The birth control pill may have been one of the most influential inventions of the 20th century. For many women, being able to prevent or delay pregnancy meant having the ability to focus on other areas of life, like education and career, without being responsible for unwanted or unplanned pregnancies. The pill essentially gave women control over their own fertility, marking a huge advancement in the Women’s Liberation Movement. 

The creation of the pill, however, was riddled with questionable practices and ethics.

The first birth control pill was developed by Harvard professor John C. Rock and assistant professor Gregory G. Pincus. After giving female rabbits a combination of estrogen and progesterone, letting them breed, and examining their fallopian tubes for evidence of fertilization, the professors moved on to clinical trials. With funding from feminist Katharine D. McCormick and support from the G.D. Searle pharmaceutical company, they performed some of these trials on mentally ill women at the Worcester State Hospital in Massachusetts, and sometimes without consent.

Rock and Pincus also had controversial reasons for their research. To start, Pincus was against sexual freedom for both women and men, creating the pill purely for the sake of scientific advancement. Ethics weren’t nearly as important to him as scientific progress. Rock, on the other hand, was Catholic and interested in the social implications of creating a birth control pill and what that would mean for women. However, he was willing to forgo ethics around the pill and its trials because he worried about overpopulation, especially in what he considered “less desirable” communities. In fact, the early stages of the creation of the pill largely coincided with the eugenics movement in America in the ’20s and ’30s. Even Margaret Sanger, birth control advocate and founder of what would later become Planned Parenthood, was known to use eugenicist ideas to advocate for birth control. 

The trials eventually ended up in Puerto Rico, where reproductive laws were more liberal, to say the least. Forced sterilization was common due to the aforementioned eugenicist ideologies of the time, leaving the women of Puerto Rico initially very willing to contribute to the trials, eager for a different birth control method. The trial began with 20 female medical students from the University of Puerto Rico, but the dropout rate was high due to the demands of the testing and side effects. Rock and Pincus were able to create a prototype drug from the trial but were still in need of participants for an official field trial. This led them to a neighborhood in San Juan where poverty-stricken women were decidedly the best candidates. 22% of women dropped out of these trials as well, with side effects remaining severe and being largely ignored by Rock and Pincus.

Enovid was introduced to the market in 1960, nonetheless, named the first FDA-approved birth control pill. Having succeeded, Pincus and Rock returned to Massachusetts where the pill quickly became widely available, though Puerto Rican women never received it. Unable to afford the now sought-after medicine, women involved in the trials were left without either compensation or the birth control they helped test. 

Putting aside the more-than-questionable ethics of the pill’s creation, the side effects still remain an issue. Headaches, nausea, spotting between periods, missed periods, weight gain, mood changes, breast tenderness, and decreased libido are just the common side effects of the pill. In more serious cases, side effects can include blood clots, high blood pressure, and even a heightened risk of breast and cervical cancer. 

Recent research has even discovered brain changes in women who take birth control. Most birth control pills contain synthetic versions of both estrogen and progesterone, and these synthetic hormones can cause side effects that natural hormones might not. In a 2010 study, it was found that women taking the birth control pill had larger brain regions similar to the brains of men, meaning birth control seemed to have a masculinizing effect on the brain. Some women on the pill even experience acne, hair growth, and sweating, symptoms attributed to a version of the pill that contains progestins made from the male hormone nandrolone, a close relative of testosterone. Other versions of the pill contain progestins made from synthetic progesterone, which has a more feminizing effect and is often used to treat acne or excessive hair growth. 

A second study conducted in 2015 looked at the brains of women on both kinds of birth control pills in comparison to women not taking any birth control. This study found that women on androgenic pills (containing synthetic progestins made from male hormones) had the same effects as the first study – larger brain regions similar to the brains of men – whereas women taking non-androgenic pills (containing only synthetic progestins made from progesterone) had larger brain areas having to do with facial recognition, which is more typical of women. Basically, androgenic birth control continued to have masculinizing effects on the brain and non-androgenic birth control had more feminizing effects on the brain. Either way, the brains of women taking birth control pills were noticeably different from those not taking the pill.

Concerns about the aforementioned side effects and hormonal changes caused by birth control have led some women to embrace the fertility awareness method, a natural form of contraceptive. A fertility tracking app called Natural Cycles that promotes this method was even cleared by the US FDA as a contraceptive in 2018 and approved as a contraceptive in the EU in 2017. While there are different methods of preventing pregnancy through fertility awareness, Natural Cycles uses daily measurements of basal body temperature to determine when a woman is ovulating. Using these calculations, the app lets users know what days they are fertile and therefore at risk of getting pregnant.

Natural Cycles claims to be 93% effective with typical use and 98% effective with perfect use, without any side effects or hormonal changes, but there has been backlash from users who feel the app has failed them. On the other hand, some women claim the app has allowed them to understand their bodies better and take fertility into their own hands. Professional opinions are mixed as well, being that fertility awareness methods have previously been reported as one of the least effective forms of birth control. Even Planned Parenthood claims that fertility awareness methods are only 76-88% effective. Nevertheless, Natural Cycles and other fertility awareness method-based apps continue to grow in popularity as more women look for hormone-free alternatives to traditional birth control.

Likewise, women’s frustration with hormonal birth control has caused many over the years to push for the development of a male birth control pill in order to give men and women equal responsibility in terms of birth control and family planning. Recent developments in the search for a male birth control pill seem hopeful, with some scientists looking into a compound called triptonide, which showed promising results with mice and monkeys. Others have recently looked to a protein called the retinoic acid receptor alpha for use in a potential non-hormonal male birth control pill. Before these promising developments, many efforts toward developing a male birth control pill have been met with unwanted side effects like weight gain, low libido, and even testes shrinkage. Nevertheless, research on prospective male birth control options continues, and can hopefully be an answer to some of the issues found in women’s hormonal birth control.

All things considered, the birth control pill certainly changed the course of history for women. It led to an economic revolution with women entering the workforce and pursuing careers that were previously unavailable to them. It decreased the number of unwanted pregnancies and abortions in the United States. It gave women sexual freedom and autonomy over their own bodies. More than anything, the birth control pill gave women a choice.

It would be unfair to say that the birth control pill is inherently bad based on its history and potential side effects. Nonetheless, it’s a discussion that deserves a comprehensive and multifaceted understanding. Women have the right not only to make choices about their bodies and family planning but to be educated in the choices they make.

For those interested in birth control options, be sure to talk to a healthcare professional and visit powertodecide.org