BIRTH CONTROL: FROM TABOO TO. TECHNOLOGY
When scientists took up the testing of hormones as contraceptives in the early 1950s, it was not an entirely new topic on their research agenda. The possible use of hormones as agents to control fertility was mentioned as early as the 1920s. The first publication mentioning hormonal contraceptives can be traced back to Austria. In 1921, the gynecologist Haberlandt described the results of experiments in which he transplanted the ovaries of pregnant rabbits and guinea-pigs into animals which were not pregnant. The animals became temporarily sterile. The author added that this “sterilization method” could perhaps be applied to women by the administration of extracts from the ovaries of pregnant animals (Vaughan 1972:9). The idea of hormonal contraceptives was first discussed in public at the Seventh International Birth Control Conference held in Zurich in 1930 (Borell 1987:83). At this time, however, it was hardly more than a theoretical debate. The nature of the substances which had to be taken to achieve contraception in women became clearer only when the first sex hormones were isolated and synthesized. In 1937, Makepeace, Weinstein and Friedman, three scientists from the University of Pennsylvania, were the first to test a hormone, progesterone, for its contraceptive activity. They described the effects of giving progesterone to rabbits: the ovaries of these rabbits did not release any egg cells (Makepeace et al. 1937). The first synthetic progesterone was developed in 1939 as a reaction to the growing interest in this hormone as a drug for the treatment of several reproductive disorders in women, a development that I described in the previous chapter (Vaughan 1972:7, 9).
Despite these developments, the paper on what came to be known as “the Inhibiting effect” of progesterone on ovulation failed to trigger research by others. Research on hormonal contraceptives gradually waned in the late 1930s, due to a complex set of factors (Borell 1987). The Second World War partly accounts for the lapse in research activities. Pincus, the “father” of the pill, described in The Control of Fertility how the special demand of war research accounted for a shift in interest toward studies of adrenocortical function, particularly in relation to physical and mental stress (Pincus 1965: 5). Moreover, birth-control research was not very popular in the 1930s because there was a widespread prohibition against any applied research by university or research Institute based scientists. In the United States as well as in Britain, scientists who opted for applied research were often pushed into less prestigious jobs (Clarke 1985). This situation continued even into the 1950s. In the United States “there were perhaps a half a dozen or maybe a dozen people working on clinical testing of any contraceptive methods in the mid 1950s. They were largely denigrated as being in the pay of pharmaceutical companies” (Jaffe in Anonymous 1978:61-62). There were other constraints that also shaped the field of contraceptive research from its early years until the late 1960s, including the political and moral taboo on sexuality, and on birth control in particular. In the United States federal and state laws prohibited the dissemination of contraceptive information, including contraceptive devices until well into the 1960s.3 The controversial status of any research that might be associated with contraception has had important consequences in terms of scientific recognition and access to research funding.4
Major American funding agencies such as the National Institute of
Health and the National Science Foundation would not fund
basic research in the reproductive sciences at a level equal to that for
research on other major organ systems. The National Institute of Health was even forbidden from funding birth control research prior to 1959.
(Clarke 1990b:20, 27)
The funding of reproductive research thus depended largely on private initiative (Ingle 1971:236).
The few reproductive research projects that actually did take place in the 1930s focused on improving fertility rather than restricting fertility. In the words of one of the American endocrinologists of that period:
We have not been trying to develop fertility control. We have been trying to improve fertility primarily, up until very recently at any rate. All through the thirties the object was to improve fertility…. It has not been, I’m sorry to say, a real objective of the biological sciences, endocrinology, to develop birth control hardware.
(Creep in Anonymous 1978:10)
The impetus for change of this restrictive political and scientific climate came from three social movements: the birth control movement, the population control movement and the eugenic movement.5 All three aimed to limit human reproduction by separating sexuality from reproduction. The birth control movement emerged as a feminist-inspired movement “to enhance women’s control over their reproductive capacities” shortly after the turn of the century in the United States as well as in Europe. The eugenics movement, aimed at “improving” humankind by “applying agricultural breeding principles to humans,” emerged in the 1880s. The population control movement, inspired by the Neo-Malthusian ideology, focused on control over the “numbers of people and their distribution in relation to the distribution of resources” (Clarke 1990b: 24).
After the Second World War these movements more or less “merged and consolidated under the banner of family planning and population studies” (Clarke 1985; Gordon 1976).6 By the 1960s the fear of a “population bomb” threatening the social order became the dominant ideology of governments in the United States and Europe, drawing leading reproductive scientists gradually into solving “population problems” (Clarke 1990b: 21). In the USA the National Academy of Sciences and Public Policy “selected population problems as its focus in 1961” (Clarke 1990c: 13). The relationship between reproductive scientists and these social movements may best be portrayed as a love-hate affair. On the one hand, reproductive scientists attempted to distinguish their work from these rather controversial movements. On the other hand, they depended on them since these movements provided increasing support and legitimacy for reproductive research (Borell 1985).
The direct impetus to change the status quo in research on hormonal contraceptives came from two women: Margaret Sanger and Katherine
Dexter McCormick. In 1951, Margaret Sanger, a women’s rights activist and pioneer for birth control in the USA, accomplished her goal of getting scientists to work on the development of “a simple, cheap contraceptive.”7 She had lobbied extensively for years for “the creation of a laboratory program of contraceptive research” (Borell 1987:53). Since the 1920s, Sanger had founded two journals to provide forums in which scientists could present their research findings about contraception (Christian Johnson 1977: 66). Her strategy to cooperate with scientists was intended to lend more prestige and legitimacy to birth control and to develop means of birth control better than the existing methods (Christian Johnson 1977:65, 66). She faced major problems in mobilizing scientists for her project. Most scientists chose to work on theoretical rather than applied problems, and were reluctant to move into this type of research, afraid of becoming the subject of controversy (Christian Johnson 1977: 66).
In 1951, at the age of 68, Margaret Sanger finally succeeded in finding her scientist: Gregory Pincus (Pincus 1965:67; Vaughan 1972:24). Pincus, a biologist interested in endocrinology and reproductive functions, started his career at Harvard and had won worldwide recognition as a prominent researcher in the study of hormones.8 Following a controversial publication on parthenogenesis in 1937 he was denied tenure at Harvard and continued his career outside the university, and not without success. In the 1940s, with Hudson Hoagland, another Harvard reject, Pincus built a major research organization: the Worcester Foundation for Experimental Biology, a private, independent, non-profit research institution located within 40 miles of Boston with social and professional ties to Harvard and Boston Universities and the State Hospital of Worcester (Christian Johnson 1977:70).
The major constraint on the Worcester Institute and Pincus in the early years was the continuous need for grants. Funds for research were not abundant in the 1940s unless one held a position at a well-supported university or research institute (Werthessen and Johnson 1974). Pincus, described by his colleagues as “a scientific entrepreneur in the best sense,” “a scientist-statesman with great organizational abilities,” succeeded in organizing the funds needed to finance the research institute (Vaughan 1972: 43-44) In the late 1940s, he contacted G. D.Searle and Company, a pharmaceutical firm that had already sponsored several other projects carried out by the Worcester Foundation, among others the development of antiepileptic drugs. At that time Searle was reorienting its interests (Anonymous 1978:31). Pincus persuaded the company to go into the hormone business. (McLaughlin 1982:135-136; Ramirez de Arellano and Seipp 1983:106).9 He convinced them “that it is to their advantage to have basic research done at the Foundation, the cost of it, they could write it off and that in every case the projects engaged in might have practical significance.”10 Searle, increasingly interested in the potential of hormones for a variety of drug applications, supported Pincus’s research with enough money to finance a staff of a dozen researchers at the Worcester Foundation. In the 1940s, the foundation’s research agenda consisted of “the testing and screening of hormone compounds submitted by Searle for evaluation of properties relevant to eventual use as drugs for the treament of arthritis and other diseases” (Christian Johnson 1977: 70). Pincus functioned for many years as Searle’s consultant for the development of hormonal drugs. Pincus’s relationship with Searle thus shows remarkable similarities with the cooperation between Ernst Laqueur and Organon that has been described in previous chapters.
Before Margaret Sanger contacted him, Pincus had no particular interest in contraception (McLaughlin 1982:97). In his own account of what made him decide to begin contraceptive research, Pincus refers to “two overtly ascertainable factors: a visit from Mrs. Margaret Sanger in 1951, and the emergence of the appreciation of the importance of the ‘population explosion’” (Pincus 1965:5). Sanger obviously convinced him of the necessity to develop hormonal contraceptives and, of equal importance, she provided him with the required funds.11 She raised $150,000 mainly from her friend Katherine Dexter McCormick, to get Pincus started on research towards what she called a “universal contraceptive” (Seaman and Seaman 1977:63). Thereafter McCormick, one of the first women graduates of the Massachusetts Institute of Technology, contributed a sizeable annual budget to support Pincus’s work. Actually, she financed the entire research effort that brought the pill into being. Not a single penny of government money was invested in it (McLaughlin 1982:93) nor was there money from Searle or other pharmaceutical companies. Searle was skeptical of the proposed project of testing hormones for contraceptive activity (Ramirez de Arellano and Seipp 1983: 106). They provided the hormonal compounds (described later), but not the money. The pill was thus born in the margins of the established medical academic institutions. Or as McCormick described it: “Personally I doubt if they, at Harvard, would ever have found an oral contraceptive!”12
This short history shows how hormone research was gradually reoriented toward contraception. Most importantly, it illustrates how the first step in this recontextualization of hormone research was initiated by feminist birth control activists, rather than by scientists themselves. Pincus decided to focus his research on the contraceptive potential of hormones only after he had met Margaret Sanger. Sanger and the birth control movement were crucial in making contraceptive research an issue on the research agenda and in creating the financial conditions for this research project. In the next section we follow Pincus to see how he tried to create the relevant contexts for the clinical testing of hormones as contraceptives.