The Morning After: A History of Emergency Contraception in the United States

Chapter 5. Building Consensus

In June of 1979, a group of healthcare professionals, scientists, lay midwives, consumer advocates, social scientists, women’s studies professors, historians, and policy analysts held a workshop entitled “Ethical Issues in Human Reproduction Technology: Analysis by Women” at Hampshire College in Amherst, Massachusetts. This workshop was the first conference in the United States to focus on women’s views of the ethical issues of reproductive technology. Topics included hormonal contraception, sterilization abuse, diethylstilbestrol and cancer, prenatal diagnosis, neonatology, and assistive reproductive technologies such as in vitro fertilization and embryo transfer. The conference participants challenged two key assumptions of contraceptive research and development: first, that the “disease” of unwanted pregnancy was worse than the health risks posed by a contraceptive technology; and, second, that the threat of overpopulation was a greater social problem than the health and welfare of women living in poverty. Although participants supported offering women a diverse range of choices of contraceptive methods, they also favored noninvasive methods that posed the least risk of long-term side effects. In particular, they recognized that a safe back-up method of contraception was needed for rape victims and for cases where other contraceptive methods failed. Belita Cowan presented her work on the ethical issues of research on postcoital contraceptives. She pointed out that until recently the various federal agencies that oversaw contraceptive research were staffed almost entirely by white males. Thus, key decisions about which studies to fund and which technologies to approve were made by those who would never have to face the health risks posed by the various drugs and devices created Building Consensus 73 Chapter 5 74 The Morning After for fertility control. Cowan claimed that this led to serious ethical lapses in contraceptive research: in the case of studies of postcoital contraception, it was unclear whether the women were aware they were part of an experiment or if they knew they were taking a drugs that the FDA had never approved for this use. Cowan concluded that women “have come to learn, in a very painful way, that men think of us as statistics, that their risk/benefit ratios often ignore our health needs and our concern for safety as well as efficacy.” Because birth control was still primarily women’s responsibility and women bore the consequences of pregnancy and childbirth as well as the health risks posed by various contraceptive technologies, “women should have the major voice in determining which contraceptive research priorities best meet our needs.”1 Helen Holmes observed that while feminist health activists favored contraceptive methods with little chance of long-term side effects, a safe, nontraumatic method of postcoital contraception was needed in case of failure of other techniques and in case of rape. However, she stated, “most postcoital methods are risky and future technological solutions may well be also.” Therefore, she concluded, “confronting the context of rape becomes an issue in contraceptive technology.”2 Feminist health activists were not the first to consider postcoital contraception in the context of rape: the earliest use of this birth control method was for the treatment of victims of sexual assault. However, feminist involvement in combating the problem of rape extended beyond medical solutions that only addressed preventing unwanted pregnancy. Instead, feminist activists in the anti-rape movement saw sexual assault as part a larger systemic pattern of male dominance in American culture. Likewise, Holmes suggested that considering rape and contraceptive technology from a feminist perspective involved more than developing a new postcoital contraceptive method. Rather, educating about rape, setting up rape crisis centers, caring for battered women, stopping pornography, and curbing violence against women were all issues that needed to be considered in the context of reproductive technology. In terms of ways to prevent pregnancy in rape victims, she and many others at the conference favored the feminist self-help procedure of menstrual extraction.3 Participants at the Ethical Issues workshop were not united on the issue of postcoital contraceptive pills. In her response to Cowan’s presentation, sociologist Kristin Luker stated that the central question was one of choice, which included not only providing a range of options, but also allowing women to make their own decisions about whether the benefits of a contraceptive technology outweighed the potential risks. Luker noted that she had spent the 1970s telling officials at FDA and other government agencies that 75 Building Consensus “effectiveness wasn’t everything. I may spend...