Long before synthetic hormones existed, women and men used every resource imaginable to space out or avoid pregnancies - withdrawal, periodic abstinence, herbal preparations, crocodile dung suppositories, half lemon cervical caps - all meant to prevent conception or end early pregnancies. None of these were perfect, and some were even deadly, but each reflected an ancient truth: humanity has always tried to manage the sacred mystery of fertility. What changed in the twentieth century was not the desire to manage fertility, but the power science placed in human hands - hands belonging to more than just a woman and her partner.
When science was able to separate women from their natural biology and disassociate sex from its life producing potential, the results were not simply medical - they were profound enough to propel sociomedical, economical, and sexual revolutions in just a few decades. But before we dive into these long lasting effects, let's understand how we got here in the first place.
Brief Overview of The Pill’s Approval
The first hormonal contraceptive pill Enovid, quickly nicknamed “The Pill” was approved by the U.S. Food and Drug Administration (FDA) for contraceptive use in 1960, after earlier approval in 1957 for “menstrual disorders”.
Initially, laws and prescription practices aimed to limit the pill’s use predominantly among married women, as societal norms at the time maintained that sex should be promoted only within a marriage. It wasn’t until 1972 that all legal barriers fell, allowing unmarried women access throughout the U.S.
In Canada, federal restrictions on contraceptives remained until 1969, when Parliament decriminalized them. From that point, birth control gradually became legally available across the provinces, though access and social acceptance varied.
When the Womb Became a Laboratory
Given such legal and cultural resistance, how did The Pill even reach approval? At the time, more than 30 U.S. states banned birth control, and both the NIH and WHO declined to fund fertility‑control research. Nonetheless, biologist Gregory Pincus and gynecologist John Rock pressed forward to develop a pill that could stop ovulation—essentially switching off a woman’s reproductive system. Because of legal constraints, their early studies were disguised as “fertility treatments” or “cycle regulation” .
Given such legal and cultural resistance to decriminalize, let alone prescribe hormonal contraceptives, you may be wondering how The Pill even reached approval? At the time, more than 30 U.S. states banned birth control, both the NIH and WHO declined to fund fertility control research, and studies proving efficacy required healthy childbearing aged women to consent to biological experimentation, painting a landscape unlikely for birth control to be born.
Nonetheless, biologist Gregory Pincus and gynecologist John Rock pressed forward to develop a pill that could stop ovulation - essentially switching off a woman’s reproductive system. Because of legal constraints, the true intentions of their early studies were disguised as “fertility treatments” or “cycle regulation”, terms linked to helping women become pregnant.
In 1954, Pincus and Rock began trials with about fifty women in Massachusetts, testing synthetic progesterone as a “fertility” treatment. The 21‑day‑on, 7‑day‑off schedule mimicked a menstrual cycle, disguising the drug’s true sterilizing mechanisms. But participation was demanding, side effects such as nausea and headaches were common, and many women dropped out. Nonetheless the trials confirmed that high-dose progestins could suppress human ovulation, clearing the way for more aggressive experimentation.
Facing murmurs of criticism and a lack of willing participants, Pincus moved experiments to the more “controlled” environment of Worcester State Hospital. A psychiatric institution where administrators, not patients, could authorize research. Funded heavily by Katharine McCormick, a suffragist and philanthropist, money was poured into the hospital to conduct renovations and improvements in exchange for patient participation. Sixteen institutionalized men and women, many of which were labeled “psychotic”, were given high doses of synthetic hormones. None of them being informed they were part of contraceptive research. Along with hormones they were subjected to invasive uterine and testicular biopsies, performed sometimes without anesthesia. When some of Pincus’ results from these experiments were published in the medical journal The Lancet, editors received letters of condemnation from medical peers including one from Dr. Pierce stating
“This use as guinea pigs of chronic psychotic patients who are not able to give or withhold valid permission in psychological research of this type must be as repugnant to many of your readers as it is to me”.
As reports of serious side effects accumulated, from nausea and vomiting to headaches and mood changes, Pincus publicly downplayed them, later stating in an interview that many pill side effects were “largely psychogenic,” happening because women expected them. Eventually, constrained by U.S. oversight, research was moved somewhere contraception was legal, oversight was looser, and women had few alternatives. Puerto Rico.
Puerto Rico: a Colony Becomes a Testing Ground
Puerto Rico, an American territory but not a state, did not offer its people the same political voice or protections as mainland citizens making it particularly vulnerable to top‑down population policies. Surgical sterilization had been promoted since the 1930s under Law 116, resulting in one in three Puerto Rican women of childbearing age being sterilized by the 1960s, the highest rate in the world at the time. The surgery became so common it was referred to as “la operación” in the same way we now refer to oral contraceptives as “the pill”. Sterilization, and later hormonal birth control, were marketed as tools to fight poverty and “modernize” the island, but they also served eugenic and political goals: limiting the number of “undesirable” or “unfit” parents, reducing migration to the mainland, and shaping who would have children in the future.
The large‑scale trials of The Pill began in 1955 across San Juan housing projects and local clinics. For many women, The Pill appeared as a gentler option to permanent sterilization, something reversible, controlled, and less drastic than surgery. Yet informed consent was a myth in this context. Language and literacy barriers, poverty fuelled economic dependence, and misleading reassurance from clinic staff all curtailed real understanding. Experimental doses were roughly ten times stronger than modern pills, leading to symptoms including extreme nausea, headaches, blood clotting, vomiting, irregular bleeding, and at least three uninvestigated deaths.
Complaints were often dismissed as “emotional” or exaggerated, reinforcing the long-standing habit of treating women’s physical suffering as psychological. By trial’s end, only 130 of 800 participants continued the pill longer than one year, a shortfall needing circumventing. In light of this Pincus framed their results not by women but by menstrual cycles observed, claiming “in the 1,279 menstrual cycles during which the regime of treatment was meticulously followed, there was not a single pregnancy.”. 1279 is a more persuasive number than 130, and these findings became central evidence for regulatory approval.
The Eugenic Driven Minds Who Funded the Research
The Pill did not emerge in a moral vacuum. Its development intersected with powerful philanthropic networks that also supported eugenics - the idea that society should shape who reproduces and who doesn’t.
The Rockefeller family, through its Rockefeller foundation, funded birth-control initiatives like Enovid and population control clinics in Puerto Rico where it could be tested. It also supported eugenic institutions such as the Eugenics Record Office in New York and the Kaiser Wilhelm Institute in Germany, whose work informed globally adopted racist policies and coercive sterilization programs, including Nazi Germany. Josef Mengele, infamously nicknamed “Angel of Death’ while working at Auschwitz was among the top researchers at the Kaiser Wilhelm Institute, and maintained a close working relationship with the institution even after transferring to the Nazi death camp.
While direct lines of command can be complex, and not all supporters of birth control endorsed Nazi eugenics, the ideological continuity between “better breeding” and fertility control is well‑documented. This is especially true among the poor and marginalized, where birth control was/is often promoted as a way to manage “undesirable” populations, rather than simply expand women’s freedom.
Margaret Sanger’s Double Legacy
No figure is more synonymous with modern birth control than Margaret Sanger.
She coined the term “birth control” in 1914 and later founded the American Birth Control League, the direct predecessor of what is known today as Planned Parenthood. She was a crucial player in financing Enovid research, both from her own pocket and by securing support from fellow eugenic investors like McCormick and the Rockefellers, and re-positioning The Pill in a new “feminist” way to gain marketing support amongst the masses. Sanger is often remembered as a champion of women’s “freedom”, upholding hormonal birth control as the primary key to women's liberation, but her writings and alliances reveal a more complicated legacy.
Sanger advocated proposals such as a “birth permit” system, in which the right to have a child would be licensed and regulated to promote what she saw as a “better distribution of babies.” In 1926, Sanger spoke to a women’s auxiliary of the Ku Klux Klan, later describing in her autobiography how her talk was well received and helped spread her message and motives for advancing birth control. She also publicly endorsed the 1927 Supreme Court ruling in Buck v. Bell, which upheld Virginia’s compulsory sterilization law and led to the forced sterilization of more than 60,000 Americans, who were deemed “unfit” reproducers.
Defenders of Sanger often argue that she was simply a “woman of her time,” navigating a culture steeped in eugenic thinking. Yet her choices - including who she worked with, which policies she supported, and how she spoke about “unfit” parents - shaped structures that still influence reproductive health today.
Reclaiming Fertility
Behind the language of progress and freedom lay a pattern: marginalized women - poor, colonized, institutionalized - paid the highest price for a technology that would later be marketed as a symbol of empowerment. The modern birth-control movement grew in soil fertilized by ideas of control, hierarchy, and “better breeding,” not solely by a desire to serve women’s integral good. From a worldview that sees human life and the body as inherently meaningful, the core problem is clear: whenever fertility is treated not as a gift to be tended, but as a defect to be engineered away in certain groups, it becomes easier to justify using people as tools for social goals. Women become data points, children become variables, and medical power becomes a way to sort lives into “welcome” and “unwelcome” categories.
This raises uncomfortable but necessary questions.
Why have natural birth control methods that share comparable rates of effectiveness (like the symptothermal method), received so little funding and attention compared to hormonal contraceptives? Why was one of the most celebrated “advances” in women’s health and liberation a drug whose explicit goal is to disrupt normal function, rather than restore or improve it? And how has the acceptance of completely separating women from our awe-inspiring natural ability to create life impacted society?
The answers to these questions may be tough to swallow,
but the women before us have swallowed much worse.
