The Team That Invented the Birth-Control Pill

For years the biologist Gregory Goodwin Pincus had been searching for a project that might establish his greatness, only to watch ideas come and go like love affairs, beginning with promise and ending in hurt feelings.

His whole career had been a recovery process, one attempt after another to start over. He’d been unceremoniously dumped by Harvard and forced to start his own laboratory in a converted garage. When Pincus met the feminist crusader Margaret Sanger in 1950 and she implored him to go to work on the development of a birth-control pill, he knew the project carried enormous risk. Such a pill would never work, other scientists had told Sanger. And even if it did work, how would one test such a thing? Who would dare manufacture it? Who would prescribe it? Thirty states and the federal government still had anti-birth control laws on the books.

Yet in many ways, the pill project was perfect for Pincus. It concerned the area of science he knew best: mammalian reproduction. And it required not only scientific knowledge but also an entrepreneurial spirit. But the best reason the project suited Pincus was that he had nothing to lose. As one of his colleagues put it: “He wasn’t afraid to go out on a limb because he didn’t have any limb.”

Years of disappointment had taught Pincus that it wasn’t always the science that determined an experiment’s success; it was often the forces surrounding the science, including public sentiment. Now that Pincus had settled roughly on the hormone progesterone as the key to his pill, he needed to build the team to do the scientific work, forge alliances with manufacturers, conduct his trials, and, if all went well, spread the news of the coming invention so that it might have a chance at acceptance.

He knew that his progestins (synthetic forms of progesterone) stopped ovulation in rabbits and rats. The next step was to test them on women. And to do that, he would have to add a player to his team—a doctor who could reassure patients they were safe and would convey to the drug companies supplying the drugs that no one would be harmed. There had never been a medicine made for healthy people before—and certainly not one that would be taken every day. The risks were enormous. Pincus settled on a physician named John Rock, a gynecologist respected by his peers and adored by his patients. Rock looked like a family physician from central casting in Hollywood: tall, slender, and silver-haired, with a gentle smile and a calm, deliberate manner. Even his name connoted strength, solidity, and reliability.

Rock had one more thing going for him: He was Catholic.

There is no mention of contraception in the Bible, Old Testament or New, nor did the term enter the vocabulary of Catholic moral theology until the second half of the twentieth century. Before then, the most relevant term used by theologians was onanisma, from the biblical story of Onan (Genesis 38:4–10), which was described as masturbation or sexual intercourse performed without the intention of reproduction. Sex was only for procreation, the Christian church declared, which made onanisma a sin.

The human reproductive system was poorly understood even in the early years of the twentieth century. Many people thought women were merely the vessels, and that the man’s seed sprung on its own into a baby. That’s why spilling seed, or losing semen, whether in sex or masturbation, was labeled a sin.

Still, the Catholic Church had no official position on birth control until 1930, when Pope Pius XI issued a papal encyclical called “Casti Connubii” (Latin for “Of Chaste Wedlock”). The pope acknowledged that birth control was widely used “even amongst the faithful,” although he wasn’t happy about it, and called this trend “a new and utterly perverse morality.” He added that it amounted to a “shameful and intrinsically vicious” attempt to get around the natural “power and purpose” of the conjugal act. The pope did, however, offer the faithful an important loophole: A married couple would not be sinning, he said, if the husband and wife knew that natural reasons prevented them from having children.

For decades doctors had been instructing women who did not wish to become pregnant to have sex only during their “safe periods.” Unfortunately for many women, until the 1930s most doctors believed the safe period came in the middle of the menstrual cycle; in fact, that’s the time when women are most likely to conceive. After scientists finally got it right, a Chicago family doctor named Leo J. Latz, a devout Roman Catholic, figured out how this information, combined with the pope’s recent declaration, offered men and women a shot at having guilt-free and baby-free sex at certain times of the month. Latz wrote an instruction manual that sold hundreds of thousands of copies.

There was more than pleasure on the line. Women all over the world were desperate to control family size or better time the arrival of children—for the sake of their health and the welfare of their other children.

In the 1930s, birth rates for all American families fell to a low of 2.1 children per mother, in large part because of the Great Depression and in part because women—including Catholic women—became increasingly comfortable with the rhythm method and other forms of birth control. Priests, alarmed by the trend, took to their pulpits to attack birth control, but their sermons did little good. For the first time, many Catholics began compartmentalizing their beliefs. Sex became something private and apart from religion. It was the rumbling before a seismic shift.

John Rock had already gained a small measure of fame as the Catholic doctor who dared defy his church: He wanted young couples to talk about sex and babies before they married. He wanted them to understand that sex was neither shameful nor obscene. He wanted society to provide safe and effective means of birth control, and he wanted married couples to have the right to use them.

For all of this, Monsignor Francis W. Carney of Cleveland called the doctor a “moral rapist.” But Rock would not budge. It was no wonder Pincus liked him.

When Rock treated women for infertility, he would begin by taking a medical history and providing a complete physical exam. If the woman wasn’t menstruating, or if she wasn’t menstruating regularly, Rock might order an endometrial biopsy. Rock was unusual among fertility specialists at the time because he also asked husbands to have their semen tested. He was also unusual—if not unique—in that he operated a rhythm clinic down the hall from his infertility clinic to teach women how to better time their sexual activity to avoid unwanted pregnancies.

Between the women seeking birth control and those patients who were trying to overcome infertility, Rock came to understand not only human reproduction but also a good deal about human relations. In the same day, he would see some women who were straining to raise more children than they could handle and others deeply wounded by their inability to get pregnant. Among the women with children, many came asking for the only thing they’d ever heard of that would guarantee an end to their baby-making days: a hysterectomy, or the removal of the uterus.

One such patient, known as Mrs. L. A., was 32 years old. She had married when she was 18, borne 11 children, and had one miscarriage. Her last five deliveries had been by Cesarean section, and her very last had been twins. She told Rock she and her husband had sex twice a month and never used birth control. The twins were only six months old when Mrs. L. A. visited Rock. She reported that her husband was trying to be “careful,” meaning that he was withdrawing before he ejaculated, to avoid getting her pregnant again. She told the doctor she was exhausted, in pain, and suffering occasional blackouts. Her periods were unusually profuse and painful. Rock suggested an immediate hysterectomy.

Meeting these women emboldened Rock. In the 1950s, every young adult woman seemed to be having children, or wanting to. Raising big families was an act of patriotism in postwar America. Men and women who couldn’t reproduce were pitied. Year after year in the 1950s, the nation became more fertile. By 1957, the average American woman would have 3.7 children in her lifetime.

Demand for fertility treatments exploded in the 1950s, but doctors offered little meaningful help. Beginning around 1950, Rock conducted a series of experiments on women struggling with what he called “unexplained infertility.” He suspected that some of the women were not conceiving because their reproductive systems were not fully developed. When a woman with such a condition did somehow become pregnant, the ensuing pregnancy helped her reproductive system mature. To test his theory, he recruited 80 “frustrated, but valiantly adventuresome” women for an experiment in which he would use hormones—progesterone and estrogen, the same hormones Pincus had been studying—to create “pseudo pregnancies.” He confessed to the women that he had no idea if it would work, but the women trusted him and went along.

He started the women on 50 milligrams of progesterone and five milligrams of estrogen and escalated gradually to 300 milligrams of progesterone and 30milligrams of estrogen. When the first round of treatments ended, no one was dead and no one had become seriously ill. That was good news. Within months, the news got better. Thirteen of the 80 women in Rock’s care became pregnant when they’d stopped taking the hormones. Rock told colleagues that the hormone-induced pseudo pregnancies seemed to have given their bodies a lift and helped them become fertile. Soon, his fellow gynecologists were calling it “The Rock Rebound.”

Only one serious problem had developed: The women taking the hormones were often convinced that they were pregnant because the hormones produced many of the same symptoms as pregnancy: the women became nauseated; their breasts grew larger and more tender; and they stopped menstruating. The women were heartbroken when Rock told them, no, they weren’t pregnant; the hormones were merely tricking their bodies and mimicking pregnancy.

When Pincus learned of Rock’s work, he was pleased but not surprised that the progesterone and estrogen were having a contraceptive effect. The important thing to Pincus was the plain fact that Rock’s patients were not dying. Here was proof that it was safe to give large doses of progestins to women.

Still, Rock told Pincus that his infertile patients were crushed to learn that their symptoms of pregnancy were mere mirages. Pincus offered an elegant solution—and one that would have enormous consequences for his own work and for the future of women around the world. He told Rock to have his patients stop taking the pills for five days each month. Their hormone levels would return to normal, their symptoms would ease, and they would have their periods.

Rock liked the idea. It would make the pill seem more natural, like a scientific version of the rhythm method.

Once that was settled, Pincus presented Rock with a proposal: Would Rock permit some of his patients to be the first human recipients of an oral birth-control pill? The women would take Pincus’s form of the pill, not Rock’s, and they would be studied carefully to make absolutely certain they were not ovulating during their pseudo pregnancies. If they still benefitted from Rock’s rebound, great. But that wasn’t the point. The point was proving Pincus’s pill would work as an effective contraceptive.

Rock agreed. Together, the men would go on to conduct tests in insane asylums and in the slums of Puerto Rico and Haiti. They would even try giving the pill to men. They knew the Catholic Church would object to their work, and they had no idea if the U.S. Food and Drug Administration would approve an oral contraceptive, or if a manufacturer would agree to sell one.

But those were problems for another day.

This article has been excerpted from Jonathan Eig's The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution.