How good is the BIRTH-CONTROL PILL?

Under strict test for two years, a steroid pill has prevented conception every time. Is it the long-sought answer to the danger of over-population? In this study of all current methods, the answer is no—not yet

JUNE CALLWOOD July 19 1958

How good is the BIRTH-CONTROL PILL?

Under strict test for two years, a steroid pill has prevented conception every time. Is it the long-sought answer to the danger of over-population? In this study of all current methods, the answer is no—not yet

JUNE CALLWOOD July 19 1958

How good is the BIRTH-CONTROL PILL?

Under strict test for two years, a steroid pill has prevented conception every time. Is it the long-sought answer to the danger of over-population? In this study of all current methods, the answer is no—not yet

JUNE CALLWOOD

In the wildly heightened search for a new contraceptive that has paralleled the world population jump of the past ten years, the most stunning product yet discovered is the oral birth-control pill, a steroid-compound tablet which when taken daily positively prevents conception, without a failure.

Civilized society has never been fond of the term birth control, a phrase that means a negation of a human life. Millions of people, including members of the Roman Catholic Church, believe that any artificial device which disturbs a conception is against God and nature. Among the millions of others who consider birth control a humane practice, the new oral pill has stirred confusion and excitement.

Any new contraceptive must fulfill three conditions to be accepted by those who accept the idea of contraceptives. It must be sure, simple and safe. To date not even the doctors presently testing the oral pill are convinced that it is more than sure and relatively simple. It may be at least a decade before they can be sure whether it’s safe.

After two years of testing, without a single detectable example of permanent harm, many doctors in Canada and the United States are still saying, as they did in the beginning, that they would never permit their wives and daughters to use the steroids regularly. Although most drugstores stock one or more of the three brands of steroids, Enovid, Norlutin and Nilevar, prepared by two ethical pharmaceutical companies, they cannot be bought or sold as contraceptives and are available only on a doctor’s prescription. Used in the treatment of menstrual disturbances, they are almost never prescribed for contraception.

Tests of the steroids’ continued on page 53

How good is the birth-control pill? continued from page 13

‘Despite tests, the steroid pill's a mystery. It will be years before it's classified hero or villain"

effectiveness as contraceptives have been underway for more than two years on a group of 250 Puerto Rican women. Although the test supervision is regarded as a model of its kind, the steroid pill is still a mystery whose final chapter hasn’t been written. It isn’t agreed yet, and won’t be for some years, whether the pill is a hero or villain.

The name steroid is derived from sterol, which is a class of solid higher alcohols found in all plants and animals. The pill is also known technically as a 19 nor compound, to indicate the structure around the molecule. By any name, the pill’s workings are not completely understood. Its effect, when taken every Jay for twenty days immediately following a menstrual period, is to block one of the functions of the pituitary gland.

The gland, itself a medical puzzler, is the size of a little fingernail and is

located at the intersection of two arrows, if one were to be driven from temple to temple and the other from the centre of the forehead back through the skull. The pituitary gland controls the function of a woman’s ovaries, causing them to eject an egg once a month. This process, called ovulation, is somehow stymied by the steroid pill’s action on the pituitary gland. Without ovulation the woman is sterile.

In about twelve percent of the cases in the Puerto Rico experiments, women taking the steroids regularly suffered such side effects as nausea and headaches. Some of the younger women had such symptoms as spotting, increase in weight, a lessening of sexual appetite. But at the conclusion of two years of testing, the project’s director, Dr. Manuel Paniagua, reports that the steroids have caused no discernible damage of a lasting nature. Women who decided to have children stopped taking the pills; they were able to conceive and delivered normal babies. One woman mistakenly took the steroids during pregnancy but her baby was unharmed. The pills, as a contraceptive, have proved one hundred percent effective when taken as directed. Even so, researchers have assigned a failure rate to the steroid pills: computed at approximately the same rate as the best contraceptives now available, the

failures are due to misunderstanding or apathy in the use of the steroid.

Of the women who complained of side effects, some dropped out of the test group and others were treated with a simple headache tablet. As a matter

of clinical curiosity, Dr. Paniagua substituted a placebo or fake pill for the headache tablet and discovered it was equally beneficial. “Our patients,” observed the doctor, “have a high rate of suggestibility.”

One advantage the steroids have over other methods of contraception is aesthetic; they can be taken at a time and place unrelated to the sex act. whose spontaneity must otherwise be predicted or interrupted. They also have the vir-

tue of simplicity and for this reason are being studied anxiously in India, where Dr. S. N. Sanyal, of the All-India Institute of Public Health, is reported to have developed a twice-a-month steroid extracted from the common sweet pea. The United States steroid presently being tested in Puerto Rico hasn’t the virtue of economy; the pills arc about forty cents apiece. At twenty pills a month a year’s supply costs ninety-six dollars.

But steroids, at any price, have an uncertain future in birth control. Some doctors are convinced that no good can come of confusing the pituitary gland for any extended period. They suspect a young woman, taking steroids to postpone her family for a few years, might be rendered permanently sterile. There is ground for suspicion, despite Paniagua’s findings, that a heavy dose of steroids taken early in a pregnancy might damage the baby. Paniagua himself has stated, ‘T agree that the steroids may have some definite, permanent effects after prolonged administration . . . For the moment at least, I believe they should be restricted to short-term use for childspacing purposes.”

The steroids can be taken as a birthcontrol device by men; there the probability of harm seems clearer. Inmates of an Oregon prison volunteered for a test study and Dr. Carl Heller discovered that their sperm count could be reduced promptly. He also discovered that there was a drastic change in the tissue structure of the testes, a change one expert labeled irreparable, and that the men suffered a personality change stemming from a decrease in libido. He concluded that steroids taken by men over a long period of time would almost certainly result in permanent sterility and possibly impotency as well. Meanwhile other experiments are making less spectacular news.

One is the test tape. Its appeal is strongest among Roman Catholics because it is the only product yet described in the press which has any apparent possibility of being approved by the church. The test tape currently being studied by Dr. Joseph Doyle, of Boston, is a sort of litmus paper which changes color in the presence of glucose, or sugar. During ovulation the test tape turns a bright green. By practicing abstinence then, the woman can avoid a pregnancy without violating religious tenets.

But the test tape is not altogether reliable. The medical committee of the Planned Parenthood Federation of America, a body of doctors that includes four professors of obstetrics in medical schools and several chiefs of obstetrics in major hospitals, recently announced: “The new tape test . . . neither indicates nor predicts the day of ovulation.

“Predicts” in this case is a more important word than indicates. A male spermatozoon lives about forty-eight hours, perhaps longer. By the time the day of ovulation is discovered, sperm deposited two days previously could already have impregnated the egg. Also, ovulation takes place abruptly. It is possible that a woman can have a test that indicates she is not ovulating and five seconds later nature will disprove it.

If women ovulated regularly the test tape might establish the critical period —but they don’t. Ovulation is subject to disturbance if the woman is tired, if she has a cold, if she is excited, if she is traveling, if she plays a round of golf. To be useful, any test of ovulation must be able to predict the process at least forty-eight hours in advance.

A doctor in Philadelphia is working on such a test. If he is successful—and it is estimated that the conclusion of

his research is “two million dollars away” —a woman will be able to make a simple test similar to a home test used by diabetics and discover her time of ovulation well in advance.

Dr. Warren Nelson, director of the Rockefeller-sponsored Population Council, is working on a project in New York using anti-estrogen substance on female rats. Estrogen is one of the two female sex hormones and is produced in varying amounts throughout the female cycle, but mostly during ovulation. Nelson has discovered that injections of anti-estrogen have arrested development of the egg.

After two years of research with animals Nelson is prepared to try his compound on humans and the first test is being arranged. If it is successful it could mean that a woman could practice birth control by swallowing a pill around the time of intercourse.

Dr. Abraham Stone, a renowned authority in birth control and marriage counseling, has said, “More advance has been made in our understanding of reproduction in the past twenty-five years than in the whole history of mankind." The present pace in unraveling the mysteries is frenetic. In Israel a group is working

“It even writes on glass.”

on contraceptive tests with anti-histamines. Plant extracts are being tested in ten countries, notably India. In many laboratories, doctors are hoping to solve the riddle of the “capacitation period,” a curious fouror five-hour lag between the time the sperm enters the female reproductory system and the moment of fertilizing the egg. “If we knew what it was doing during that time,” commented Dr. Nelson, “we might discover how to interfere with it.”

The forms of contraception likely to become the most popular in North America in another five years are presently undergoing final testing before being placed on the market. These are the insert tablets. One, a foaming type, has proved effective in Japan but tested less well in the United States. The other, a non-foaming tablet that dissolves readily, has shown better test results and many doctors feel that it may be the next big contraceptive seller.

Some dozen governments have incorporated birth control into their national health programs. Japan has had the most success, cutting its birth rate almost in half in ten years by means of sterilizations, an estimated million legalized abortions, and, more recently, widespread distribution of contraceptive information and materials.

Puerto Rico performs about four thousand sterilizing operations every year on young women and an uncounted number of men. Sterilizing has become so popu-

lar that in some city hospitals sixty percent of the maternity patients request sterilization operations. Puerto Rican women who have emigrated to New York are returning home for the operation.

Russia began under Communist rule with the legalization of abortion “in the interest of the health of the working woman” and for years in Moscow abortions outnumbered births. Then, “in the interest of the health of the working woman,” abortions were outlawed. Three years ago they were made legal again and accompanied by promotion of contraceptives, the first in Soviet history.

India and China, where the populations are multiplying three times faster than in Europe, have also instituted intense contraceptive distribution. One Indian doctor observed recently that if India’s death rate drops to the level achieved in medically more advanced countries without a simultaneous drop in the birth rate—this is the situation in Puerto Rico —India in a single century will fill five earths as full as ours is today.

It was India’s plea for a new kind of contraceptive that stimulated research in the United States. “Ten years ago India asked us for help,” relates Dr. Abraham Stone, vice-president of the Planned Parenthood Federation of America. “They needed a contraceptive that wouldn’t require privacy or plumbing, that was highly effective but harmless, that was inexpensive, that wouldn't need complicated instructions for use. We had nothing to give them.”

A multiplicity of effective contraceptives is now available, or about to be, and North Americans, within the limits of their budgets or conscience about such matters, have access to most of them. Some eighty percent of North Americans have used some form of birth control at least occasionally, to limit the twenty-five children a woman biologically can have in her lifetime to a number they are financially and emotionally able to provide for. The market, estimated at $200 million a year, is already so important that several established pharmaceutical houses that never before prepared any contraceptive products are now manufacturing a variety and researching others.

Doctors grade the effectiveness of any contraceptive according to a scale based on a hypothetical period of a hundred years of fertility. In a hundred years of fertility where no contraception device or practice is used, eighty pregnancies would occur. Against this scale Quebec had the highest rate of pregnancies of any area in the world, with an average of sixtyfive pregnancies per hundred woman years, among women married in the 1890s; by contrast, in recent years Great Britain has had six using the best contraceptive methods available.

This scale is used to rate all methods of birth control. The range is from a high of thirty for methods that include no devices to a low of five for some of the most prevalent contraceptives being used now. The only known contraceptive with a zero rating is the steroid pill, if taken as directed.

Nevertheless, Ortho Pharmaceutical Corporation, the world’s largest manufacturer of medically approved female contraceptives and for many years the only one, is not considering the steroid pill very seriously at the moment. Preparing to market an insert tablet after ten years of research and testing. Vice-President W. Vincent Abrahamson recently remarked, "We’ve known how to stop a woman ovulating for the past twenty years. There’s no trick to that. The difficulty is stopping ovulation without any harm being done. So far, we don’t know any product that can do it.” ★