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Correction to This Article
A timeline with the article about the 50th anniversary of the introduction of the birth control pill incorrectly said studies show that the pill might prevent cervical cancer. Some studies have shown that it could increase the risk of that cancer.
Oral contraceptives have had broad impact but some seek alternatives to the pill

By Melissa Bell
Washington Post Staff Writer
Tuesday, May 11, 2010; HE01

On May 11, 1960, 50 years ago today, the pharmaceutical company Searle received approval from the Food and Drug Administration to sell a tiny pill named Enovid for birth control. A simple combination of two hormones -- progesterone and estrogen -- the pill inhibited ovulation. If taken correctly, it promised a 99.7 percent effectiveness rate in preventing pregnancy. Enovid had already been on the market for three years as a treatment for menstrual disorders; its approval as an oral contraceptive marked the first time a medicine would not treat or prevent an illness, but would rather be prescribed to healthy people.

With the new pill, an advertisement claimed, women would be "freed from their chains at last." The ad showed a naked Andromeda, an Ethiopian princess in Greek mythology, bound against a rock as a sacrifice to an angry sea monster. Enovid, the ad suggested, would liberate her from those chains.

It was a bold promise.

So popular was Enovid that its descendants are referred to simply as "the pill," as if no other medicine came before, or after. It is the first, the last, the only pill.

Five decades on, little doubt remains of its impact: It is hailed as one of the 10 greatest public-health accomplishments of the 20th century. It allowed women to choose if and when they would have children. By 2002, 11.6 million American women were using the pill, according to a government-sponsored study, and today it has been taken by more than 80 percent of all American women.

After 50 years, however, its boastful promise to unfetter women rings hollow to some. Half of American pregnancies remain unplanned. Almost four in 10 women using the pill and other reversible birth control methods are not happy with them, according to the Guttmacher Institute, a nonprofit research group that focuses on reproductive health. And a small but vocal chorus of women calls for the medical field's reliance on the pill to be reexamined.

"It's handed out like candy," said Holly Grigg-Spall, a 27-year-old blogger who stopped taking the pill last year and encourages other women to do so at Sweeteningthepill.blogspot.com. "You imagine it's just this harmless little pill," she said, but she believes women do not think enough about the potential side effects.

An early vision

The revolutionary contraceptive was envisioned by a nurse, Margaret Sanger, who began working on the Lower East Side of New York almost 100 years ago and saw the results of many botched back-alley abortions. Sanger, who believed her own mother's 18 pregnancies led to an early death at the age of 50, talked of "a magic pill" that would allow women to control when they had children. Sanger, who went on to found the group that would later become Planned Parenthood, was 80 when the pill was approved, and her grandson Alexander, now chair of International Planned Parenthood, said his grandmother had only one thing to say: "What took so long?"

While Alexander Sanger continues to fight for the right to birth control, he cautions about the danger of overstating the impact of the pill. "It has done less than we dreamed and less than our opponents feared," he said. "Do we have the right contraception for every woman at the right stage of her life? No."

U.S. women use the pill more than any other form of contraception, according to the 2002 National Study for Family Growth, but Lawrence Finer, director of research at the Guttmacher Institute, said he anticipates that new studies will show an increase in the use of non-hormonal forms of contraception. Michelle Fegely, a gynecologist in Manassas, said that some of her patients are requesting copper IUDs because "they are purists; they don't want hormones in their body."

Changing times

Long mythologized as liberating women to have sex without the risk of becoming pregnant, the pill began by "saving the saved," according to Alexandra Pope, author of "The Pill: Are You Sure It's for You?" Its first adopters were middle-class women already in committed relationships and usually on another form of contraception: married women like Jan Nyenhuis, now 69, who meticulously used a diaphragm, stopping twice for planned pregnancies. But twice the method failed, she said and "nine months later . . . " After finding out she was pregnant for the fourth time, she fell into a depression. "I knew what I was going to be doing for the next six years," she said. After giving birth to her fourth child, she switched to the pill.

Five years after the FDA's approval, 5 million women had tried the pill, but many switched to it not as some declaration of independence, but because it was an easier, "less messy" option than the diaphragm. As one 79-year-old woman recalls, "It was not a revolt; it was a relief."

That relief ushered in an era of dynamic changes in the American family. In 1970, according to the National Center for Health Statistics, the typical U.S. woman married at 20 and had her first child at 21. Today, women are having their first child four years later, on average, and they are marrying six years later.

Those statistics reflect another shift: More single women give birth. There has also been a dramatic increase in the number of women who are over 35 when they have their first child, from one out of every 100 in 1970, to one in every 12 in 2006. Women now make up half the workforce, and they outnumber men at college. "The pill," said Elizabeth Kissling, professor of women's and gender studies at Eastern Washington University, "had a profound effect on women's lives and their relationships" by giving women greater control over their fertility.

The pill has gradually been folded into the fabric of women's stories: For some, starting the pill has become a rite of passage akin to getting their first period. "I walked to Planned Parenthood the day after I lost my virginity 17 years ago," said Kathleen Wise, a 31-year-old chef in San Diego, "and I have been on the pill uninterrupted ever since." District gynecologist Marilyn Jerome said young women come into her office expecting to go on the pill before they head off to college.

Like any medicine, the pill has side effects. The earliest versions of the pill had 10 times more estrogen than the equally effective contemporary pill, and it could cause blood clots, strokes and, in some rare cases, death. In the 1960s women started complaining about their experiences to Barbara Seaman, a writer for Ladies' Home Journal. Her book, "The Doctors' Case Against the Pill," published in 1969, came to the attention of Sen. Gaylord Nelson (D-Wis.), who called for hearings on the pill's safety. No women, not even Seaman, were invited to testify. A group protested the hearings, and the media attention eventually led to a lowering of the estrogen in the pills and the insertion of safety information in every pill packet.

A new age

Aided by the Internet, a new wave of women has begun sharing experiences and seeking out contraceptive alternatives. Christina Hannah, a Web designer in Indiana, had been prescribed the pill to ease heavy menstrual pain. The drug helped control her periods, but within three months she began suffering from sleeplessness, nausea and anxiety. After many doctor's visits, she Googled the name of her pill, Yasmin, and found a "survivors board."

Yasmin, it turned out, had become the subject of lawsuits against its maker, Bayer, by women who said they had suffered strokes and blood clots in their lungs. Bayer, in an e-mailed statement, said that it stands behind the safety of its oral contraceptives and that the lawsuits focus on side effects warned about in their labeling. Internet forums have hundreds of women sharing stories of how they felt the pill affected them. Hannah said, "I probably would have just thought I was going nuts, if I had not found these people."

The Internet has offered women a space to communicate their worries about the pill, a space left by their doctors who may not be providing enough information to their patients, said Beth Jordan, a District gynecologist and the medical director of the Association of Reproductive Health Professionals. "It's a knee-jerk reaction. The pill is always offered."

"There's this huge distance between what women want and what [the medical community] is willing to provide," said Laura Wershler, executive director of Sexual Health Access Alberta, a nonprofit that advocates for reproductive education. "We're so used to and comfortable with this fast-food birth control, we don't want to take the time to think about fertility management."

Grigg-Spall, the blogger who encourages women to stop using the pill, came up against this lack of information when she started feeling depressed after switching to a new brand. When she compared notes with a friend who was also feeling depressed, the only mutual change they could identify in their lives had been the new pill they had both started. When Grigg-Spall went to her doctor with her concerns, she said, the doctor recommended she try another pill, not another type of contraception.

Grigg-Spall said that over the decades women had to fight for the right to access the pill, so it seemed dangerous to ever complain about the side effects.

From a medical perspective, the pill has been a success. Studies show that it probably reduces ovarian cancer. Doctors such as Jordan believe the risks of taking the pill are much lower than the risks of unintended pregnancies: "The pill is great . . . but we need a richer, more nuanced conversation about the different options."

A new age of women, wary of taking hormones and accustomed to questioning medical advice, wants just that:

"We are kind of addicted to the pill," Grigg-Spall said. "You become hooked on . . . it."

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