medicalization of women’s bodies that has since become naturalized in the US. The history of hormonal birth control pills is also the history of the changing shape of medical authority and its relationship to women’s bodies.
Medicalization is the process by which aspects of human life come to be viewed as being under the purview of medicine, especially in the modern period where there is a recognized professional medical authority. With the advent of the Pill, and its rapid adoption by a huge proportion of women, an entirely new patient demographic was created. For the first time, healthy women of childbearing age might expect to take medication for a significant portion of their lives not to prevent or mitigate illness, but rather to prevent pregnancy, something that is usually not considered pathological. While pregnancy and childbirth had been almost fully medicalized by the time of the Pill’s introduction in 1960, women were now patients even when they were not pregnant.
Because of the nature of hormonal contraception, which prevents ovulation, a gynecological exam was required in order for women to receive a prescription. Whereas a women might only have such an exam if she was experiencing gynecological illness, millions of healthy women were having exams in order to get the pill. As Andrea Tone points out in her article “Medicalizing Reproduction,” this medicalization also became an opportunity for the medical profession to graft preventative screening onto these exams and to make them routine for women, where they had only been sporadically administered before. Performing a pap smear for cancer screening was a simple and quick addition to the exam. Additionally, breast exams could be performed at the same time. The evolution of the yearly exam that many women have today was driven in large part by the introduction of the Pill.
Medicalization as an analytical term evolved from sociological discourse, and it was, especially early on, associated with the negative effects of increased medical authority, especially over women’s bodies. We’ve written about this kind of medicalization before, where women’s bodies are the field on which medical and scientific progress is played out, often with the effect of curtailing women’s autonomy and sometimes their lives. Although the medicalization that accompanied the Pill has resulted in a huge increase in cancer prevention, there have of course been consequences for women. In exchange for the freedom that the Pill provides, many women have experienced dangerous and even deadly side effects from use of hormonal contraceptives. The risk of stroke and cardiovascular disease in increased by use of the Pill, and women have reported significant discomforts like nausea and migraine headaches. Despite problems with the Pill, it retains its modern mystique, and other contraceptive methods are often viewed as old-fashioned in comparison. Tone calls this a “hormonal imperative,” which is a feature of the Pill’s amazing commercial success and the market it created for almost identical pills with only minor differences.
As Leila has described, both the benefits and the risks of hormonal contraceptives are unevenly distributed among groups of women. Access to and the ability to pay for the necessary medical exams prevented many marginalized women from getting the Pill. Use of the Pill has been construed as a weapon wielded against marginalized groups as much as it has been as a tool for women’s liberation. Medicalization has also been a key tool of imperial practice around the world, where it is often billed as one of the ‘gifts’ that the colonizers offer to colonized people in exchange for occupying their homes.
There are definite colonial overtones to the way that the first pill, Enovid, was tested in large-scale trials in order to obtain FDA approval. Trials were conducted in Puerto Rico for very specific reasons. Gregory Pincus, the scientist recruited by Margaret Sanger to develop the pill, thought that if the poor and uneducated women of Puerto Rico could be taught to use the pill correctly, there would be no problem convincing the FDA that women in the United States could also use the pill correctly. The lack of strict regulation on clinical trials in this period worked in favor of Pincus and his team. They were not obligated to inform the women of the experimental nature of the Pill, or to explain the risks involved with taking the Pill. The clinical trials of the Pill are rightly remembered as a controversial and traumatic episode in Puerto Rican history, and should serve to remind us that it is often the bodies of poor and marginalized women upon whom our beloved scientific innovations and liberating inventions are tested and built.
Medicalization is a powerful analytic that encourages us to look more closely at incidents in the history of medicine that are usually labeled as a net good for humanity. In the case of the Pill, women paid for the benefits of the Pill by ceding part of their life to medical authority, and more often than we would like to remember, they sometimes paid with their own health or even their lives. Medicine is never wholly or transparently benevolent, especially for women, and acutely so for women of color.
Andrea Tone, “Medicalizing Reproduction: The Pill and Home Pregnancy Tests,” Journal for the Scientific Study of Sex Vol. 49, no. 4 (2012).
Elaine Tyler May, America and the Pill: A History of Promise, Peril and Liberation (Basic Books, 2010)