I’m a 23 year old woman and am intrigued by the public’s relationship with the birth control pill. It was undoubtedly a huge step towards female empowerment through scientific innovation in the 60s, but now the pill seems to be something that we’re stuck with whether we like it or not. Despite its serious and vast ranging side effects, the pill is the most commonly used form of contraception in the UK. Meanwhile, the ‘male pill’ has been lurking in developmental stages for over 60 years. Why has scientific progress slowed so dramatically since the introduction of the pill? Contrary to celebrating it (and its inadequacies) year after year, we should be forging towards its improvement and embracing new alternatives.
The story begins in the 1950s when Margret Sanger convinced Gregory Pincus to begin work on creating a contraceptive. Initial tests on female rats in 1952 demonstrated that progesterone inhibited pregnancy. The work progressed rapidly, and in 1954, 50 women in Massachusetts underwent clinical trials for an early iteration of the pill. Two years later, in what was clearly an exploitative trial, the pill was given to 1,500 women in Puerto Rico, where a lack of legislation allowed the tests to go ahead. Side effects were noted and ultimately discarded, and the pill was approved by the FDA in the US in 1957 for use in severe menstrual disorders. Following a large number of women adopting its use, the pill was legalised as a contraceptive in 1960 in the US, and 1961 in the UK.
Hurrah! Science and policy have collaborated to produce and legalise a pill which gives women a choice over pregnancy. This part of the story is, I think, one of success, at least in certain lights. We’ve seen collaboration of a scientist and a women's rights activist, the rapid development of a drug, and its use to revolutionise the lives of (privileged and married) women at the time.
But if the story stopped here it would be quite a boring one. What has happened since the introduction of the pill demonstrates a lackadaisical attitude from the scientific community towards furthering the development and knowledge of contraceptives.
Unsurprisingly, a drug that was created, tested questionably and adopted within 10 years came with its share of teething issues. There were many health scares that came about after the pill’s introduction; most notably, cancer. In fact, the chemical makeup of the pill has changed significantly over 60 years; one day’s dose of the pill in the 1960s is the equivalent of a whole week’s now. Imagine the assault on their bodies that these ‘empowered’ women would have experienced when adopting this medication fresh off the shelf. The problems with the original pill were so extensive that eventually, in 1988, the original pill it was taken off the market and improved alternatives took its place.
But even with historic and more recent improvements, the pill still isn’t perfect. Distrust and disquiet have been growing around the pill and its effects throughout the female millennial population. Just a handful of issues with the pill include: depression, anxiety, loss of sex drive, heavy periods, acne and a risk of long term infertility.
Yet, we fail to move towards an alternative. Conversations with friends verify my experiences. For me and so many others turning up to the doctors aged 16, the only contraceptive that was advised or discussed was the pill. On returning to report a problem with this method, the most common advice was to “try another pill”. The other options at our disposal are manifold: the coil, the IUD, newly developed contraception apps based on cycle tracking (now medically supported), condoms, female condoms and the diaphragm. Depressive side effects from the pill are common and are likely to stem from its hormonal function, but 2/3 of women aged between 20-25 still use it. Could this be the result of over-prescription and a lack of responsibility from GPs?
It is after all a doctor’s responsibility to prescribe an effective treatment for each individual, but things aren’t always this simple. Doctors themselves complain of the problems with prescribing birth control to women in rushed appointments. A key issue here is recognition of the power contained in these tiny pills. They have the ability to transform lives for better or worse, and therefore require at least a lengthy discussion prior to their adoption. This doesn’t seem to be recognised by the medical community at large, in fact, the pill is even prescribed to fix problems outside of its remit, such as acne and irregular periods. It seems like we should be limiting its use, rather than using it as a cure all.
Women seeking birth control require some proactivity from individual doctors, who must use their time effectively to explore contraceptive options with patients, rather than prescribe according to the status quo. The education sector and public health campaigns alike should build awareness of new contraceptives, which could help to remove stigma around newer (often more effective and less emotionally invasive) alternatives. It represents a failing in the dissemination of scientific knowledge and healthcare information that there are many possible contraceptive options and yet women and girls alike seem to be oblivious to them.
Besides embracing the multitude of contraceptives on offer, there is another area where we really aren’t progressing. One particular contraceptive has actually been stuck in development since 1957.
It is, of course, the male pill. With work starting on this just seven years after that on the female pill, why has it still not made it to market 60 years later?
The answer here is nuanced, obviously affected to some degree by the nature of those propagating the research, or allocating the funding. I am of course talking about men who often sit in a position of power, and for whom the male pill just might not be particularly attractive. Sarewitz and Woodhouse argue that science serves its creators: the rich and powerful, but could this also be the case in terms which genders research seems to favour?
However, men have been publicly calling for a male alternative to the pill for some time. Trials have started and stopped for almost as long as the female pill has existed. Irritatingly, men don’t seem particularly accepting of the side effects that contraception often brings with it. Trials on a male hormonal option have been halted after reports of effects on libido and general mood – side effects which definitely sound familiar to me, and did not stop me being prescribed the pill with wholehearted enthusiasm.
But the male contraceptives currently in development are showing promise. These are fully reversible injections to the vas deferens which prevent ejaculation. The method is being developed separately in two countries; the Indian version, RISUG, has been tested on humans for years and seems to be tantalisingly near completion, while the US's Vasalgel is still in animal stages. Hopefully this injection of enthusiasm into the development of the male alternative to the pill will translate into a legalised product before the pill’s 70th birthday. Although, the companies that make their billions from the current contraceptive solution have a vested interest in slowing this progress.
I have not tried to suggest that the female pill is bad or wrong for everyone, it does of course have its strengths. It's possible that male oriented research and a lack of innovation has resulted in slow progress in contraceptive research, but now we must focus on moving forward. Scientists, doctors and drug firms should not let themselves be lulled into celebrating the success of the pill over developing and propagating superior alternatives.