- The Washington Times - Thursday, May 6, 2010

It has been hailed as one of the greatest public health breakthroughs of the 20th century. It enjoys overwhelming approval in public opinion polls. But the ripple effects of the pill - approved for general use 50 years ago this weekend by the U.S. government - are still a hot topic of debate.

As the oral contraceptive enters its own middle age, the fierce battles in the court of public opinion appear to be largely a thing of the past. Polls show that public approval of birth control is overwhelming, with only 14 percent of those surveyed in a recent Harris Interactive poll saying they thought the pill’s impact on society was negative.

The U.S. Centers for Disease Control and Prevention ranked the pill as “one of the top 10 public health achievements of the 20th century,” noted Lawrence B. Finer, director of domestic research for the Guttmacher Institute, which focuses on research related to sexual and reproductive health.

“That, and the fact that three-quarters of all women of reproductive age have used the pill, say something about the impact of this method,” Mr. Finer said.

But beyond its physiological effectiveness, the pill has wrought a profound revolution in social and sexual relations, a revolution that not everyone welcomes.

The pill has given rise to a “contraceptive ideology” or a feeling that people are entitled to perfectly functioning birth control, said economist Jennifer Roback Morse, founder of the Ruth Institute.

Even the best kinds of contraception can and do fail, said Mrs. Morse, whose institute is part of the National Organization for Marriage. The best advice for men and women, even in the post-pill era, is to treat any act of sexual intercourse as potentially creating a child, she said. “Sex is not a sterile activity.”

But even the Roman Catholic Church’s 1968 stand against the pill and other artificial means of birth control failed to slow the drug’s quick and broad acceptance. Within just two years of Pope Paul VI’s encyclical against contraception, studies found that almost as many Catholic women used the pill as non-Catholics.

By 1970, two-thirds of all Catholic women and three-quarters of those younger than 30 were using the pill and other birth control methods banned by the church.

Concerns about oral contraceptives’ effect on health and environment also persist.

At Salon.com, Glamour magazine editor Geraldine Sealey - echoing more than a few other women - wrote that taking birth control seems to kill her libido.

And on the horizon, the issue of underpopulation is emerging. Should the world ever decide that it needs more, not fewer, babies, the battle over the social value of birth control could certainly reignite.

The saga of a safe, widely available means of birth control officially started May 9, 1960, when the Food and Drug Administration announced that it would approve Searle’s Enovid as the first commercially available contraceptive.

While the pill boasts several fathers, it had only two mothers: One was an activist nurse who wanted to prevent women from dying from self-induced abortions or, like her own mother, from childbirth exhaustion. The other was a wealthy heiress who decided not to have children with her mentally ill husband and wanted other women to have a foolproof way to do the same.

Together, birth control advocate Margaret Sanger and heiress Katherine McCormick are widely acknowledged as the indomitable forces behind the creation of a “magic pill” that today allows about 100 million women around the world to control their reproduction.

Both Sanger, who died in 1966, and McCormick, who passed away a year later, lived to see their lifelong devotion to the issue pay off. Many of the fathers of the birth-control pill, such as scientists Carl Djerassi and Gregory Pincus, Harvard gynecologist Dr. John Rock and Searle researcher Frank Colton, also witnessed its success.

The pill operates on the principle that a woman cannot get pregnant again during a pregnancy. When a woman takes daily oral contraceptives, she is essentially tricking her body into thinking it is pregnant. The birth control regimen, which includes a week of placebo pills that allow for menstruation, can be repeated as many months as wanted.

The pill’s benefits were many: It proved to be almost 100 percent effective (provided a woman took it as prescribed), it was reversible and, not insignificantly, it was completely private - a woman could use the pill without a man knowing about it.

The safety of the pill has always been paramount. About the time of its debut, thalidomide, a sedative approved by some national health organizations for pregnant women dealing with morning sickness, was found to cause horrible defects in their children.

Early studies on the pill suggested links to dangerous blood clots and heart attacks, and by the 1970s, women with circulation problems, fibroid tumors, diabetes, kidney or liver problems, or histories of strokes and heart attacks were advised not to use it. Today’s birth control products contain lengthy warnings about side effects.

“We have done more research on the birth control pill than any medication in history, so it’s extremely well understood in terms of its risks and benefits,” said Dr. Anne Davis, a gynecologist and medical director of Physicians for Reproductive Choice and Health.

It’s a myth that the pill or any hormonal contraceptives, like the patch or ring, carry big risks, said Dr. Davis, who also teaches at Columbia University Medical Center in New York.

Even one of the more serious risks associated with the pill - blood clots - is exceedingly small, she said.

In fact, being pregnant comes with risks, but when people want to have a child, they accept those risks, she said.

Today, “the average woman spends more than 20 years avoiding pregnancy,” and the only two 100 percent effective ways to do it are to have a hysterectomy or never have sex, said Dr. Davis.

With birth control pills, she said, women have another choice that is “as effective as possible, safe as possible for women, preserves their fertility if they should want to have more children, and allows them to space their children, and have healthy families and be healthy themselves.”

For some, the introduction of the pill has been an unmitigated blessing.

“We are all across the world very fortunate that that pill came on the market because it has revolutionized sexuality,” sex therapist Dr. Ruth Westheimer said in an interview with the Agence France-Presse. “How wonderful that a woman doesn’t have to worry all the time.”

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