Most people today will associate hormones with the pill. Hormonal contraceptives are indeed the most powerful outcome of the introduction of the concept of the hormonal body in the 1920s and 1930s. Although the possibility of using hormones as contraceptives was mentioned as early as 1921, it took three decades before scientists actually began to develop contraceptive hormones. When the pill eventually came into existence, it was greeted with enthusiasm. By the late 1950s and early 1960s, less than a decade after initial testing in animal studies, the pill was being consumed daily by millions of women all over the world. Never before in medical history had a medical technology witnessed such a rapid and broad diffusion (McLaughlin 1982:38; Segal and Atkinson 1973:350). “Probably the best indicator of its acceptance is the fact that we no longer use a capital P or inverted commas when writing about it, because everyone understands that the pill refers to only one kind of tablet,” at least in the western industrialized world (Bromwich and Parsons 1990:24)
The contraceptive pill was a novelty on the market for contraceptive methods at that time. It was the first physiological means of contraception. That is, it prevented pregnancies by intervening in the internal processes of the body, rather than by means of an extraneous device (Rock 1963: 168).1 Contraception now might be achieved by taking an “aspirin-like pill that would be unrelated to sexual intercourse.” Moreover, the pill was a novelty since it would be the first drug in the history of medicine given to healthy people for a social purpose (McLaughlin 1982:120; Vaughan 1972:51).
This chapter focusses on how hormones were made into contraceptives. How did scientists succeed in transforming hormones into completely new types of drugs? For, prior to the 1960s female sex hormones were mainly used as drugs for menstrual and menopausal dysfunctions. What kinds of actions were required to make hormones into the contraceptive pill? In order to understand the story of the pill we need to theorize about what actually happens to scientific artefacts when they not only get out of the laboratory but also get into a new generation. Constructivist approaches, again, may be helpful. Constructivists hold that scientists do not operate independently or
outside a social or political context. They actively select and create the contexts in which their claims may be made relevant.2
This is exactly what happened in the case of the pill. In 1953, Gregory Pincus decided to develop a pharmaceutical product for one specific purpose: the control of fertility. Pincus thus chose to make knowledge claims about hormones relevant in a totally different context. This drastic change in the history of hormones may best be understood if we explore the activities that went into this recontextualization. I shall describe how the pill could be called into existence only if scientists redirected their work to other evidential contexts in which they could establish the required links between the technology-in-the-making and its new audiences and consumers. The successful transformation of hormones into contraceptives required a linkage to a world which was not yet inhabited by hormones: the world of birth control. By entering this domain, the story of hormones became entangled with big politics. The birth control arena was, and still is, a highly political world in which birth control ideologies mix with cultural imperialism. During the making of the pill, the story of hormones turned into a very dramatic one in which Caribbean women became the guinea-pigs of one of the most revolutionary drugs in the history of medicine.
I begin with a brief history of how the development of contraceptives became an issue on the research agenda of endocrinologists in the early 1950s. Next I analyze in detail the clinical trials and field trials in which hormones were made into contraceptives. In contrast with the previous chapters, this chapter deals particularly with research and development activities in the United States. The pill was developed in the United States, not in Europe. The dominant position of European scientists and pharmaceutical firms in the field of hormones, characteristic for the 1920s and 1930s, was broken in the mid-1940s by the newly established Syntex Corporation. This American firm introduced a much simpler and cheaper production process based on the use of plant raw material, thus replacing the more expensive and time-consuming practice of using human and animal materials (Gelijns 1991:161; Maisel 1965:43-58).