On the Pill: A Social History of Oral Contraceptives, 1950-1970 (review)

Elizabeth Siegel Watkins. On the Pill: A Social History of Oral Contraceptives, 1950-1970. Baltimore: Johns Hopkins University Press, 1998. viii + 183 pp. Ill. $25.95.

The first thought that occurred to me when this book arrived in the mail was that it seemed rather a slim volume to deal with such a rich topic, located at such a busy intersection of twentieth-century traffic: governmental authority vs. private enterprise; medical authority vs. consumer autonomy; the ethics and risks of biotechnology; gender relations; social and religious mores; the meaning of family; media and the cultural construction and reconstruction of technologies--fill in the rest yourself. As I sit down to write this review, the same thought nags at me: why doesn't this book take its subject as far as the author's very impressive research suggests it could?

This criticism is not meant to detract from the virtues of Elizabeth Watkins's interesting and well-written account. She explains the roles of Margaret Sanger, Katherine McCormick, and Gregory Pincus in developing oral contraceptives, and offers a good overview of the medical and social reactions to their introduction in 1960. Her centerpiece narrative concerns the role of "the Pill" in crystallizing the women's health movement in the late 1960s and in challenging medical authority and paternalism. She provides a solid account of Barbara Seaman's controversial book, The Doctors' Case against the Pill (1969), and reactions to it; the Gaylord Nelson hearings on the drug industry; the roles of feminist groups such as D.C. Women's Liberation; and the fight over an FDA-mandated patient package insert, the first of its kind.

The conflict between women, physicians, regulators, and manufacturers turned on the question of the Pill's safety: what were the absolute and relative risks of hormonal regulation of fertility? What defined "high risk": estrogen content, the woman's medical history, the duration of use? How could the Pill's risk be assessed against the risks of other contraceptive methods or of multiple pregnancies? The absence of consensus on these points, Watkins argues, revealed the tenuousness of medical expertise and created a new space for consumer activism.

This is a cogent argument, but many resonances of the story go unexplored. How did medical and cultural perceptions and expectations of sexual and fertility risk change throughout the decade of the Pill's introduction? What are the differences in the way physicians, epidemiologists, and consumers frame and interpret data on risk? How did women shape the expectation of "the right to . . . safe, and reliable contraception" (p. 137) within the context of a new feminist consciousness? Watkins could not have addressed such questions within the limited scope of this book; but she has handled her complex subject well, opening the way for further analysis and debate.

Marcia L. Meldrum
National Institutes of Health

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