CNN Insight

The Pill - 40 Years After Its Introduction

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

JONATHAN MANN, INSIGHT (voice-over): A medication so well known and widely taken, it hardly needs a name. For 40 years, it has simply been "the pill," a drug that changed the way people live and love.

(on camera): Hello, and welcome.

There are millions and millions of women for whom pregnancy is a marvel, a blessing and a choice. An entire generation that's grown up expecting something their mothers couldn't even imagine - dependable and independent control over reproduction. It's a measure of how much the pill has changed our world that many of us can hardly imagine our lives any other way.

There are, to be sure, many women who have no access to safe or easy birth control. There are many women and men who oppose its use, whether with a pill or any other method. But no one can deny how different our world is because of it.

On our program today - 40 years after its introduction in the United States and in the rest of the world, the pill. We begin with CNN's Garrick Utley.

(BEGIN VIDEOTAPE)

GARRICK UTLEY, CNN CORRESPONDENT (voice-over): Long before Gloria Feldt moved to New York City to live and work, she lived, married and became a mother at age 16 in a small farming community in west Texas.

GLORIA FELDT, PLANNED PARENTHOOD FEDERATION: Our parents didn't talk to us about sex, and birth control, forget it. I mean, nobody would even utter those words.

UTLEY: By age 20, she had three children. That was in 1962.

FELDT: It was at that point, mercifully, that the pill entered my life. As soon as I heard about it I knew, yes, give me that pill. Give me that pill now.

UTLEY: That is what other women were demanding, as the pill helped to fuel the 1960s spirit of freedom and rebellion against tradition. Suddenly, a woman could plan a career first, and family and babies later.

JEFFERSON AIRPLANE (singing): Don't you want somebody to love.

UTLEY: From the lyrics of the new rock music to the rise of the feminist movement.

DEMONSTRATORS: Equal pay for equal work.

UTLEY: ."Make Love Not War" was more than a rallying cry against authority; it echoed the belief of young men and women that in the ultimate intimacy of sex, authority resided with the individuals alone.

(on camera): And there was something else about the pill. When it was first introduced, the fear of AIDS still lay 20 to 25 years in the future. That meant for the first time in human history, men and women coming of age in the 1960s and '70s, the Baby Boomers, could enjoy a sexual relationship free from the fear of an unwanted pregnancy or a potentially fatal disease.

(voice-over): Today, the pill is the most popular form of birth control that is reversible -- three-quarters of American women of child- bearing age have used it.

And what lies in the future?

DR. CAROLYN WESTHOFF, COLUMBIA PRESBYTERIAN MEDICAL CENTER: I think we're going to continue to have pills, and that might be the fundamental form of hormonal contraception, but we will also see more and more hormones delivered in injections, implants, patches to wear on the skin, rings to go in the vagina, perhaps things that can be inhaled.

UTLEY: For Gloria Feldt's work at Planned Parenthood, those new contraceptives could be important. But in her personal life, after having her three children, it was the pill that made the difference, as she thinks it has for men as well as women.

FELDT: That aspect of what the pill has brought I think is often overlooked -- simply enabling women and men to have a much more equal kind of personal relationship and a much less stressful personal relationship.

UTLEY: But a relationship in which the woman will still bear the responsibility for avoiding pregnancy. Male hormones are proving more difficult to regulate for contraceptive purposes, and so a pill for men is still a work in progress.

Garrick Utley, CNN, New York.

(END VIDEOTAPE)

MANN: The pill isn't just one pill. There are, of course, many kinds. And those pills have changed. Unwanted pregnancy aside, they're even good for the health of many of the women who take them. Here's CNN medical correspondent Rhonda Rowland.

(BEGIN VIDEOTAPE)

RHONDA ROWLAND, CNN MEDICAL CORRESPONDENT (voice-over): Author Rosemary Daniell recalls the day the pill was approved for marketing.

ROSEMARY DANIELL, AUTHOR: Oh, I was ecstatic. I sensed right away that it was revolutionary, that it meant freedom for me as an individual.

ROWLAND: But at the same time, the pill did cause some real medical problems. Forty years ago, the first pills contained at least five times more estrogen than they do today.

DANIELL: I never had problems. I've talked with women who could not take it because of the danger of thrombosis.

DR. ROBERT HATCHER, EMORY UNIVERSITY: The blood clots, the pulmonary emboli into the lung, blood clots to the lung. Heart attacks and deaths related to oral contraceptives are markedly decreased now.

ROWLAND: The pill is not only safer now, it actually has health benefits. It reduces the risk of two types of cancer, ovarian and endometrial, the lining of the uterus, by suppressing ovulation.

HATCHER: And not only that, it's a protective effect that lasts for years, at least 15 years after she stops taking the pill.

ROWLAND: The longer a woman takes the pill the more protection she gets. Birth-control pills also prevent ovarian cysts, benign breast disease and acne. Again, it is the effect of the hormones. While some women mistakenly think it's a good idea to take a break from the pill, doctors say women can safely take it for decades.

In fact, a study following 46,000 women for 25 years showed women who took the pill have no more health risks than women who never took it. Still, there can be side effects.

HATCHER: There are things like bad headaches, depression, decreased interest in sex, decreased ability to have orgasms, and those are very real.

ROWLAND: But for other women, those aspects improve while on the pill.

(on camera): Soon even more women may have access to the pill, and it may be even cheaper. While many countries make the pill available over the counter, you need a doctor's supervision in the United States. But next month, the FDA will consider making the pill available without a prescription.

Rhonda Rowland, CNN, Atlanta.

(END VIDEOTAPE)

MANN: For more on the legacy of the pill, we turn now to a person we saw a short time ago in Garrick Utley's report - Gloria Feldt, president of Planned Parenthood Federation of America, this nation's oldest and largest reproductive health care and advocacy organization.

Thanks so much for being with us.

FELDT: My pleasure. I'm delighted.

MANN: There are older forms of birth control. There are other forms of birth control. There is even at least one more popular form of birth control. What is it about the pill that seems to be, in retrospect, so revolutionary?

FELDT: Well, you're right. Birth control has been around since before people even knew what caused pregnancy. Because people have always wanted to be able to decide for themselves when they're going to have children and whether they're going to have children.

But it wasn't until the birth control pill became available that we had a method that was at once safe, effective, easy to take and separated the act of sexual intercourse from the act of using contraception itself. And so, it just revolutionized birth control because it made it so much more effective and safe, and all of a sudden women had so much more ability to decide for themselves how to plan out the rest of their lives - whether to go to college, whether to seek a profession.

It literally created a whole new world for gender relationships and social justice for women.

MANN: Well, I want to ask you more about that because there are so many facets to women's lives. There are so many freedoms that they have gained, so many freedoms that so many are still trying to gain. How important is control over reproduction, given all of the ground that's been covered and, in so many nations, all the ground that's yet to be covered?

FELDT: If a woman can't control her fertility, she really can't control the rest of her life. But if she can decide for herself whether and when she's going to have children, she can protect her own health, and she can set the rest of the course of her own destiny. It's really about self-determination. It's also increased women's lifespans tremendously.

At the turn of the last century, for example, women dying in childbirth was just so normal that everyone knew of people who had encountered that, and women's lifespan was much, much shorter than men's. Today, women live longer than men, and it's all because of more reliable birth control - the pill first and foremost among that.

MANN: Now, the pill is a medication. It's not a miracle, and we're not doing an advertisement for it. Women still do get pregnant taking the pill, don't they?

FELDT: Yes, there is no perfect contraceptive method, including the pill. And in fact, there also are no perfect people yet on this earth. So it's possible for a woman to miss a pill or to miss several pills and become pregnant or to take it incorrectly.

There can sometimes be interactions with other drugs such as, oh, mycin-type drugs. So there are problems with any method, and it's important for women to have accurate and complete information about how to take any method, including the pill, and what the risks and benefits are.

MANN: Gloria Feldt of Planned Parenthood. We're going to ask you to stay with us. We have to take a break. But when we come back - we change our focus a little bit to the politics of the pill. Stay with us.

(COMMERCIAL BREAK)

MANN (voice-over): Estimates are that worldwide more than 100 million women are now taking the pill. It's most popular in Western Europe, where half of married women use it. It's used the least in China, India and Japan.

(on camera): Welcome back.

For women of childbearing age, there are a lot of reasons not to use the pill. It is, first and foremost, a medication. And as we've been hearing, it is to be used with care. But for women and for entire countries, there are also political and moral concerns.

Joining us now to talk more about that is Donald Critchlow, a historian at St. Louis University in the U.S. state of Missouri, who has written extensively about the history of birth control. Thanks so much for being with us.

DONALD CRITCHLOW, AUTHOR, "INTENDED CONSEQUENCES": Thank you.

MANN: When you look at contraceptives, and at the pill in particular, I would imagine it just seems a whole lot more politicized than the run-of-the-mill pharmaceutical than you find on a drugstore shelf. Can you tell us a bit about that?

CRITCHLOW: Well, the introduction of the pill in the post-war period led to a great deal of political controversy. But I, in fact, think that today in contemporary America, there is not a great deal of controversy about contraceptive usage. About 80 percent of American women use contraceptives.

Where I do think it has become an issue or is in three areas - its relationship to contraceptive programs and their relationship to sexual education programs, relations with usage of the pill and out of wedlock births and also usage of the pill and a very rapid and dramatic increase in STDs that we're experiencing in this country.

MANN: What about internationally, because it's not just the United States that is using birth control. It is other countries as well - sometimes with and without the support of the United States, sometimes with and without the support of international institution.

CRITCHLOW: Well, internationally, contraception is a very hot issue, and it's been that way at least since the 1970s, when the United Nations began holding population - international population and family planning meetings. As you probably know, the Beijing 5 meeting is coming up in New York under the auspices of the United Nations, and this conference has come under heavy criticism from Catholic groups that feel that they're being excluded from that conference.

It also has created controversy even today in Kosovo. The United States Agency for International Development has been accused of establishing programs in Kosovo that has targeted Albanians under the - with the support of Milosevic. And I think a final area where international family planning continues to be controversial is the introduction of contraceptives into poor women in developing countries that do not have proper health care.

MANN: You touched on a lot of ground there. But one of the institutions that's been very powerful, especially within the United Nations, in fighting family planning is the Vatican. Has the Catholic Church changed its attitude in any way since the `60s and `70s when it comes to the birth control pill? Its opposition to abortion, of course, is very determined and well known.

CRITCHLOW: It's - the church officially has not changed its position on birth control. There was some hopes for a while in the early 1960s that the Catholic Church was going to take a different position. But with Humanae Vitae issued in 1968, the church has stayed as steadfast against artificial contraception.

MANN: I suppose we should make that point clear. Its opposition is, of course, to artificial contraception, not what it or what others would call family planning.

Is it just the church, though? When you look at the institutions and the communities that oppose the use of the birth control pill, is the Vatican really the only institution that comes to mind? Some Muslim nations, I believe, also have a lot of trouble with it.

CRITCHLOW: Well, the - in the international meetings, a rather strange alliance has been formed with Muslim countries, Catholic countries and Vatican countries. And on some occasions, the Catholic - the Communist countries have allied with these forces as well to denounce family planning as, you know, a capitalist ploy not to address the problems of economic development.

MANN: Given the controversy that continues to surround the pill in so many places, is the distribution of the pill, is the development of contraception in general being affected? Would the world be seeing different kinds of contraception, different kinds of investment in contraception, different availability of contraception if there weren't these powerful interests opposing it, do you think?

CRITCHLOW: Well, I don't think - I think this is a matter of degree. Clearly, opposition to the development of pills such as the UR- 486 (sic) pill, which is seen, in fact, as abortracide, has drawn opposition, and its development and marketing have been affected, especially in the United States.

MANN: Donald Critchlow, St. Louis University, thanks so much for this.

CRITCHLOW: Well, thank you.

MANN: When we come back - a bitter pill for men to swallow. Stay with us.

(COMMERCIAL BREAK)

MANN: Welcome back.

When it comes to birth control, men have been getting off lightly. Yet a recent survey showed that two-thirds of men questioned in Edinburgh, Capetown, Shanghai and Hong Kong said they would take on the responsibility. The poll found that Scottish men are the most willing to take a contraceptive pill.

Overall, a male pill is currently undergoing clinical trials at the Medical Research Council in Britain. Clinical scientist Dr. Richard Anderson told us about the program earlier.

(BEGIN VIDEOTAPE)

DR. RICHARD ANDERSON, MEDICAL RESEARCH COUNCIL: What we're developing is a prototype male contraceptive that works really very similarly to the female pill in terms that you take exogenous hormones in either a pill or injection form, and that suppresses your ability to reproduce by suppressing the production of sperm in the case of men.

MANN: How effective is it?

ANDERSON: Well, at the moment, we're just doing relatively small scale biomedical studies. So we're not really launching proper full- scale contraceptive studies. But the trials we have under the way at the moment, the great majority of men's sperm counts goes down to zero. So that looks like being extremely effective.

MANN: Do they notice anything else about it? Are there any side effects?

ANDERSON: There really aren't any side effects. Most of the men who are taking it with the current preparations don't really know they're on anything at all. They feel absolutely normal.

MANN: Any long-term health concerns?

ANDERSON: Well, this is something that will take the long term to establish. And clearly, you know, more and more problems are emerging with the female pill, and they are, you know, giving us pointers to the sort of things we should be checking out for in men. They're also enabling us to look into these things prospectively from men and to try and iron them out before they get onto the markets.

MANN: Let me ask you about that. How soon before a pill of this kind is on the market?

ANDERSON: Well, at the moment, there's no pharmaceutical industry input into this. And that is obviously one of the major holdups to hold back the development of male pill. But a couple of companies are now starting to talk rather more positively about it. And if they do start taking it seriously, we're probably looking at sort of still seven or eight years minimum before something becomes available.

MANN: Now that's extraordinary when you think about it because on this day in the United States we're marking an anniversary, around the world, women have been able to take the pill for decades, and you're saying there's no pharmaceutical industry interest or there hasn't been much. Why is that, do you think?

ANDERSON: That's right. Well, it's been the story with contraception generally, although the contraceptive pill has, as you say, been widely available, many companies I expect feel there's a degree of market saturation. And developing a contraceptive is a much more problematical thing from the risk point of view than many medicines because you're giving it to healthy people, and the people don't take the fact that you're protecting them against pregnancy in quite the same way as you're treating them for heart disease or pneumonia or whatever.

So you haven't got the prevention - or treatment of disease to offset any possible risks or side effects.

MANN: So you think men will take the pill?

ANDERSON: Yeah, I do actually. You know, it's not going to be a market leader like the female pill. But it's going to have a significant share of the market like many of the - mini pill, for example, or the IUCD. You know, these are not used by vast numbers of - or vast percentages of people. But because everybody or virtually everybody needs contraception, you don't need that many, that big a percentage to still mean it's a lot of people.

MANN: Dr. Richard Anderson, thanks so much for this.

ANDERSON: OK, thank you.

(END VIDEOTAPE)

MANN: There are other contraceptives in development and being introduced into some markets. Gloria Feldt, president of Planned Parenthood Federation, is back with us.

We just heard about the male pill. Are there other kinds of contraceptives that are being developed that we're going to see sometime soon?

FELDT: Well, there are some other hormonal methods that essentially use the same technology as the pill but in different forms. There are patches that release the hormone that would last for a week or so. There will be a once-a-month injectable that should be coming to the marketplace fairly soon.

There have been other kinds of barrier methods as well, and of course, methods like microbicides that could both potentially protect against sexually transmitted infections as well as protecting against pregnancy show some promise. But for now, the pill remains at the top of most people's list.

MANN: What happened to the RU-486, the French-developed abortion pill? It's not a contraceptive, per se. But the doctor who developed it was very optimistic about how it could change lives and prove helpful. It hasn't seemed to catch on, at least in the United States. Are people using it successfully elsewhere?

FELDT: Well, RU-486 or mifepristone, as it is called in the United States, has not yet been approved by the FDA, and it is, as you said, not a contraceptive method. It actually terminates pregnancy. So it's different from what we're talking about right now.

I would like, however, to mention emergency contraception, since we're talking about other contraceptive methods. We tend to forget about it because it is not new. But I think it is seeing a new popularity. Emergency contraception is just regular birth control pills that can be taken in a certain dosage within 72 hours after intercourse and can prevent a pregnancy from occurring.

And so, again, it's not a new technology. It's another use of an existing technology that is based upon the existing birth control pill. It could prevent half of unintended pregnancies and half of abortions in this country if every woman had ready access to it.

MANN: For people who are in favor of safe and dependable birth control, is the medical problem essentially solved? Is the science done? Are the challenges now elsewhere?

FELDT: No, it's most unfortunate that so little is spent on research for better and more effective contraceptive methods. I think we'd all like to see a reversible method that is like sterilization but is reversible and therefore would be more likely to be 100 percent effective or very nearly 100 percent effective.

You know, it's important for women and men as well - and I was very interested in the segment on the male contraceptive pill - it's very important for people to have options and choices because for each individual at a given time in his or her life and depending upon their relationship situation, one contraceptive method may be right and another contraceptive may be right at another time.

So informed consent, full information, a wide range of options - all of these things are very, very necessary for people to be able to make good and responsible healthy decisions about childbearing.

MANN: Gloria Feldt of Planned Parenthood, thanks so much for being with us.

FELDT: Thank you.

MANN: That's INSIGHT for this day. I'm Jonathan Mann. Stay with us. More news ahead.

END

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