The pill turns 50

It travels in their purses, or lives in a bathroom drawer. For 12 million women in America, it's part of their daily routine, like brushing their teeth.

A little pill often given little thought.

This year marks the 50th anniversary of the birth control pill. It was formally approved as an oral contraceptive by the U.S. Food and Drug Administration on June 23, 1960.

For many it was a cause for celebration. Others, including the Catholic Church, were less enthused.

Today, some believe the pill has not met its expectations and has a long way to go.

But there's no denying the pill has had major ramifications for women.

Magic pill?

Having reliable birth control available has changed nearly every aspect of women's lives, according to Alison Piepmeier, director of the Women's and Gender Studies Program at the College of Charleston.

"Pregnancy impacts virtually everything: a woman's physical abilities and vulnerabilities, her work, her personal relationships, etc. For women to have the ability to decide when or if they'd like to be pregnant, and when or if they'd like to have children, means that they have a level of control over their lives that women before the mid-20th century simply didn't have."

Sloane Whelan, South Carolina field coordinator of Planned Parenthood Health Systems, said the pill has played a key role in the decline of unplanned pregnancies and maternal and infant mortality rates.

It also has drastically affected women's quality of life, she said.

The pill put women in charge of their reproduction, Whelan said. Unlike condoms and other forms of contraception available at the time, the pill did not rely on a partner's cooperation.

"The pill is one of the most profound medical advancements for women, because it allowed women to have the power to decide when and how many children they'll have, therefore giving them the ability to pursue further education and employment opportunities," Whelan said.

In her book "America and the Pill: A History of Promise, Peril, and Liberation," Elaine Tyler May examines early expectations for the pill from advocates, developers, manufacturers, observers and Cold Warriors.

She concludes that the oral contraceptive fulfilled some of those dreams and not others.

"The pill did not solve what many at the time saw as the most pressing problem facing the world: the population explosion," Whelan writes in her 2010 book. "Nor did it put an end to war or poverty. It did not eradicate unhappy marriages, unwanted pregnancies, abortions, or unwed motherhood. ... It did not

unleash a sexual revolution or alter the sexual habits of the unmarried."

It also was not as safe as developers had hoped.

But it was paramount to some of the most profound developments in private and public life over the past 50 years, May says.

"It did provide an important tool for millions of women to effectively control their fertility, freeing them from fears of pregnancy and constant childbearing and enabling them to take advantage of expanding opportunities for education, employment, and participation in public life."

The pill grows up

The pill actually was available as early as 1957 for treating menstrual disorders, according to Diane Wendt, curator in the National Museum of American History's medicine and science division. As many as half a million women were taking the pill before it was approved as an oral contraceptive.

"I don't know if anyone's been able to prove this, but there's this idea that a lot of women developed menstrual irregularities during that period," Wendt said. "There was a lot of information (about contraceptive benefits) being passed from person to person."

The museum has showcased birth control pills in an exhibit called "Science in American Life" since the early 1990s, and Wendt reports renewed interest in the exhibit this year.

Since the pill's birth, it has stayed remarkably the same, Wendt said. Once memory aid packages, or dial packs, and blister packs were developed, little else changed.

Dr. Angela Dempsey notes that the content of the pill has been altered since the 1960s.

Newer progestins have been developed that have less androgen -- or male hormone -- effects, says Dempsey, an MUSC assistant professor of obstetrics and gynecology specializing in family planning.

The pill also started out with a fairly high dose of estrogen -- 50 to 100 micrograms -- and has decreased steadily so that today's pills typically contain 20 to 30 micrograms.

"The significance of the estrogen dose decreasing so much is that estrogen is the hormone in the pill that we believe causes most of the safety concerns," she said. Lowering the estrogen dose has dramatically lowered the risk of blood clots.

The current risk of a blood clot for a woman on the pill is two to three times higher than for a woman not taking it, Dempsey said. It is still a "very, very low risk," much lower than the risk of having a blood clot in pregnancy.

Eight out of 10 women will use the pill at some point in their lives, she said.

"The pill remains the most popular birth control method, probably because it's been around the longest and people have the most familiarity and experience with it," Dempsey said. "Most women who start taking the birth control pill are really happy with it. But it's great that we have lots of choices because the birth control pill isn't going to be the perfect choice for every woman."

Recently, extended-cycle pills have hit the market, allowing women to have four periods per year, or none at all.

Dempsey said many women are excited to learn having a period is not medically necessary.

What's next?

Educator Piepmeier calls herself "a huge fan of the pill" but says it's unfortunate that it's one of the few forms of birth control available. She points out that much of the research has focused on hormonal birth control.

"Women have to pump their bodies full of hormones in order to have the most effective birth control. And even in this market with a variety of birth control pills available, many women still do experience side effects. I was on the pill for a decade, and I chose the pill that made me feel nauseated every few weeks rather than the one that gave me terrible mood swings.

"I would love to see more research being done into birth control options that affect men's bodies."

According to May, scientists were working on a birth control pill for men at the time the women's birth control pill was approved by the FDA. Obviously, that hasn't materialized.

"In fact, since World War II, 13 new contraceptives for women became available ... but not one new male method," May writes. "By the mid-1990s, only a fraction of the funding for contraceptive research was dedicated to male methods."

Whelan of Planned Parenthood said not nearly enough women have access to birth control. Her organization hopes to change that by making sure birth control is defined as preventive care under health care reform.

"While we can celebrate this (the pill) as one of the hugest medical advancements for women, I think the public needs to be reminded and the state Legislature needs to be reminded that we still have a lot of work to do, especially in South Carolina where there are astronomically high unintended pregnancy rates," Whelan said. "Women deserve the right to have access to affordable contraception."

Reach Kristen Hankla at 937-5548 or khankla@postandcourier.com.