The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (38 page)

“For different people, yes,” Sanger said, “it certainly was for me, and for my husband. We had a very happy marriage. . . . He had different friends than I had.”

Television was new, and Americans, including Sanger, were only beginning to understand its power. At the start of the decade, televisions were in 9 percent of homes. By the end of the decade they were in 90 percent, and the average person was watching forty-two hours a week. Back in Tucson, Sanger’s teenage granddaughters watched in dismay, waiting for Sanger to find her footing and launch a counterattack. They were not used to seeing her bullied, seeing her seem so uncertain of herself. Her son Bill, watching in New York, began to cry.

Wallace may have won the battle, but he had missed the story. He never asked Sanger about the birth-control pill. If he had, he might not only have broken news, he also might have engaged Sanger in an even more heated discussion about whether sex should be for pleasure and whether such a pill might encourage greater numbers of women than ever to “neglect their families” in favor of careers. But Wallace did capture the moral complexities of Sanger’s life and work. Though she had stated repeatedly for more than forty years that she was interested in using science and politics to solve social issues, her crusade had always been a moral one, and her whole life had been an expression of that crusade. In her war with the Catholic Church, in her fight for greater sexual freedom, and in her belief that women would never be treated equally until they controlled their own bodies, she had never shied away from battle and stayed in for the long war.

Science was forging ahead, largely without Sanger now, in the search for better birth control. A new generation was thinking in fresh ways about what women needed to do to gain power and claim independence. Sanger was a part of history. She had fought and compromised, making bold choices and bad ones, but she was no longer the leader of this movement or any other.

As the harsh lights of the television studio cast shadows in close-up across Sanger’s wrinkled face, American television viewers watched a warrior whose time had almost passed.

After Sanger’s appearance, sacks of mail arrived at ABC’s offices and at Planned Parenthood. Sanger glanced at a few—“
It is just too bad
that your mother didn’t practice birth control 95 years ago when she had you—(because you look that old you old bag),” one read—and threw the rest away.
But she did read an editorial
that appeared in response to her TV interview in a September issue of the
The Evangelist
, a weekly publication of the Catholic diocese in Albany, New York. It read, in part: “Wallace, who claimed ‘to explore the economic, moral and religious aspects of birth control’ was the instrument whereby Mrs. Sanger, veteran proponent of barnyard ethics and race suicide, was given her entrance into millions of decent homes to taint them with her evil philosophy of
lust and animalistic mating
.”

Sanger wrote in her diary that the “
R.C. Church is getting more defiant
and arrogant. . . . Young Kennedy from Boston is on the Stage for President in 1960. God help America if his father’s millions can push him into the White House.”

As usual, Sanger had nothing good to say about Catholics and the Church. She had accepted John Rock, but that was as far as she would go. Had she been less obstinate, she might have realized that John Fitzgerald Kennedy, the Democratic senator from Massachusetts, was part of a new generation of Catholics. Kennedy’s beliefs had been shaped by his religion, but religion had not had a strong effect on his political views. Had Sanger been less obstinate, she also might have noticed that by the late 1950s some theologians were openly expressing curiosity about the birth-control pill. As the scientific experiments surrounding the pill garnered publicity, Catholic women were meeting with their priests and asking whether this new form of birth control might be acceptable to the Church. Responses varied. Priests all over the country had to make up their own minds as to what to tell their parishioners. Not all of them stuck to the Vatican line.

When Enovid went on the market in 1957 and doctors began offering it clandestinely to women for contraception, everything changed, in part because the Church had not yet figured out how to react. Here was something new. It wasn’t billed as birth control and yet it worked as birth control. Even better, it didn’t
look
like birth control. A woman who was ashamed or uncertain of her anatomy did not have to struggle with awkward devices to have sex. She could take the pill in the morning and forget about it entirely when she decided whether or not to make love to her partner that night. She could take it without telling anyone but her doctor. It was the most personal of choices, and that important change in psychology allowed many women to consider contraception for the first time. Often their friends encouraged them, their doctors helped them, and their priests, receiving no clear guidance from the Vatican, did nothing to get in the way.

John Rock was not the only one who thought the Church might eventually approve the use of Enovid. The Church allowed women to have sex after they’d undergone hysterectomies. That was because their sterility had come about as a cure for a disease. If a woman had undergone a hysterectomy for the express purpose of having sex without fear of making babies, the Church would not have condoned it. In other words, the Church had declared that it was acceptable for women to shut down the process of ovulation to treat endometriosis, excessive bleeding, or painful menstruation. Enovid treated those same ailments in much the same way, by shutting down ovulation.

Pope Pius XII appeared to accept this line of thinking, at least to an extent: “
If a woman takes this medicine
, not to prevent conception, but only on the advice of a doctor as a necessary remedy because of a disease of the uterus or the organism,” he said, “she provokes an indirect sterilization, which is permitted according to the general principle of actions with a double effect.”

The principle of double effect, introduced by Thomas Aquinas, is often invoked to explain why actions that can cause harm may be permitted. It is permissible to kill a man in self-defense, for example, provided one does not intend to kill him. The action is acceptable because the goal was saving one’s own life, not causing harm to one’s assailant. A doctor who believed that abortion was wrong, even to save the mother’s life, might be willing to perform a hysterectomy on a woman with treatable cancer because the bad effect (the death of her fetus) flowed as an indirect result of the good effect (saving the mother’s life). Intent was everything. Evil was still evil. But as long as the evil was unintentional, guilt might be allayed.

Not surprisingly, the debate grew murky. Was an irregular menstrual cycle enough reason for a woman to take a pill and receive both the good effect (regularity) and the bad (contraception)? Was painful menstruation painful enough to qualify as an ailment? Was fear of pregnancy a legitimate medical concern? What if the fear of pregnancy was causing a woman to suffer a mental breakdown or raised her risk of a heart attack? What if pregnancy might cause her to suffer heart failure? What if pregnancy might cause her other children to starve?

Then there was the matter of the rhythm method. If the Church permitted women to use the rhythm method to determine when it was safe to have sex without fear of pregnancy, perhaps it would permit women to use the pill to regulate their menstrual cycles and practice safe sex more reliably.

“It seems to me,” the American Jesuit John Connery wrote, “that perfect regularity is as legitimate a goal as
perfect health or perfect vision
.”

These were not easy problems to solve, especially for a group of celibate men. But in the end, only one man’s opinion would matter when it came to setting the Church’s policy, and that was the pope.

THIRTY

La Señora de las Pastillas

P
INCUS AND HIS
wife Lizzie never explained sex to their daughter, Laura. Instead, when Laura was about fourteen, her father left a book called
A Marriage Manual
, by Dr. Abraham Stone, on the dining room table for her to read.

“
I thought it was so strange
,” she recalled.

In the fall of 1957, when she was twenty-two, Laura went to work for her father in Puerto Rico, signing on as an administrator for the continuing field trials in Rio Piedras and Humacao. Laura was a great beauty, like her mother, with an hourglass figure and penetrating eyes. She also had her mother’s pluck. She was still a virgin at the time, but before her work in Puerto Rico was done she too would begin taking the pill her father had invented.

“
La señora de las pastillas
,” the women in the Puerto Rican trials called her. The pill woman.

In one of the slums Laura visited, urban planners were building new houses over the existing shacks so that residents could continue to live in them during construction. She was fascinated by the maturity of the young women she met, many of whom were younger than she but already caring for children.

She recalled:

Many of them were never actually married
. They were too poor to get licenses. They would pose with their heads through cardboard wedding dresses for their wedding pictures. I would ask them, as Catholics, how did they feel about not being married, and they would say, “I have a direct relationship with God, and he understands why I have to do this.” They were very poor. They were desperate not to have more children. But the men, some of them were macho, and they wanted as many children as possible. With the pill, they didn’t have to tell their husbands they were using birth control.

For Laura, who had recently graduated from Radcliffe College, Puerto Rico was another kind of education. She marched into the slums with her clipboard in hand, asking questions such as “How many times did you have intercourse this week?” and “Did you practice interruption as a method of birth control?”

Laura spent a year in San Juan, and while she was there she met Michael Bernard, a young Harvard graduate working as an urban planner for the Puerto Rican government. When Laura told her father she had fallen in love and begun taking the birth-control pill, he was not upset. His main concern was side effects.

She said she hadn’t experienced any.

Throughout the late 1950s, Goody continued to make frequent trips to San Juan, with occasional visits to Haiti as well. Lizzie usually accompanied him. They would stay at lush tropical hotels and sit on the patio at night, smoking, sipping cocktails with little umbrellas in them, and listening to the surf crash against the shore. In the mornings, Lizzie would sleep while Goody would meet with the doctors, scientists, and nurses working on the trials.

Pincus usually brought laboratory technicians from Massachusetts to Puerto Rico so that they could perform Pap smears and endometrial biopsies, tests that the
medical team in Puerto Rico couldn’t handle
.

The trials in Rio Piedras and Humacao were proceeding smoothly, but efforts in Haiti were not so successful. The team of doctors and social workers there was not as competent, and high illiteracy rates made it more difficult for
Haitian women to follow directions
. Still, Pincus was determined to enroll as many women as possible in the study, and to keep a close eye on those who’d been participating the longest. He was also eager to test lower doses of Enovid—2.5 and 5 milligrams instead of 10—to see if it would remain effective while reducing side effects.

By the end of 1958, more than 800 women had enrolled in tests of the pill, but only about 130 had taken it for a year or more. Those were small numbers for a medical trial, even by 1950s standards. Yet while some doctors and journalists had suggested it would take years of testing on thousands of women before a drug like this would be approved for contraception, officials at Searle did not want to wait for Pincus to obtain more results. In December, even as Pincus continued to tinker with the dosages and the makeup of the pill, Searle was preparing to make the next big step: requesting approval from the FDA to sell Enovid as an oral contraceptive.