The most incisive guide to issues facing the American family today . . . An invaluable resource for anyone wishing to stay on the cutting edge of research on family trends.
-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia
One winter night in 1950, Margaret Sanger and the scientist Gregory Goodwin (“Goody”) Pincus met in a Park Avenue apartment to discuss the taboo topic of birth control.
For years, Sanger had agitated for women’s rights, specifically as they related to reproduction and sexuality. She had proclaimed that women should have the final authority over their own bodies, that only when they could postpone or avoid pregnancy would they be able to enter the workforce or participate in politics at the same rate as men. She also wanted to “liberate” sex for women, taking away the concern of pregnancy. The answer to these dilemmas, Sanger believed, was a “completely foolproof method of contraception.” She wanted a pill, “something a woman could swallow every morning with her orange juice or while brushing her teeth, with or without the consent of the man with whom she was sleeping.” And she thought that Pincus, a “genius” young scientist with a reputation for dabbling in the uncomfortable, was the man who could help her.
Pincus said that yes, he believed such a thing was possible.
And so began a ten-year project that culminated in Enovid, the first oral contraceptive. In his narrative of the quest, former Wall Street Journal writer Jonathan Eig focuses on the “Four Crusaders” of the subtitle: Margaret Sanger, Gregory Pincus, Catholic obstetrician and gynecologist John Rock, and the heiress and suffragette Katharine McCormick. This particular cast, Eig argues, was crucial. Without any one of them, the whole project would have collapsed.
At this juncture in her life, Sanger was over 70 and had a lifetime of projects to her credit already. She was the impetus, the one who started the project rolling. Sanger’s obsession with finding a contraceptive stemmed from two motives: First, her passion for women’s rights; and second, her experience working in clinics in the very poorest neighborhoods of New York, where she met many impoverished women with large families and uncaring husbands who were desperate to stop having babies. In spite of certain passages where Eig seems almost smitten with the young Sanger (at one point he describes her as a “sexy slip of a woman, a redheaded fireball of lust and curiosity”), he is nonetheless fairly honest about her shortcomings: Sanger all but abandoned her own children; had a series of affairs while married to her first husband; pushed for divorce in spite of her husband’s desire to save the marriage; and, towards the end of her life, became addicted to a mix of sleeping pills, pain medication, and alcohol.
Goody Pincus was a noted and very bright young scientist who, at the time of his first meeting with Sanger, had already been let go from Harvard for his experimentation with in vitro fertilization and the resulting negative media attention. Eig writes that Pincus’s driving passion was a “quest for greatness,” sometimes at the expense of common sense. When members of the media asked him about the implications of his in vitro fertilization research for humans, Pincus responded that “he was not concerned with such things.” He wanted to experiment, to see how far science could take him.
Rock, one of the nation’s most noted physicians, had long been experimenting with doses of progesterone as a remedy for his patients’ infertility when Pincus persuaded him to join Sanger’s project. He speculated that giving the ovaries a “rest” for a bit helped his patients to get pregnant when they stopped taking the hormones. Rock’s Catholicism and his diplomacy made him a valuable asset for the birth-control team, and he ran the very first trials on his own (consenting) patients. It was his greatest hope that his Church would one day see the value he did in birth control.
Katharine McCormick’s huge fortune made all of the work of the others possible. (Although Planned Parenthood contributed as well, that funding paled in comparison.) When she was 29, Katharine—already an heiress to a large fortune—married Stanley McCormick, youngest son of Cyrus McCormick. In the years following, her husband’s mind collapsed to schizophrenia, and he was moved to a family estate in California. Katharine spent the next 40 years of her life supervising his care and seeking a cure. Upon Stanley’s death, Katharine McCormick became one of the world’s wealthiest women. She was active in women’s suffrage but interested in birth control from a personal standpoint as well: She believed it would have been a disaster if she and Stanley had born children.
After a thorough introduction of his cast, Eig spends the rest of the book narrating the ten years of experimenting and testing before Enovid was finally approved by the FDA and made available for sale. The tale is a gripping one, in no small part because of the eccentricities and large egos of the characters. Sanger becomes crankier and crankier as the project drags on, Pincus’s wife goes on shopping sprees with McCormick’s money, McCormick herself patiently continues to write checks, and John Rock finally emerges as the grandfatherly sort, the one whom the team chooses to present their case to the public.
But the tale is also troubling, for, as Eig points out several times, this was the first time in American history that scientists had set out to create a medication for the healthy. A few of Eig’s observations in particular bear repeating here. First, the way in which the team goes about procuring human subjects for testing is something that no scientist today (one hopes) can get away with. Pincus first enlists Rock to experiment on his infertile patients. Rock explains to the women that if they stop ovulation for awhile, their chances of becoming pregnant may increase. A few do in fact become pregnant when they go off the pill, but what becomes apparent to Pincus and Rock in these and other trials is that American women are not reliable test subjects. They forget to take the pill every day, or, not liking the side effects (bleeding, nausea, and headaches among them), they quit the experiment altogether. Pincus begins to find subjects wherever he can—in an asylum for the insane, and among the poor of Puerto Rico and Haiti. A colleague in Puerto Rico even makes it mandatory for her students to participate in trials, at the cost of their grade. (Tellingly, all of the students leave the trials anyway.)
A second fact that impresses the reader is a consequence of the first. Due to the difficulty of getting human subjects, Pincus and his team pursued FDA approval with shockingly little testing. In his application to the FDA, Pincus talked about the effectiveness of Enovid in 1,279 menstrual cycles—which sounded far more impressive than 120 women over varying short periods, all less than two years. The FDA approved the drug anyway, ironically enough as a remedy for “irregularity” and infertility (the “Rock effect”). Nonetheless, as Eig explains, doctors were free to prescribe the drug for whatever ailment they deemed appropriate, and one of the known “off-label” uses was the inhibition of ovulation. Shortly after, the FDA approved Enovid as the world’s first oral contraceptive.
That was almost 60 years ago, and the consequences of The Pill have been far-reaching indeed. Even Eig, who seems awestruck at times by his cast, admits that the effects of separating childbirth from sex and marriage are not always pretty. In the beginning of the book, he writes that “Neither [Sanger] nor anyone else could have imagined how birth control would . . . contribute to the spread of divorce, infidelity, single parenthood, abortion, and pornography.” Nonetheless, he romanticizes the tale, at times sounding rather ridiculous. Pincus’s development "set men and women free for generations to make love in cars on cold winter afternoons; in rowboats under moonlit skies; in corner offices late at night; in penthouses and dormitories; in houses, huts, and hotel rooms—in all the places where men wooed women or women wooed men, a spark was struck, and inhibition surrendered to desire."
Apparently the ills of divorce, infidelity, single parenthood, abortion, and pornography pale in comparison to the joy of sex in a cold car.
Eig also admits that Sanger’s pill has had the opposite of her desired effects. Sanger believed the pill would make sex more joyful for women; in at least some women, birth control actually lowered libido. She thought the pill would make marriages better, “but divorce rates have shot up since its advent.” Perhaps the greatest irony lies in the fact that Sanger and others touted the oral contraceptive as a cheap, efficient, highly effective remedy for poor women struggling with too many babies and for the worldwide “problem” of overpopulation. As Eig writes, “the pill has been far more popular and had greater impact among the affluent than the poor and has been far more widely used in developed countries than developing ones.”
What Eig does not comment on, but what is worth mentioning, is that the pill fundamentally altered the marriage marketplace by making sex something that men expect before tying the knot, and can in fact get almost wherever and whenever they please. Before the pill, sex itself was a powerful motivator to marriage. This is no longer so. With a new economy in which the wealthy and college educated are able to sustain stable careers, upper-class women still see the benefit to marriage, and to delaying childbearing until after marriage. (See Charles Murray’s Coming Apart, or Naomi Cahn and June Carbone’s Marriage Markets.) Those with less education and far fewer opportunities see no protections in marriage, and unwed childbearing, cohabitation, divorce, and other markers of family instability are rampant among the lower classes. The greatest victims are of course the children of the poor, who suffer all the heartbreak of family breakdown, and then continue in their parents’ footsteps when making their own decisions about family.
So it seems that the poor, the women that Sanger was most interested in helping, most suffer the Pill’s unintended consequences.
Nicole M. King is Managing Editor of The Family in America.