Sixty years ago this month, the U.S. Food and Drug Administration approved the birth control pill for distribution in the United States—a game changer for women’s lives. Before approval of the pill, most women were married by age 19, and more than half of them were pregnant within the first seven months.
Once the pill became available, women for the first time in history had a reliable form of contraception that freed them from the unrelenting fear of unwanted pregnancies. With a 99 percent success rate, if taken properly, the birth control pill meant that women could invest in their educations and careers without the fear that they would have to cut their ambitions short because of an unexpected pregnancy. The pill also encouraged more open attitudes toward sex and fueled the women’s movement.
In my classes at Smith College, I teach about the history of the pill. How two elderly female activists—Margaret Sanger and Katharine Dexter McCormick—demanded a contraceptive pill that women could take like aspirin, then paid for the scientific research. How a Harvard biologist named Gregory Pincus convinced a pharmaceutical company into risking the possibility of a devastating boycott to develop this revolutionary contraceptive.
I teach my students about how a dangerously high dosage of the contraceptive pill was tested on women in Puerto Rico, and how doctors ignored women’s reports of side effects.
The FDA approved the pill on May 9, 1960, at a dosage level 10 times the standard dosage today. Women reported side effects—nausea, dizziness, headaches, stomach pain and vomiting—but doctors minimized these complaints. Then in 1969, journalist Barbara Seaman published a hard-hitting expose about the dangers of the high-dosage birth control pill.
Congress scheduled hearings in January of 1970. As a doctor who testified at the hearing later described the dosage level of the pill at the time, “They used a sledgehammer to drive a small nail.”
In typical fashion at the time (and still), male members of Congress invited a long line of male doctors and researchers to testify. Young feminists were having nothing of it. They showed up in droves and disrupted the hearings, demanding action from the legislators. As a result, the dosage of the pill was adjusted downward. (The PBS documentary, “The Pill,” tells this fascinating story.)
For 50 years, the pill has given women a safe and reliable way to prevent the heartache and health risks of unwanted pregnancies. And while the Roman Catholic Church has opposed contraception, polls show that the birth control pill enjoys widespread support among the American public.
Despite the safety and popularity of the birth control pill, health insurance companies often did not cover the costs of the pill. While most FDA drugs are immediately covered by health insurance, even Viagra, the pill was excluded from many plans for years—a blatant example of male bias in the insurance industry. Feminists fought for insurance coverage of the pill by lobbying Congress, to no avail. They also sued employers for sex discrimination for failure to cover contraception in employer-sponsored health plans, with some success.
But the breakthrough was the 2010 passage of the Affordable Care Act, which for the first time prohibited sex discrimination in health insurance and required coverage of all preventative health care without copays.
Then in August of 2011, the Obama administration issued regulations defining preventative health care to include coverage of all FDA-approved forms of contraception. For the first time, women with health insurance had a legal right to contraception coverage.
But this victory did not last long. Conservatives immediately began mobilizing to demand a broad exception from the contraception coverage requirement. The Obama administration had exempted churches and other religious institutions, but conservatives wanted exemptions for business owners with religious opposition to birth control. The craft retailer Hobby Lobby sued and took their case—Burwell v. Hobby Lobby—all the way to the Supreme Court. The conservative court ruled in their favor, carving a large exemption into the ACA contraceptive requirement for closely-held, privately owned businesses.
Then, in October of 2017, the Trump administration issued new regulations, vastly expanding the exemption to apply to all businesses and to cover not only religious objections, but moral objections of any kind. Trump gave all employers the right to veto women’s access to birth control. Reproductive rights advocates have challenged the exemption, and the Supreme Court heard oral arguments in the case earlier this month.
I tell my students that when I was their age in the 1980s, contraception was not a political issue. It was not controversial outside of the Catholic hierarchy—even though Catholic women had always used contraception at rates similar to all women.
But today, there is an all-out war against contraception in America. Anti-abortion conservatives have blurred the line between abortion and contraception, arguing that “the pill kills.” What does it kill? Babies, women, the environment and marriage, argues Rita Diller, national director of Stop Planned Parenthood International.
“Free the Pill!”
Republicans’ all-out war on Planned Parenthood has had tremendous success under the Trump administration, which gutted the country’s national family planning program—called Title X—last year.
But reproductive rights advocates are pushing back with a campaign to make the birth control pill more accessible and affordable. The group Free the Pill is lobbying the FDA to make the birth control pill available over the counter, removing unnecessary doctor’s visits for prescriptions and giving more people greater control over their reproductive health. In fact, the pill is already available over the counter in many countries around the world. And the pill is extremely safe—safer than many drugs already available over the counter.
The Oral Contraceptives Over-the-Counter Working Group—a coalition of over 100 national, state and local reproductive health, rights and justice organizations—argues that the prescription requirement for hormonal contraception is a barrier for some people, including those who lack health insurance, as well as those who are insured but face other obstacles such as difficulties getting to a health facility or expenses related to taking time off from work for a clinic visit.
Additionally, young women and immigrant women report cultural and linguistic barriers to accessing quality, comprehensive reproductive health services. These barriers can make prescription access challenging. The COVID-19 pandemic has exacerbated barriers to health care, and the struggling economy has resulted in mounting job losses, making the need for accessible, affordable birth control pills more critical than ever.
Sixty years is too long to wait for birth control options that better meet people’s needs. Women have a human right to safe and effective birth control.
The FDA should approve hormonal birth control for sale over the counter, and Congress should require health insurers to cover contraception without a prescription. In this way, women would move significantly closer to realizing their human right to have full control over their reproductive lives.