How Britain learnt to love the Pill

From the New Year, oral contraceptives will go on sale in chemists. It's another milestone in its extraordinary history. By Jeremy Laurance

It was the first lifestyle drug, launched against fierce opposition from the moral right, which revolutionised social and sexual attitudes and helped define the 1960s. Now, almost 50 years on, it is to be made available over the counter without a prescription.

Another milestone in the history of the contraceptive pill was signalled last week with the disclosure that, from the New Year, pilot schemes in two south-London primary care trusts, Southwark and Lambeth, will, for the first time, allow pharmacists and nurses to provide it to women over the age of 16.

The aim is to test whether making the Pill more easily accessible reduces unwanted pregnancies. Pharmacies are open for longer hours than GP surgeries and do not require an appointment or have long waits. The Family Planning Association said that it received scores of calls from women who had run out of the Pill and didn't know where to go to replenish their supply in the evenings or at weekends. Britain's teenage-pregnancy rate remains the highest in Western Europe (though it is falling in many areas) and difficulties with access to contraception are believed to be a key factor.

The Pill is now considered so safe and its use so routine, that the involvement of a doctor is no longer required. Half a century ago, a very different attitude prevailed...



The beginning – early skirmishes

The Pill was licensed in Britain in 1961. Women who desperately wanted it fought a tense battle with the religious, state and medical authority figures who tried to stop them getting it. One group of provincial doctors accused a colleague of "undermining the reputation of the medical practice in the neighbourhood as well as the morals of the public at large". A Catholic scientist condemned contraceptive users as "ignorant of the fact that sustained happiness comes only from dutiful sacrifice". By contrast, the poet Philip Larkin celebrated the changes it wrought with the immortal line, "Sexual intercourse began in nineteen sixty-three". Credit for the discovery is usually attributed to Carl Djerassi, the Austrian chemist (also a novelist and playwright) but several others were involved in its development.

The Pill gave women unprecedented control over their fertility, and it did not interfere with spontaneity or sensation. For the first time, sex became an act that women could enjoy on an equal footing with men. But feminists who grew up in the 1960s have more recently claimed that it was a "misogynist tyrant in disguise", urging women to be ever more available for male pleasure, and pumping their bodies full of chemicals.



The medical revolution – Has it increased happiness?

It was the first prescription drug to bring large numbers of healthy young women into doctors' surgeries, launching the era of preventive medicine and screening, as Lara Marks observed in Sexual Chemistry: A History of the Contraceptive Pill, published in 2001. It allowed women to control their bodies and plan when to have children with a reliability of which previous generations could only dream. But the consequences that have flowed from that – delayed childbearing, the huge increase in women going out to work, an obsession with perfect sex, and the rise in infertility have led some to question whether it has increased or diminished human happiness.

Today, more than 3.5 million people in the UK use the Pill, and 300 million are estimated to have used it worldwide over the past four decades. Not all societies were impressed, however. In Japan, fears that it would lead to an increase in sexually transmitted diseases (due to reduced condom use) prevented it from being approved for almost 40 years. It was finally licensed there in 1999, and only 1 per cent of Japanese women of childbearing age use it, compared with 25 per cent in the UK.



Is it safe? – risks and benefits

From the start, fears about the long-term effects of the Pill dominated medical debate. Few drugs are taken daily for years by healthy individuals not suffering from any medical condition. In those circumstances, a guarantee of safety was paramount. The Royal College of General Practitioners established a research project in 1968 with one of the largest databases in the world. Its latest report, published in 2007, 39 years later, found that far from causing cancer, as long suspected, the Pill provides protection against it.

The results, published in the British Medical Journal, showed that it caused a small increase in cervical cancer but this was outweighed by reductions in ovarian, womb and bowel cancer, for women who had taken it for up to eight years. Women who used it for longer had a slightly increased overall risk. There was no effect on breast cancer. Professor Valerie Beral, head of the Cancer Research UK Epidemiology Unit at Oxford University, estimated, in The Lancet earlier this year, that the Pill had saved 100,000 lives from ovarian cancer worldwide, because of the huge number of women taking it. An earlier study by Professor Beral showed that taking the Pill was linked with a slight increase in breast cancer, but this returned to normal 10 years after stopping it. The Pill does carry a small risk of triggering blood clots (thromboses) and of causing heart disease and stroke in women who smoke or have high blood pressure and are over 35. These women are advised to avoid the standard combined pill containing oestrogen and progestogen, and opt instead for a progestogen-only pill.



The impact on women's sexuality

Young single women have always had sex – statistics show that in 1875, 40 per cent of brides were pregnant on their wedding day. What changed with the advent of the Pill was that they were able to enjoy sex for the first time.

The effect has been long-lasting. Those who were in their thirties during the sexual revolution of the 1960s still retain a liberal attitude to sex now that they are in their seventies, four decades later. A Swedish study published in the British Medical Journal earlier this year found that septuagenarians were having better sex, and more of it, than ever before. It was the women who were particularly satisfied with their sex lives, more so than the men.

But for some women, the Pill triggers mood swings, health problems and sexual difficulties. Scientists say that these women have lower levels of testosterone – the male hormone, also present in women, which affects the libido. A study published in the Journal of Sexual Medicine suggested that the Pill suppressed the hormone both directly and through suppression of ovulation in a "double hit", and warned that GPs should consider this physiological effect of the drug before assuming that a woman's sexual problems were psychological.

Several studies over the last 30 years have claimed to show a link between the Pill and loss of sexual desire in certain women. But the Family planning Association said that there were many other confounding factors, such as the nature of a woman's relationships, and it was impossible to tell if the association was cause and effect.



The end of menstruation

The Pill works by turning the ovaries off so that they stop producing eggs. This means that the regular bleed that women on the Pill have each month is not a genuine menstrual period, but a fake. When the Pill was first introduced in the 1960s, it could have been designed to eliminate the monthly bleed. But there were no simple pregnancy tests available and scientists believed that women would want the reassurance of a regular period as proof that they were not pregnant. And with church leaders railing against it, drug manufacturers felt that to mimic the natural monthly cycle as closely as possible would make it more acceptable.

As a result, women on the combined pill take it for three weeks followed by a seven-day break when they have a "withdrawal" bleed – not a genuine menstrual period. (Women on the progestogen-only pill take it continuously but have a similar regular monthly bleed).

Doctors say that there is no reason why women on the Pill should continue to suffer the pain, discomfort and misery of menstruation. The bleed that they have is not natural and the idea that menstruation is normal is wrong (throughout history, women have been pregnant or breastfeeding or post-menopausal, so didn't have periods). Some gynaecologists admit to personally taking the combined pill continuously to put an end to menstruation.

In the US, a contraceptive pill, Lybrel, launched last year, is the first that is recommended for taking 365 days a year, to eliminate periods altogether. Its makers, Wyeth, have applied to launch it in Europe under the brand name Anya.



A male pill soon?

In your dreams. Surveys suggest that women would be enthusiastic about handing over responsibility for contraception to men – especially if it were guaranteed by a hormonal implant under the skin. But progress is frustratingly slow. A key difference between the male and female reproductive systems is that while in women it works like clockwork, producing an egg each month, in men it is continuously producing sperm. Interrupting the male reproductive system without affecting the libido presents a greater, and so far unsolved, challenge.

Freedom years: The Pill's breakthroughs

1954

Dr Gregory Pincus and Dr John Rock begin trials on 50 women of the drug that would later be called Enovid, the first oral contraceptive pill.



1957

It is approved by the US Food and Drug Administration (FDA) in 1957, but officially is only licensed to treat medical problems, not for use as a contraceptive.



1960

The FDA allows Enovid to be sold as a contraceptive pill.



1961

The pill is first licensed in the UK.



1967

12.5 million women worldwide use the Pill.



1968

On 25 July, Pope Paul VI condemns the use of artificial contraception in an encyclical, Humanae Vitae.

1984

Emergency hormonal contraception (known as the "morning-after pill"), which can prevent pregnancy up to 72 hours after intercourse has taken place, is licensed for use in the UK.



2001

Women can buy emergency contraception without a prescription.



2007

A report from the Royal College of General Practitioners finds that, overall, the Pill protects against cancer.



2008

On 1 October, Sarah Palin states she "would not choose to participate in that kind of contraception".



On 12 December, the Vatican condemns the use of the morning-after pill.

James Berrill

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