Why the Oral Contraceptive Is Just Known as “The Pill”

Rare is the cultural object that can co-opt unmodified the very category of which it is a part: Even the Bible is referred to as the good book. Yet when people speak of the Pill, you know they don’t mean aspirin or Prozac but rather that mother of all blockbuster drugs, the birth control pill.

A synthetic blend of the female hormones progesterone and estrogen, oral contraceptives were approved by the Food and Drug Administration in 1960, the year that swept Kennedy’s space-aged Camelot into the White House. The pill, too, seemed mythic and new, the age-old dream of avoiding unwanted pregnancy brought to you by modern science, stylishly packaged in a carousel that looked like the dial of a Princess phone.

The drug’s impact was immediate and immense. By 1962, well over one million American women were taking oral contraceptives. By 1964, the pill had become the most popular form of reversible birth control, a position it retains today both here and abroad. Yet some historians dispute the common notion that the pill kick-started the sexual revolution. They point out that premarital sex had been on the rise since the 1920s, in step with the growth of cities and the car culture and the decline in parental control. “Even in the 1960s, very few women used the pill when they first started having sex,” said Elaine Tyler May, author of America and the Pill and a professor of history at the University of Minnesota. “There was still a stigma attached to planning for sex.” The vast majority of the pill’s early adopters, she added, “were women who were already married.” Far from fomenting recklessness, the pill proved a source of stability, allowing women and couples to shape their narrative arcs as they never had before. “We sometimes take it for granted, but the ability to have children when one wants to, to time childbearing in a way that works for the individual and the couple, is fundamentally important to the way we live our lives now,” said Lawrence Finer, director of domestic research at the Guttmacher Institute. The successes of the feminist movement, and the mass entry of women into the workforce, the professions and academia, might not have been possible without the pill’s power of predictability. The pill has non-contraceptive uses, too, including the treatment of painful periods, acne and unwanted hair growth, said Melissa Gilliam, professor of obstetrics and gynecology at the University of Chicago Medical Center. It cuts the risk of ovarian and uterine cancer nearly in half.

The provenance of the pill is complex and subject to tetchy debate, but one indisputable pioneer was the activist Margaret Sanger, who coined the term “birth control” and was imprisoned in 1916 for opening the nation’s first family planning clinic (an operation that later became Planned Parenthood). The sixth of 11 children, Sanger blamed the death of her Irish immigrant mother at age 50 on the strains of constant childbearing, and she conceived of a “magic pill” that would allow women to control their fecundity without their husband’s permission or knowledge if need be. Sanger and Katharine McCormick, heiress to the International Harvester fortune and the second woman to graduate from the Massachusetts Institute of Technology, sought researchers who might make the fantasy pill a reality.

By 1950, scientists had identified the chemical underpinnings of human reproduction and fabricated the relevant hormones, but because birth control remained largely taboo most researchers avoided it. Sanger and McCormick supported Gregory Pincus, of the Worcester Foundation, a proud maverick who’d recently shown that synthetic progesterone, or progestin, suppressed ovulation in rabbits. Buoyed by a McCormick grant, Pincus approached John Rock of Harvard Medical School, who dared teach birth control, about testing progestin as a contraceptive in women. Human trials began in Massachusetts in 1954, initially under the ruse of “fertility treatments,” and were later moved to Puerto Rico. At some point, synthetic estrogen in the medication mix proved a boon in stanching side effects like breakthrough bleeding, and today most oral contraceptives combine progestin and synthetic estrogen in varying concentrations, all much lower than in first-generation pills.

Like any drug, the pill has drawbacks and side effects. It has been linked to rare complications like blood clots and been the subject of lawsuits. The Catholic Church does not approve of it. But while it may not be a magic pill, it is still the Pill.

“It would have been an obvious choice for one of the ten objects that made America,” Natalie Angier the Pulitzer Prize-winning journalist and author of Woman: An Intimate Geography says of the first oral contraceptive pill.