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It's Astounding That We're Still Debating the Pill After 50 Years

Brendan Smialowski, AFP/Getty Images

It wasn't easy to create a birth control pill in an era where contraception, along with abortion, was still illegal in most of the country. In his new book, The Birth of the Pill, veteran journalist Jonathan Eig writes on the history of how four people came together to make oral contraceptives a reality in the 1950s. (Ann Friedman reviewed it for the New Republic here). The creators wouldn't have expected the challenges women still face today to their reproductive rights.

I spoke to Eig about this in the context of the contemporary debate on abortion and contraception in America. This conversation has been edited for length and clarity:

Rebecca Leber: What's surprising or unique today about the fight over contraception, like co-pay free birth control, given the history of the pill? 

Jonathan Eig: The thing that strikes me is that we're still fighting over it. When these people set out to invent the pill in the early 1950s they would never have imagined that it would be so controversial today. They would have believed that once the pill had gotten out there and people saw there was a much easier way for women to control fertility then all the controversy would end. Because women would adapt to it and men would realize it helped and it worked, and we would have stopped fighting over it. It's really striking that we're still having many of the debates we had in the country 50 years ago. 

RL: But the pill has lost a lot of the stigma around it, while other forms are much more controversial, and we're seeing states enact a number of abortion restrictions. So is there anything prescriptive that could be applied to today's conversation?

JE: I think the things that haven't changed is we're still viewing the control of reproduction as if it were somehow immoral. There's still this sense among some people that women should only have sex when they want to have a child, and nobody says the same thing for men. I think that's one of the constants here. 

RL: I wanted to ask about the idea of male birth control. Every few years we see there might be a male birth control pill, just around the corner. What is standing in the way? 

JE: There are a lot of things standing in the way. One is that men don't have as much incentive to push for new or better forms of contraception. They're not the ones that get pregnant. And the drug industry is reluctant to do a lot of research on new products here because they have a winner with the pill, they make a lot of money for that. They are very much afraid of litigation around anything in the area of reproduction so there has been a reluctance to spend money on R&D [research and development]. In many ways, men have been given a free pass. One of the intended consequences of the pill is it puts all the responsibilities on women and men have gotten used to the idea that they don't have to do anything. And that's unfortunate.

RL: Now we're seeing some Republican candidates endorse the pill over-the-counter, presumably as a way to reach out to women voters. Is this progress? 

JE: It's a good idea especially if it's part of a broader campaign of more access to contraception. The pill is not the answer for everybody and it's not the most effective form of birth control. Long-term solutions that women don't have to take every day are better than the pill, unfortunately they're more expensive. If the idea is just to give access to over-the counter birth control pills and not other options then it's a bait-and-switch. It could be part of a good solution or it could be part of progress if we couple that with greater access to other forms of birth control as well.

RL: One of the long-acting forms of contraception is IUDs (intrauterine devices). Medical groups have endorsed this as the most effective option for the reasons you mention. But it's still fairly uncommon. So what would change that? 

JE: When women are given access to it and are given opportunity to have long-term birth control such as IUD or implants, they go for those and prefer them to the pill. When you make them available and affordable it's a win-win. They end up being less expensive in the long run because they reduce unwanted pregnancies better than the pill. It's a matter of resetting some of the attitudes about these things. The IUDs could use a better marketing campaign and could use better public relations. We as a society could make them more affordable and provide more incentives to give women the access when they want them. 

RL: What are some of the challenges we've seen to advancing reproductive choice?

JE: I think we're not making much progress. We're closing health clinics all over the country. We're making it harder for women to have access. There are better forms of birth control available now than ever. And when we offer them to women, when we make them available, and we've shown that it works. We save money in the long run, we reduce unintended pregnancies, and we reduce abortion. 

RL: How are advocates today navigating this tricky minefield where there are new legal barriers to access to abortion and contraception?

JE: In many ways the conservatives on this issue are winning the public relations battle. They declare that some forms of birth control are equal to abortion when science says they're wrong, but they just keep saying it. I don't know what you would do about that. It seems to me there is one battle at a time. You get clinics closing in Texas with this most recent decision with the most recent decision. Hobby Lobby has stripped away access from some women to have their contraception paid for by insurance. The other side can only fight back one round at a time. Perhaps at some point people will realize it's a broader problem and fight back. 

RL: How far does that suggest we've come policy-wise?

JE: When the pill was launched, it was done at a time when birth control was still illegal in many of the states and the laws weren't being enforced. They really believed that once women had access to the pill that all the laws would become irrelevant and fall away. It appeared to be going in that direction for a while, because 1965 Griswold v. Connecticut established the right for women to have access to birth control as a part of their right to privacy. And it looked like this fight was finally coming to an end. That's not what happened. In the '70s and '80s you began to see this conservative backlash and ever since then we've gone back to the logic of the 19th century that it's immoral to control reproduction. It doesn't make much sense, but that's where we are.