In this series, The Week looks at the ideas and innovations that permanently changed the way we see the world.
The contraceptive pill in 60 seconds
The combined oral contraceptive pill, known informally as “the pill”, is a hormone-based medication designed to prevent pregnancy. It is taken orally, usually on a daily basis.
The pill works by blocking the hormones in the pituitary gland that would normally prompt monthly ovulation, ensuring that no eggs are exposed to potential fertilisation in the womb.
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The word “combined” refers to the fact that most formulations on the market are based on two hormonal components – oestrogen and progesterone – although progesterone-only alternatives are available.
Taken according to the instructions, the pill has a close to 100% success rate as a contraceptive – although this rate declines with imperfect usage. Commonly reported side effects include irregular bleeding, weight gain, nausea and headaches, while some research has also suggested a slightly increased risk factor for conditions including thrombosis, breast cancer and depression.
How did it develop?
Since ancient times, humans have sought to limit the chance of pregnancy arising from sexual intercourse with methods ranging from herbal remedies to practices such as coitus interruptus, with varying, but generally limited, degrees of effectiveness.
Although several methods of medical birth control were available by the 20th century, the most simple and reliable of these – the condom – put control of conception in the hands of the male partner.
The idea of a pill that would give women direct control of their fertility had long been floated as a fantasy – including by pioneering birth control advocate Margaret Sanger, who opened America’s first family planning and birth control clinic in 1916.
In the 1950s, Sanger and heiress Katharine McCormick provided financial backing for a research team led by endocrinologist Gregory Pincus – one of the handful of doctors willing to stray into the then-contentious field of medical birth control – to develop and test the first contraceptive pill for mass use as birth control.
The drug was licensed for use by the US Food and Drug Administration for contraceptive use in 1960, and within a couple of years “well over one million American women were taking oral contraceptives”, says the Smithsonian magazine.
In the UK, the contraceptive pill became available to women for the first time from December 1961, when it was approved for prescription on the NHS. In practice, however, “only a limited number of married women” were prescribed the pill in the early days, according to the National Archives. Nevertheless, it was “the first step towards wider change”.
Unmarried women would not be able to access the pill until 1967, when parliament passed the NHS Family Planning Act. It enabled local health authority family clinics to extend contraceptive services to all women regardless of age or marital status, ultimately giving more women access to the pill – although significant stigma over unmarried women accessing the pill remained for some time.
Critics on both sides of the Atlantic claimed that the widespread availability of the pill would lead to sexual promiscuity and the breakdown of the nuclear family. In 1968, Pope Paul VI formally declared the Catholic Church’s opposition in the papal bull Humanae Vitae.
But despite moral opposition and a series of health scares in the 1970s that drew attention to the potential side effects of the pill, it continues to be among the most widespread forms of contraception, particularly in the developed world.
According to a 2019 United Nations report, more than 151 million women around the world use the contraceptive pill.
How did it change the world?
A reliable, safe and accessible contraceptive that could be taken without the knowledge or consent of a male partner gave women revolutionary power over their lives.
On an immediate practical level, women could avoid the health risks of pregnancy and childbirth and the financial pressures of an expanding family. Looking at the bigger picture, the pill also altered the economic and social opportunities open to women.
Because the pill theoretically allowed women to have sex whenever and with whomever they wanted without the risk of an unwanted pregnancy, it is frequently linked to the “sexual revolution” of the 1960s.
Yet “cultural views on sexuality and women’s roles were shifting well before the pill was introduced”, says Time magazine. All the same, the availability of the pill was a contributing factor in the profound shift in social attitudes to dating, cohabitation and sex out of wedlock during the late 1960s and 1970s.
Perhaps even more importantly, control of reproduction also gave women unprecedented economic independence.
Before attitudes towards working mothers began to change back in the 1960s, pregnancy often meant leaving the workplace, leaving mothers dependent on their husbands or sympathetic relatives for financial support.
With the pill, “women were able to postpone having children or space births to pursue a career or a degree that had never been possible prior to the pill,” says the US Public Broadcasting Service (PBS).
“The pill has been a very important tool in the liberation of women,” wrote The Guardian’s Angela Phillips in 2006. “Not because it freed us to sleep around but because it allowed us to be economically independent.”
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