Today, theaters fill with movies about teenagers experimenting with sex. The competitive job market drives many women to wait until later in life to have children as they pursue their educational and career goals. In times such as these, oral contraception attracts the attention of feminists, religious leaders, those who do not want children yet, and those who do not want anymore children. "Pill scare," "abortion," and "sex," all terms associated with oral contraception, evoke certain emotions, mostly negative, in the minds of several people, old and young. Despite the controversy that oral contraceptives raise, this birth control method, five years before its 50^th birthday, remains a common choice, and it will lead us into the 21^st century.

According to Asbell’s history, before the discovery of the Pill, women had few options in the field of birth control. Though available, condoms often proved ineffective and unobtainable. Most women did not know how to correctly use the diaphragm or cervical cap because of the dearth of literature offered on sex, or, more importantly, birth control. Abortion seemed a common answer for many women with families who could not afford children. The women often performed the abortions themselves and sometimes, they resulted in the mother’s death. Women who knew that they could not financially support children would risk their own lives rather than have another child (1). For the poor families that already had several children, an unwanted child made for a tough dilemma. If not for the Pill, the case would remain the same today.

This revolutionary concept arose from popular demand. Margaret Sanger and Katharine McCormick, the "two mothers," of the Pill commissioned Gregory Pincus and John Rock to create what Sanger termed a "simple, reliable, nonintrusive birth control technique: a pill" (7). Using the synthetic oral form of progesterone created by Carl Djerassi and Frank Colton, Pincus and Rock began conducting experiments in oral contraception (1). Progesterone, a hormone, lets a woman’s body know that pregnancy has occurred, and administering this hormone prevents ovulation by causing her body to think that it has occurred. When Pincus and Rock first tested their idea on fifty women in Massachusetts in 1955, the experiment yielded amazing results: not one of the fifty women ovulated (1). FDA approval followed in 1960, and the Pill's use has continually increased since that time.

Since that success, controversy has struck, and much of the opposition comes from the religious community. Oral contraceptives make sex easily accessible to all without the risk of pregnancy, and, therefore, people can decide to have sex before marriage without anyone knowing. The Church condemns fornication, but today, many couples do not wait until marriage to have sex, and the Church cannot stop them. So, oral contraceptives benefit society in that they keep pregnancies planned and children wanted, and that they continually reduce abortion rates, making abortion, another contested topic among the religious community, a lesser concern. Despite all the social opposition, oral contraception still remains beneficial.

The benefits of Pill use go to both the old and the young. Today, adolescents experiment with sex, and adults look down upon them if pregnancy occurs. Not only that, but pregnancy prevents most adolescents from getting a higher education and some from even graduating high school. If adolescents use the Pill, then they do not have to worry about pregnancy and they can still enjoy sex. Benefits spread to the older generation as well. In a case study by Dr. Herbert Peterson, a 40-year-old, married woman says that some of the benefits of the Pill include regular, predictable periods, a spontaneous sex life, and no worry of using condoms and/or diaphragms (6). Some older women use the Pill for hormone regulation in their pre-menopausal years. The Pill has thus dramatically improved the quality of life for women, old and young.

In addition, many would oppose the fact that oral contraception has been healthy for women because the media’s influence has produced a series of "pill scares." Dr. Herbert Peterson, chief of the women’s health and fertility branch at the Centers for Disease Control and Prevention in Atlanta, reports that "a consistent link between taking the pill and breast cancer diagnosis [has been observed in women] before [age] 35" (2). However, this hypothesis, when tested, held little ground. The Collaborative Group on Hormonal Factors in Breast Cancer did a study in 1992 that shows the link miniscule: "one cancer per 20,000 women for those taking oral contraceptives between the ages of 16 and 19, with the risk rising to an additional 9.4 cancers per 20,000 women for those taking oral contraceptives between the ages of 25 and 29…" (8). Walling thus concludes, "oral contraceptives are unlikely to directly cause breast cancer" (8). Though some women experience headaches, nausea, or slight weight gain, research indicates that using the pill can "[cut] a woman’s risk of ovarian and uterine cancer and [lower] the incidence of pelvic inflammatory disease" (2). Not only does it cut risks of certain diseases; it stands out in its effectiveness when compared to other forms of birth control.

Alternative forms of birth control prove readily available to women today, yet few of them can compare to the benefits of using the birth control pill. Norplant, one of these options, begins working after a fifteen-minute procedure in a doctor’s office; it lasts for a full five years with a failure rate of less than one percent. Depo-Provera, a hormone, gets injected into a muscle and it remains effective for three months (1). Other options such as condoms, diaphragms, sponges, tubal sterilization, vasectomy, and spermicides also exist. Some users find "barrier methods" such as condoms, sponges, and diaphragms uncomfortable and inconvenient to use. Likewise, permanent methods such as tubal sterilization and vasectomy prevent couples from having children ever again though they may desire them later (6).

The invention of the birth control pill not only gives couples better options, but it has its impact on innovative birth control methods as well. A "morning after," anti-abortion kit has just recently received FDA approval. Women can use the emergency kit after unprotected sex or contraception failure by taking one pill within 72 hours of intercourse and another 12 hours later (5). The process does not involve abortion since it expels the fertilized egg before it implants itself in the uterus (3). A pill for men may follow in the next century; scientists currently experiment with the idea. They have, however, encountered obstacles and few companies are willing to risk the production of the male pill because they do not believe that a desire exists for it (4). However, these innovations since the Pill’s discovery may eventually lead to a one hundred percent effective birth control method.

Certainly, all can consider the invention of the Pill the forefront for fulfilling the mankind’s desires. It has given women options that they had never had in the past, couples successful relationships, and women careers and education. While it causes continual controversy, its benefits far outweigh all the risks involved, both physically and socially, and the difficulty lies in believing that any other recent scientific discovery has had such an impact. After all, four out of five women use the Pill as their primary form of birth control (2).

Asbell, B. The pill. New York: Random House; 1995. 334-368.
 

In Chapter 22, Asbell informs and presents many sides to several controversial issues dealing with birth control options for men and women. He begins by illustrating the newer innovations for females, hence the "not-a-pill" portion of the title of the chapter. He then mentions that Norplant begins working after a fifteen-minute procedure in a doctor’s office which lasts for a full five years with a failure rate of less than 1%. Asbell then explores the history, side effects, and drawbacks of Norplant in-depth. Next, he introduces Depo-Provera, a hormone injected into a muscle which remains effective for three months. Asbell also briefly touches on an innovative vaccine and then addresses the social issues that birth control has for both men and women. A woman does not desire all the responsibility for the contraception, yet she does want control and assurance that she will not get pregnant. Since oral contraceptives for males quickly approach, Asbell also points out, truthfully, that there remains much doubt as to their effectiveness.

In Chapter 23, Asbell gives an informative history of the morning after pill beginning with experiments as early as 1959 when the Pill was about to get approved by the FDA. However, this research faded into the background, most likely because John Rock, one of the creators of the Pill, believed it a cause of abortion. The government legalized RU 486, the next step in morning after pill discovery, in 1988. This pill induces early abortion, and the government monitored it closely. The abortion pill had a high cost, not only financially, but ethically. The process of RU 486 abortion causes pain and illness in its users. Asbell follows up this brief history by illustrating anti-abortionist opposition. Near the end of the chapter, Asbell interestingly tells of the morning after pill we know today. A single dose of RU 486 works within 72 hours after unprotected sex by preventing its implantation in the uterus. Although, FDA approval certainly awaits in the U.S.; Europeans continue to use this pill. Not only does he tell of the morning after pill, but he ends his chapter with a surprising tip that papaya contains a strong enzyme, that, if a pregnant woman eats one whole fruit daily she will probably abort within a week.

Thirty-five years ago, in 1960, the FDA approved the birth control pill. Today, 4 out of 5 women use this method as the primary method of birth control. The author claims that, because of this discovery, women can enjoy sex without worrying about getting pregnant. Susan Scrimshaw, dean of the school of public health at the University of Illinois in Chicago, says that because of the pill, women can achieve educational and career goals without omitting sexual relationships from their lives. The author employs statistics to point out that younger women use the pill, and addresses possible health risks. Dr. Grimes then explains that the pill holds little to no health risks for nonsmokers. The writer then introduces the issue of a possible link to breast cancer, and Dr. Herbert Peterson, chief of the women’s health and fertility branch at the Centers for Disease Control and Prevention in Atlanta, points to the fact that a link exists between breast cancer in women over age 35 and taking the pill. However, the author refutes the point convincingly, when he/she includes some of the benefits of taking the pill such as cutting a woman’s risk of ovarian and uterine cancer and reducing the risk of pelvic inflammatory disease.
 

The Food and Drug Administration declared morning after pills safe. Climons informs of that fact, and gives instructions on their usage. A woman takes the pills the first time no later than 72 hours after unprotected sex and then again 12 hours later. People in Europe have used the morning after pill for years; but the United States’ government continually slows approval. No company has yet risked producing the pills and, as a result, doctors remain unaware as to which pills work best. Climons accurately tells us that the method has shown approximately 75% effectiveness in preventing pregnancy. Because of its success rate, reproductive experts say that this pill could prevent several unwanted pregnancies, and the statistics that Climons uses convincingly point to that fact. Anti-abortionists found the pill murderous, but FDA officials assured them that pregnancy begins at the time that the fertilized egg becomes implanted in the uterus. Finally, Climons clearly asserts that high doses of birth-control pills prevent ovulation, fertilization and implantation, and that they do not cause abortion though many people have such a misconception.

Cohen, P. Sugar pill holds promise for male contraceptive. New Sci. 149:2019; 1996.

Cohen introduces a pill that contains a sugar that hinders sperm. Scientists know its effectiveness because the male rats they test that eat the compound and acquire lower fertility rates with little or no side effects. Scientists have more difficulty providing a man with a pill because he produces thousands of sperm to a woman’s one egg. Scientists found that manipulating male hormone levels, the strategy of the past, proved ineffective and, as a result, Gossypol had to be taken off the market. This drug stopped sperm production, but prolonged use lead to shrunken testicles and scientists found infertility in the patients after they stopped taking the drug. Joseph Hall, biochemist at NCSU, thought it better to try to disrupt sperm function rather than production, and he performed subsequent experiments. Cohen explains the process by which the sugar pill works and then told of its effectiveness in rats with little side effects. It works in bulls and rams as well, but scientists have yet to test it on human sperm. Experts give opinions as to why this approach proves better than past approaches. Carl Djerassi, the inventor of the Pill for women, says the problem lies in the development taking many years and millions of dollars to come to the market. Companies display little interest in putting the money into the discovery because of the risks associated with it.

Nightingale, the associate commissioner for health affairs, authoritatively gives an informative article on the FDA approval of an emergency contraception kit indicated for the prevention of pregnancy after believed contraceptive failure or known unprotected intercourse. The kit includes an information book with instructions, and Nightingale includes an abriged version of these same instructions within the article. He also gives convincing statistics on effectiveness in a sample set of 100 women. Warnings given include that women should not use emergency contraceptive pills (ECPs) as a routine form of contraception. Nightingale illustrates the side effects as well.

Peterson offers a case study about one of his own patients, a 40-year-old woman who found, at age 39, the benefits of taking the pill. Dr. Peterson begins by describing the woman’s situation and giving health facts. "Mrs. B" used several contraception methods over her lifetime and she planned only one of her children. Neither she nor her husband liked the use of a condom or diaphragm. The diaphragm gave her backaches. Mrs. B did not at first desire to use the pill because she thought it unnatural. However, when she finally did try it, she found that she had the best mense (period) of her life, and she wished she had discovered it earlier. Though she has headaches as a result of using the pill, she notes that benefits far outweigh risks. Peterson then gives statistics that prove that the pill offers a good contraception method for older women as well as young. Experts consider the health benefits greater because the risk of death associated with pregnancy increases with age. Peterson convincingly condones the use of oral contraceptives in this study.

The author writes an informative history of the birth control pill. In the early 20^th century, Margaret Sanger wanted a better birth control method. In conjunction with Katharine McCormick, she commissioned Gregory Pincus, a biologist. McCormick paid Pincus $40,000 and he got in contact with a gynecologist, Dr. John Rock. After the discovery of an oral form of progesterone, scientists could inject the hormone into rabbits and trick them into thinking they were pregnant. Pincus and Rock tested this remarkable discovery on humans. In 1954, they tested the pill on 50 individuals with no sign of ovulation. Soon after, the FDA approved the pill, and, though it sparked much controversy from the Catholic Church and even feminists, its use is widespread today.

Walling sets up an informative and persuasive article in her evaluation of a study conducted to show the link between breast cancer and the use of birth control pills. A collaborative group and they pulled from all available studies that included at least 100 women. They found two results. No evidence of an increased risk of breast cancer existed in the women who quit using oral contraceptives ten years previously. The risk increased with age, but scientists found it small even at its highest levels. Walling’s comments on the researchers’ cautiousness not to lead others into misinterpretation of their results, clearly convince the reader of the accuracy of the data. The editor’s disclaimer, given at the end of the article, asserts that scientists do not know the risks for users of low-dose pills. He also notes the positive effects of oral contraception although he does not give much detail about them.