The pill to prevent conception had many fathers and at least two mothers. Most of them were initially concerned with world overpopulation, not women's sexual freedom. In Margaret Sanger (see Chapter 21) and Katharine McCormick, heir to the International Harvester Company fortune, the goals of the movements for birth control and for population control meshed. The two women wanted a safe, inexpensive contraceptive that would be easy to use in the poverty-stricken slums of the world. In the postwar climate that favored technological solutions to social problems, they recruited Gregory Pincus, a pharmaceutical scientist working in a small Massachusetts laboratory grandly called the Worcester Foundation for Experimental Biology. Pincus desperately needed money to keep his lab afloat. Assured of McCormick's support to the tune of $2 million, he went to work in 1950 on Sanger's request for an oral contraceptive that would be as simple to use and as plentiful as aspirin.

Like most scientists, Pincus drew heavily on the

earlier work of others. Chemists in the 1930s had synthesized estrogen, the female hormone that prevents ovulation (stopping the female body from forming and re-

leasing an egg). Others had worked on progestin, the hormone in the ovaries that keeps sperm from fertilizing an egg. Pincus utilized their experiments with rabbits, as well as Carl Djerassi's synthesis of steroids and the work of gynecologist Dr. John Rock. None of these scientists had birth control on their minds. Indeed, Rock, a Catholic was seeking an effective hormonal pill to help women get pregnant.

After years of experimenting with hundreds of combinations of substances, Pincus and his collaborator, Dr. M. C. Chiang, synthesized a mixture of estrogen and progestin that they believed safe and effective in suppressing ovulation in most women. In dubiously ethical practices, Pincus set up field trials with psychiatric patients and male prisoners (thinking it might work on men). Puerto Rico was the site for his first large-scale clinical trial of the oral contraceptive-- because he could "attempt in Puerto Rico certain experiments which would be very difficult in this country." He followed that with tests in Haiti. Called Enovid, and produced by the G. D. Searle drug company, the pills were approved by the Food and Drug Administration (FDA) in 1957, but for gynecological disorders--not as a contraceptive.

At the time, thirty states still had laws banning or restricting contraceptive use, and most drug companies feared the controversy such a pill would arouse. The other drug companies left it to G. D. Searle to ask the FDA to approve the drug as a contraceptive. In May 1960 the FDA approved Enovid for contraceptive use. It did so, in large part, because of widespread concern about overpopulation and the threat of communism. Many feared that a teeming nonwhite underclass was tailor-made for a communist takeover, and thought the likelihood of that threat could be minimized by controlling population and thus reducing hunger, poverty, and disease in the world.

Many American women embraced the new technology with enthusiasm, and Enovid, unexpectedly helped to foster a sexual revolution in the United States. By 1965, despite being condemned as immoral by the Catholic Church and denounced as a technology of genocide by African-American militants, "the Pill" (as it was commonly called) had become the most popular form of birth control in the United States, used by 6.5 million married women (unmarried women were not counted in official reports). In 1968 Americans spent as much on the Pill as on all other contraceptive methods combined. By 1970 more than 10 million American women were "on the Pill."

Pincus was deluged with fan letters. A grateful user in St. Paul kissed his picture in the newspaper, "for this is the first year in her eight years of marriage that she has not been pregnant." And in a song named "The Pill," Loretta Lynn sang, "All these years I've stayed at home while you had all your fun/ And ev'ry year that's gone by another baby's come/ There's gonna be some changes made right here on Nurs'ry Hill/ You've set this chicken your last time, 'cause now I've got the Pill."

Although widespread use of the Pill and the sexual revolution occurred together, the former did not cause the latter. Primarily married women consumed the Pill in the 1960s. It would take larger social changes in the United States before doctors would readily prescribe it for unmarried women, before the young would claim sexual pleasure as a right, and before a woman's libera-

tion movement would be strong enough to insist on a woman's right to control her own sexuality. Permissiveness resulted more from affluence and mobility, from changed attitudes and laws, than from the Pill. Still, the Pill disconnected fears of pregnancy from the pursuit of sexual pleasure, and breaking reproductive shackles made sexual freedom more likely. The greater degree of autonomy and choice in women's sexual-reproductive lives changed the experience and meaning of sex, in and out of marriage.

The Pill has not been a universal panacea. One woman's medical miracle became another's social concern and a third woman's health problem. High amounts of estrogen in the early pills caused blood clots and strokes, disabling many women. Because the Pill was available only with a doctor's prescription, the oral contraceptive increased doctors' control over the sexual lives of women. While conservatives sought to stem the tide of promiscuity and pornography they blamed on the Pill, feminists charged that women bore the costs of contraception because men controlled the medical profession and pharmaceutical industry. At the same time, liberalized sexual behavior proved less emancipating and more exploitative than feminists first expected, and the disagreement about such issues as birth control, abortion, premarital sex, and obscenity hastened the demise of the liberal consensus.

To date, the Pill has neither significantly limited population growth in the Third World nor ended the scourge of unwanted pregnancies in the United States. It has changed the dynamics of women's health care and altered gender relations. The first medicine produced for a social, rather than therapeutic, purpose, it remains the pharmaceutical swallowed as a daily routine by more humans than any other prescribed medication in the world.