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The Taste of... The Pill

The Taste of... The Pill. The Controversial Use of Puerto Rico For the Development of the Contraceptive Pill As an historic example of how social, political and economical power shapes sex. By

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The Taste of... The Pill

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  1. The Taste of... The Pill

  2. The Controversial Use of Puerto Rico For the Development of the Contraceptive Pill As an historic example of how social, political and economical power shapes sex

  3. By Jesús Estrada Doctor of Human Sexuality Presented at the SSSS 50th Anniversary Conference Indianapolis, Indiana 2007

  4. History of birth control in 20th century • Puerto Rico • - The Pre-Trial Phase • - The Trial Phase • - The Post-Trial Phase

  5. The Pre-Trial Phase • -The US government efforts to control Puerto Rican population • The Trial Phase • -Large-scale Pill trial performed in • Puerto Rico • Post-Trial Phase • -Regret and protest for the trials and the way population was controlled in PR

  6. The Pre-Trial Phase Resident of a slum area. Ponce, Puerto Rico. (Jack Delano 1941). Library of Congress

  7. The Spanish regime left the Island in: • Extreme poverty • Famine • Overpopulated • After the Hispanic-American War (1898) • The Island turns from a Spanish American • colony into a United States property.

  8. Overpopulation was a major concern for the • United States regime in Puerto Rico. • Efforts were made since the beginning of the • 20th century to reduce overpopulation. • None were effective as expected. Native Puerto Ricans (1903) (As a captioned on the original picture) Detroit Publishing Co. no. 016746. Gift; (State Historical Society of Colorado; 1949. ) Library of Congress.

  9. The Pre-Trial Phase-A Chronology • 1900-1917 • United States officials in Puerto Rico express • concerns about Puerto Rican overpopulation. • Neo-Malthusianism and Margaret Sanger’s • ideas is sprouting amid those in social, • economical and political power.

  10. 1917 • Inspired by neo-Malthusianism American • industrialists, scientists, social workers, and • middle and high class Puerto Ricans trace a • population control plan for Puerto Rico. • 1920 • United States government begins to promote • birth control in Puerto Rico.

  11. 1923 • Using a false name future governor and political • leader Luis Muñoz Marín writes an article in • La Democracia newspaper defending both • Margaret Sanger and neo-Malthusianism. • El Imparcial newspaper responds condemning • neo-Malthusianism. • Muñoz Marín at El Mundo newspaper: • “Of all Puerto Rican ailments, overpopulation is • the worst.” (Translation of the Researcher)

  12. 1923 • San Juan’s Bishop Carvana at • La Correspondencia newspaper: • “To accept neo-Malthusianism is like to • suicide the race.” • (Translation of the Researcher) A native hut (1903) Detroit Publishing Co. no. 016746. Gift; State Historical Society of Colorado; 1949. Library of Congress.

  13. 1925 • Formal birth control clinicsstart to be • sponsored in Puerto Rico with Federal funds. • Dr. José A. Lanause Rolón founds the • Ponce Birth Control League . • -Its approach is educational. • -Social pressure makes it last less than a • year.

  14. 1932 • The Puerto Rico Control League • is organized and opens a clinic to gives out • contraceptive services (it last two years only). • 1934 • Sixty seven new birth control clinics are opened • with Federal funds.

  15. 1936 • The Maternal and Childcare Health • Association opens 23 other birth control clinics • with Federal funds too. • Catholics pressure convinces Federal • Government to discontinue the program.

  16. 1937 • Time magazine: • - “…one basic remedy for the islander’s • appalling poverty is to cut their appalling • birth rate…” • Clarence J. Gamble allegedly pushes for the • legalization of birth control in Puerto Rico.

  17. 1937 • Law 136, The Eugenic Law, is approved on • May 12. • Contraceptive advice or services to prevent • pregnancy is not a felony. • Comstock Act is not applied in Puerto Rico.

  18. 1937 • New 160 birth control clinics open • Involuntary sterilization begins Law 136 of 1937 The “eugenic law”. (Excerpt)

  19. 1939 • United States continues to support birth • control clinics and the distribution of • contraceptives in Puerto Rico. Family in a slum area in Yauco, PR. (Jack Delano, 1942) Library of Congress

  20. 1940 • The Puerto Rico’s Health Commissioner, • Dr. Eduardo Garrido, creates the Bureau of • Maternal and Infant Care. • New 122 birth control clinics open.

  21. 1943 • The United States Congress concludes: • - “Puerto Rico is one of the most densely • populated parts of the world.” Widow and child of a farm laborer. San Sebastian, Puerto Rico (vicinity). Jack Delano (1942) . Library of Congress

  22. 1946 • Future governor Muñoz Marín: • - “If population growth is not reduce nor • productivity increased, unemployment • will rise, even with the help of Federal • funds…” (Translation of the Researcher) • 1947 • A 6.6% of ever-married women are already • sterilized.

  23. 1949 • The Puerto Rico’s Commissioner of Health • concludes that: • -Public hospitals should be used once or • twice a week to perform fifty sterilization • per day.

  24. 1954 • The Family Planning Association of • Puerto Rico is established. • United Nations Demographic Yearbook: • -Puerto Rico’s population per square • kilometer in 1953 is 31 times the • average of ten Latin American countries • and 12 times the average of the • United States.

  25. The Trial Phase A family of the Río Piedras area. Jack Delano (1942) Library of Congress

  26. Margaret Sanger dreamed of a contraceptive • pill easy to take as an aspirin that could be • used for contraceptive purposes. • In 1951she met doctor • Gregory Goodwin Pincus. • Implores him to take her • quest for a pill. Margaret Sanger

  27. 1955 • After receiving funds from Sanger’s friend, • Katharine McCormick (upon Sanger’s • request), Pincus needs a place to perform a • large scale trial of the Pill. Katherine McCormick

  28. 1955 • Since anti-birth control laws in Massachusetts • and many other states make impossible for • Rock to conduct the large study in humans he • needs for FDA approval… • Rock and Pincus look for a place to launch the • first, large-scale clinical trial of the Pill.

  29. 1955 • Pincus visits the Island and see it as the perfect • place. • There are no anti-birth control laws. • There is an extensive network of birth control • clinics already in place.

  30. 1955 • The Island is one of the most densely • populated areas in the world. • Puerto Rico, being an island, offers them a • stationary population that could be easily • monitored. • Island’s officials support the idea in the hope that it would stem Puerto Rico’s endemic poverty.

  31. 1955 • Allegedly in Pincus mind: • -If he could demonstrate that the poor, • uneducated women of Puerto Rico could • follow the Pill regime, then, women • anywhere in the world could too. At the home of a farm laborer along the road in the hills near Yauco, Puerto Rico. Jack Delano (1942). Library of Congress

  32. 1955 • Searle Pharmaceutical provides the pills under the brand name of Enovid. • Rock selects a high dose to ensure no • pregnancies would occur while • subjects are in trial. Enovid

  33. 1955 • The Pill is 20 times stronger than the pill that will • be used in U.S. 30 years later. Helen Rodríguez-Trías (1922-2001) Puerto Rican physician and advocate against involuntary or forced sterilization. Argued the Pill ‘s dose was 20 times stronger than the pill used 30 years later.

  34. 1956 • Two trial strategies: • -To take birth control out • clinics (Home setting). • -To start the Pill regime • shortly after having the first baby. (Hospital setting). Family living in a slum area in Yauco, Puerto Rico.Jack Delano (1942). Library of Congress

  35. 1956 On the month of April the large trial in humans begins. The Pill is tested on Puerto Rican women of great socio-economic deprivation who were living in a slum area used to be known as El Fanguito –“the little mud.”

  36. The trial strategy selected by Pincus and Rock • is to take birth control out of clinics. Rock Pincus

  37. To take it directly into women’s • houses. • Through female peers. • Hired as social workers or nurses instructed to • both give women the Pill and seduce them to visit • clinics.

  38. 1957 • Edris Rice-Wray is the medical director in • charge of the Pill trials. • She reports the Pill was 100% effective in • preventing pregnancy. • She reports also the side effects.

  39. 1957 • Rice-Wray reports that many women • complained of nausea, dizziness, headaches, • stomach pain and vomiting. • She reports that so serious and sustained • thesewomen’s reactions were that she thought • the Pill’s side effects were so uncomfortable as • to be generallyaccepted by women.

  40. 1957 • Pincus and Rock decide to dismiss Rice-Wray • observations. • Both of them take no action to assess the • causes of the side effects. • They prefer to believe that Puerto Rican • subjects’ complaints are psychosomatic, and • that side effects are minor effects compared to • the contraceptive benefit of the Pill.

  41. 1957 • Three Puerto Rican women die while • participating on the Pill trials. • No autopsy or investigation is conducted to • assess if the Pill is related to the deaths. • No informed consent is required to subjects.

  42. 1958 • The total birth rate in Puerto Rico starts to • decline. • 1959 • Rev. Truman B. Douglas • - “This service to the cause of population • control,” he says, “is a positive • expression of Christian compassion • and humanitarian concern.” (Time magazine, 1959)

  43. 1960 • Searle is doing $27 million annually using • Enovidfor menstrual disorders, and pushes • FDA for its approval as a birth control. • FDA approves Enovid as a birth control pill • on May 11. Enovid. "Physician's professional sample.” (The package holding the Pills and insert.) http://www.mum.org/enovid-e.htm October 30 2007

  44. 1961 • Studies relates the Pill to blood clots, heart • attacks, and strokes. Norinyl Tablets Orth0-Novum (Images accessed at http://www.pbs.org/wgbh/amex/pill/filmmore/pt.html)

  45. 1961 • “Birth Control Prepares the Ground for • Communism…” • “…shameful that one part of the society and the • government support neo-Malthusianism.” The San Juan Star newspaper (April 26, 1964)

  46. 1962 • There is evidence of at least 11 deaths all • allegedly related to the Pill. Picture by Jack Delano (1941)

  47. 1963 • Syntex pharmaceutical joins to the birth control • market and the trial with a 10 mg pill named • Ortho- Novum. In the slum area called El Fangitto. San Juan, Puerto Rico. Jack Delano (1941) Library of Congress

  48. 1964 • Wyeth Pharmaceutical joins to the Pill trials with • a contraceptive pill composed of Norgestrel • and Mestranol. In the slum area. Ponce, Puerto Rico. Jack Delano (1941). Library of Congress

  49. 1964 • PR government endorses a new plan to turn • existing health centers into birth control clinics. • Notwithstanding, an official policy is denied. • From now on Puerto Rican government seems to • give signs of ambiguity in relation to the Pill. • (Karen L. Michaelson, 1981)

  50. 1964 • The San Juan Star newspaper headlines: • -“Govt. Scored on Birth Control”. • -“The Commonwealth Government • was strongly attacked yesterday at the • International Planned Parenthood • Federation Conference for refusing to • carry out an active birth control program • in Puerto Rico.” (The San Juan Star, April 21, 1964)

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