The Pharmaceutical Industry and the Pill

HPSC2665 short essay (week 10), S2 2006

To blame the pharmaceutical industry for actively dragging its heels over the development of a female contraceptive pill is to ignore the overriding influence of the wider social and political climate that existed before WWII. On one hand, obscenity laws made the distribution of information and scientific research on contraception illegal (Marks, 1999). On the other, with respect to fertility and heredity, personal choice and planned parenthood were not as powerful arguments as eliminating 'bad stock' from the breeding population of the nation. This meant that in the United States surgical sterilisation was the preferred contraceptive method, employed on an institutional scale by state government authority, practised on those individuals (male or female) who were judged to meet the criteria for compulsory sterilisation (Kevles, 1995). The remainder of the 'fit' population were encouraged to have large families, and no doubt the dearth of safe and reliable contraceptives was considered essential to this end. Under these circumstances, it becomes clear that the pharmaceutical industry in isolation was not to blame for the lack of effort to develop a contraceptive pill, but that such a prospect was viable neither morally, legally nor commercially.

'Population control' before WWII would have been guided by the principle that a high birth rate was indicative of superior national racial stock, tempered by the eugenic notion that the high birth rate of the poor and other undesirable classes of humanity was outstripping that of the desirable honest, hard-working middle classes, a situation that clearly had to be reversed if any kind of national progress was to continue. Only after WWII did an idea of the world's limited resources gain political currency and with it the perspective that a smaller population meant less poverty. But as with the previous sterilisation policies, the assumption by those in power was that those who they least desired to breed were not able to make that decision or stick to it by themselves and that intervention was necessary for results to materialise. Advocates of population control, like advocates of eugenics before them, identified the poor as those whose fertility needed to be managed and described them as the group with the least ability to manage their fertility[1]. The stereotypes of the unemployed welfare mother, relying on the state to feed her unwholesome brood, is alive and well today. Implicit even in the name of 'population control' is the idea of management over the group, not individuals controlling their own reproduction. Thus I imagine that it came as quite a shock to governments and the pharmaceutical industry alike to realise that women were capable and desirous of controlling their fertility.

The most successful application of the contraceptive pill was for effective family planning, generally in a middle-class environment. It is doubtful that even Margaret Sanger or Katharine McCormick envisaged this outcome when they imagined the pill, focussed as they were on the plight of poor women (Marks, 1999). To expect the pharmaceutical industry to have been aware of the future commercial potential of oral contraceptives before they were actually released to the public is to credit them with an impossible prescience. In addition to this, they were not in a position to advance the idea of the contraceptive pill, with the law against them and (before WWII) a strong program of surgical sterilisation already medicalising fertility. Fertility and contraception as lifestyle choices were, as evidenced by the experience of the 1930s (Watkins, 1998), more to do with the changing role of women in society rather than the availability of contraceptive methods.

References

Kevles, D (1995) In the Name of Eugenics. Harvard University Press, Cambridge.

Marks, L (1999) 'Human guinea pigs? The history of the early oral contraceptive clinical trials.' History and Technology. 15: 263-288.

Watkins, E S (1998) On the Pill. John Hopkins University Press, Baltimore.

[1] c.f. Elizabeth Watkins' (1998) description of the president of Planned Parenthood, Alan Guttmacher's views on contraception for the developed and developing worlds. He envisaged the contraceptive pill as a superior method for a discerning and motivated population, who were also in a position to expect and demand reliability. However for the vast majority of women, he believed that the IUD was more appropriate (not to mention more economical) despite the reduced reliability. “No contraceptive could be cheaper, and also, once the damn thing is in the patient cannot change her mind. In fact, we can hope she will forget it's there and perhaps in several months wonder why she has not conceived” (Guttmacher, quoted in Watkins, 1998, p.70).