Later this month we will be celebrating the birthday of the oral contraceptive pill which was officially born (received marketing approval) on 23 June 1960. The approval was given in the USA, and a year later Germany, Australia and the UK followed suit. The launch of ‘the pill’ must be one of the iconic events characterising our generation.
Medically, the pill has been a resounding success. In the UK alone there are 3.5 million women currently taking it (that means use by 3.5 million couples!), which equates to roughly one in three women of reproductive age. Worldwide the number of women is around 100 million.
But the Pill has been much more than a simple medicine, it has been a force for change in our society. Its origin itself is interesting. It was not born in the laboratories of drug companies with a mission of commercial gain. Uniquely, it was a product driven by the community in which Margaret Sanger, a feminist in the family planning movement who was determined that each woman should be ‘the absolute mistress of her own body’, and Katherine McCormick, another feminist and also a wealthy philanthropist. Working together they forged and funded most of the research necessary to develop the pill. Only when the hard work was done did industry get involved and even then rather grudgingly.
Then, we see how the pill has become ‘owned’ by us all, in that through a mixture of gratitude, reverence and familiarity users have granted it proper-noun status, so ‘the pill’. And this sentiment was essentially universal, France has ‘la pilule’, Spain ‘la pastilla’, Italy ‘la pillola’, Germany ‘der pille’ and so on. Like ‘the Queen’, it is often given a capital ‘P’ (as it will be here!). Moreover, it has become so much part of our everyday life that when, as a doctor, I would ask women what medicines they were taking, their lists would often leave out the Pill (‘oh, I don’t see it like one of those’)
The Pill changed the woman’s lot as it indeed went some way to making women ‘mistresses of their own bodies’. With the Pill, it was now women who could chose whether or when to have children, who were freed of the fear of unwanted pregnancy and so abortion, and who could confidently remove the desensitising aspects of sex that surrounds the use of barrier methods. Such new and fundamental autonomy cannot but have helped advance the woman’s movement of the 60s and 70s.
The Pill also changed attitudes towards medicines generally. Until the Pill’s introduction, medicines were prescribed for people who were unwell (i.e. patients). With the Pill, by and large those who took the product were fit, young and healthy. So the medical establishment had to reconsider risk-benefit analysis. The risks could no longer be balanced against the problems arising from leaving an illness untreated. Rather, they had to be considered in terms of what an otherwise healthy woman might expect or be prepared to tolerate. Henceforth, any assessment of side effects would have to involve the views of the recipient(s). In reality, society was having to consider the implications of lifestyle drugs.
Finally, the Pill changed our attitudes relating to the capacity of children under the age of 16 to think and make decisions for themselves about health matters. It introduced the idea that such decision-making could be done in confidence with a doctor (or other health care professional), without necessarily the knowledge of a parent or guardian. The UK position, which has also been adopted in Australia, Canada and New Zealand, was sparked off by a parent (a certain Mrs Gillick) who believed she had a right to decide whether or not her daughter would be prescribed the Pill. When considering this issue, the court argued that “As a matter of law the parental right to determine whether or not their minor child below the age of sixteen will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed”. This was a change of momentous importance as it covered health decisions generally.
So, on 23 June we should raise our glasses to the Pill and wish her a very happy 50th. In so many ways the Pill has done us all proud.