Big Talk: The History Of The Pill - PART ONE

Before we start today's episode, we would like to begin by acknowledging the traditional owners of the land on which we're recording today, the Gadigal people, and pay our respects to elders past and present.

Hi, I'm Hannah. And I'm Sarah. Welcome to Big Talk. Big talk deep dives, the big news stories that you've heard of, but you don't know all the serious and salacious details about. We revisit the most shocking headlines of the past that have shaped. We know today. And in this episode, we're looking at the contraceptive pill.

Look, I mean, I've been on the pill. I've been on multiple pills. Have you been on the pill? Multiple. I don't think there's any woman that hasn't been tried for the pill. I was tried for the pill like year nine because I had heavy periods and bad skin. Like there's so many reasons that you're put on it. And everyone has their love or their horror story.

It's a discussion point over a wine. I'm really excited to talk about this because I ebb and flow between being very grateful for it and taking issue. But I also think what we want to explore here and we'll get into the pitch in a second, but I think it is this tension between recognizing what the pill did for women, but also that we're in a different generation, we're in a different world context right now.

And how can we improve it? What are the experiences of women and how is it failing us in some ways too? Maybe we should give the context at the very top. Tell me about your pill story. So I was put on the contraceptive pill probably year ten.

And I remember for some reason crying for an entire year, every single day, having a lot of fluctuations with, you know, my body and getting about ten months in and wondering why I felt really depressed. And I said to my mom, Can I go to a psych? And she said, Can we just try going off the pill first? Completely fine. Really? I was incredibly mood affected, depressive tendencies.

And I didn't try the pill again until I was at university for the reason the pill is intended to be used. And that kind of changed again, but everything fluctuated. Skin, hair loss, lots of different factors. And ultimately now I'm not on the pill, but I also have lots of friends that are. What's your story?

I was put on the pill in I actually think it was as early as like year eight. Yeah. Always had really bad acne. Yeah. They put me on the pill immediately for that. I ended up having to also be s be on it and definitely stay on it when I was on Ruracutane. Rakutane Girlies here. High five in the room. If you're listening, we're with you and we feel our chapstick in our pockets still to this day. It was such a tough one being on Rakutane and the pill.

And just being in a hormonal teenager at the same time because of course I was going through these huge mood fluctuations and I mean my mum that thinks I was a tyrant for most of my preteens, early teens.

Um, but it was really tough because I didn't know what was what either, because all of them could have been the culprit as well. You know, girls are scary regardless. I was the scariest of them all. Um Yeah, and then I have always stayed on the pill because and and I find this I've always had to stay on the pill because I tried to go off it. Maybe it was about three or four years ago now and I felt amazing off it. Like I was like, wow, hold on. Yeah.

I'm awesome. And then and then my skin got bad again. Yeah. And I went back to the dermatologist and I told her that I'd I'd taken myself off the pill. And she was like, Well, what the fuck did you do that for? And I had to go back on the pill. And I remember saying to her, like, I don't really know how this is gonna work long term though. Like, does this just mean that my cystic acne is gonna come back? What if I wanna go off the pill to have kids? And she was like Yeah!

Anyway, that's going to be $500. It's not funny at all. It's not funny at all. It's not funny at all. And I'm so I've stayed on it because I'm now s scared of going off it. And it feels a bit taboo to criticize the pill because of all of the benefits it provides, not just to women but to everyone. We should also caveat this conversation by saying it's always seen as like women's empowerment, but men are so protected.

by the experiences that we have on these forms of contraceptive. Um and they benefit so broadly from them that we're the ones paying for them and where the ones enduring the side effects a lot of the time. Yeah. And a lot of people who are on these pills don't have side effects and that should be noted too. But I also just love I was gonna say this at the top before we go into the pitch, we're really getting into it now. Um the names they give them. Like I was on Yaz and then I was

I did level in as well for a while, but I was mostly a Yaz girl. Wait, I could check what am I even on? Helen Brutus Helen, could you bring it back? I carry I have to carry it with I'm also so fucking bad at taking it. Like on it? Really? Stardust did my ten AM every day. Some people who do it straight when they wake up are so brave to me. That is so powerful. I remember being at a camp at school and some girl had the like

The one that beeps at you every day. Wow. And so she took it like right on time every day. And I was like, wow, I'm more of like a loose morning and afternoon. I like to just put satchets in like put the packet. on my bedside table, on my dressing table, in the car, at my work desk. There's always a sash. At some point in the day I go literally There is always a sash I knew you. And it's also funny because

I think on Estelle though, I've remembered. Oh, I've been on Estelle too. I've been on Estelle and Yaz. Thank you for saying that. I also want to say That there are people listening who are going to be a little bit more. That means it's ineffective. You drop effectiveness if you take it outside of the window. We know. We're terrible. Like you know, it's her Yep.

I am going to become an IUD girly very soon. Excited to announce that on the pod to think. Breaking exclusive. I have a lot of friends that are like, why aren't you on the IUD? And I go, because I have cystic acne. Well, I'm gonna give maybe we'll do a day in the life when come with me to get my IUD on the on the on the Instagram. I literally pitched to Hannah this week that we were gonna start doing like

Day in the life carousels. I was like, I think it'd be really fun to do these carousels. Also, sorry, can I say how you guys really pitched it? Sarah said. I know there'll be sort of an aesthetic difference. Sarah showed me hers, and it's like the perfect flat lay of her makeup bag, and she goes,

I know you're just gonna go like gotten out of bed and I'm like'cause I thought at first you were saying mine was gonna be way more aesthetic. I thought, that's very kind of you. Show me your photos and I went, Oh, I understand what you meant. I want for you the opportunities you deserve as my fashion forward friend, okay?

So l I know the listeners are nodding their heads along in car right now thinking if anyone can this is so on topic now. If anyone does take these photos, like these outfit photos, how the f- Fuck are you taking them? Do you all just have incredibly well lit places? I I don't get it. Where are you all getting this source of natural light and these ginormous mirrors from? Also, who's taking these photos?

Who who out of your friends is taking all these photos every morning? Can I just say I thought you knew the answers to this and I was too afraid to ask you because I thought you were gonna tisk tusk at me for not knowing. And this has been so affirming. Also, pulling this off the only big talk where we've been able to do this. Before the Iraq War, we could only do this about butterfly ballads. We did say before this we're like this one will be a bit chatty, won't it?

Should we do the pitch? Sorry. Also you did want to say you wanted to work in a wreck for big d for you also wanted to work in a notice to say please listen to the Iraq War episode and I found a way by just doing what I just did. So could you please listen to that too? I did.

I tha I did so much research on that big talk and it is particularly relevant right now. So please listen to it if you haven't. And I it's not that people aren't listening, I just think I should be the number one listened one. I actually think I should beat Hamer Shenandy this month, so let's go. Let's go for the pin. The contraceptive pill has been called many things, controversial, life-changing, revolutionary.

But one of its most impressive achievements is being so universally well known that we simply call it the pill. And it's also the first medication that was designed for a non-therapeutic purpose. Now it's estimated that over a hundred and fifty million women worldwide use the oral contraceptive pill. But these days, there's also a growing conversation, especially online, about going off the pill, how much we really know about it and what it's doing to women's bodies.

The pill is used for many different reasons. It's not just about preventing pregnancy. Many people take the pill to manage acne, heavy periods, PMS, or conditions like endometriosis and PCOS. And from the pill, the male contraceptive pill has also entered the conversation and there's been a rise of influences and misinformation. So in this big talk, we want to start by looking at the contraceptive pill's introduction in Australia.

Actually, not to go against you, but um before we dive into that, I wanna zoom out for a second and talk about and talk about birth control more broadly because humans have been trying to figure this out for a very long time. So thought I wouldn't take you on a bit of a history tour here. Let's let's get to the Bible. Thankfully I've managed to go back to ancient history. One of the oldest references we actually have of the of contraception comes from the Bible in the book of Genesis.

There is a story of Onan who practices what we now call uh Coitus Interruptor. Okay, History Channel presenter. Coitus Interruptus is Coitus Interruptus. That's kind of crazy. I'm gonna use that. Coitus Interruptus, which is hilarious. Uh it's also known as like withdrawal or the pull out method and in this story it was to avoid fathering a child with his deceased brother's wife. Awesome, totally normal.

So even thousands of years ago, people were thinking about ways to prevent pregnancy. Another example for you. In three hundred and eighty four to three hundred and twenty two BC The Greek philosopher Aristotle didn't think I'd be talking about Aristotle in the I didn't realize the pill was gonna go this far, but it's incredible. It's like in the Arach War I managed to like start f four years before it started.

So Aristotle is believed to be one of the first people to suggest using natural substances as spermics, things like cedar oil, lead ointment, or frankincense oil. And in ancient China, similar methods were used where women would drink a cocktail of lead in mercury. Obviously we know that's very unsafe. Um just because this is like do not drink on a bleach bottle. Obviously no that's very unsafe. If you're listening to this, that's do not do that. A cocktail of lead and mercury.

And it would cause obviously it would cause brain damage, kidney failure, death and sterility, which is the absolute permanent and irreversible inability to conceive. Now fast forward to twenty-three to seventy nine AD. So just recently Yeah. Let's just fast forward. Record scratch. Let's just Please insert a record scratch. No. That'll be awesome. Fast forward. And we have Pliny the Elder, who was the Roman author of natural history. And his advice.

Was to simply avoid sex if you want to avoid pregnancy. So he's actually the earliest known advocate of abstinence. So what sucks is like Pliny the Elder thought of that and schools Up until like two days ago. Stayed with that. Another Greek gynaecologist, Sanus, in two hundred AD told women to hold their breath during sex and then sneeze afterwards to prevent pregnancy. That's disgusting for a number of reasons.

How do you force a sneeze? How underwhelmed are you? Just look at the light to like not let a breath out. I really like to mention how little you must be doing. I also just gotta say I didn't realise this big chalk is gonna be my favourite again this month. Every month it's my favorite for a new reason. It's already my favorite with this. I'm not done. Jumping ahead to the eighteenth century. between seventeen twenty five and seventeen ninety eight.

We meet Giacomo Casanova. Oh, beautiful. In his memoirs, he describes some of his um experimental contraceptive methods. But most famously he recounts using the empty rind of half a lemon as a kind of primitive cervical cap Something you may have actually seen referenced in uh a few T V dramas. Sounds like it would sting. Sounds awful. Then in eighteen twenty seven there's a major scientific breakthrough.

And scientists discover the female egg, the ovum. So, up until that point, people only knew that semen had to enter the female body for contraception to happen. So identifying the open was the first real step forward in understanding the biology of human reproduction. Of course, women are always lagging in the health investigative space from this far back from recently. I blame plenty the elder.

By 1843, scientists had worked out something even more specific, that conception occurs when sperm enters the female egg. So before this, there was a widespread belief that men created life and that women simply provided a place for it to grow. So this discovery fundamentally reshaped how reproduction was understood. I don't think it's that.

I don't really think that point's being driven home and I was about to say that's kind of interesting'cause it's really seen as like men are the deliverers to women o and we are the vessels rather than we are the creators of life. By the eighteen seventies, birth control had become a lot more visible. At least in America, uh, a surprisingly wide range of contraceptive devices became available, including condoms, sponges.

douching syringes, diaphragms, and cervical caps. Okay, so back to the pill. Let's lay the groundwork of what contraception looked like just before the development of the pill and how it then came about. So, before the pill options were extremely limited, and most of them required the cooperation or permission of a male partner. Dun dun And if he wasn't on board, well Pacifically that's the end of the conversation. Um, not in my house, but it's like

You can see how this is kind of the way that of the world. Like even to recently when we think about the no-fault divorce and all of these kind of things that have actually empowered women to make choices in their relationships and about their own bodies. But in many countries, contraception wasn't just hard to access or to boo. Actually illegal.

Then in nineteen fourteen, Margaret Sanger entered the picture. She was a nurse in New York, a first wave feminist and an American birth control activist who opened the first birth control clinic in the US in nineteen sixteen. Her work was the cornerstone in setting up what we know today as Planned Parenthood. Now, it's important to note Marie Stowe.

who was also another famous advocate of birth control in the early twentieth century. But we're also going to focus on Sanger's work as she led the child for the development of the pill. Also If you're in Australia, Marie Stopes is still around and they have lots of c private clinics around the country that operate to provide reproductive health services like contraceptive implants and abortion services. Amazing clinic. I visited there many times. It they're an incredible team.

So, Sangha's idea of the pill came about from her time working as a nurse in New York's slums, where she watched women come into clinics absolutely overwhelmed and exhausted, and obviously sick from repeated pregnancy. She saw the toll of childbirth, like repeated childbirth, extensive childbirth, was taking on these women's bodies. And she also saw women risk and lose their lives from unsafe backstreet abortions. Yeah. Actually More on that.

the big talk we did on abortion rights. Yeah, on Roe v. Wade. It was that was a really again, my one of my favorites. One of my favorite It was one of my f it was an amazing also like the complexities of the feminist movement and the people at the front lines of this advocacy too. It's a great story.

I just want to focus on abortion for a moment too, because it played a massive role in the push for the pill here in Australia. Because at the time, the most common methods of birth control were abstinence, withdrawal, and breastfeeding. And there was so much misinformation around contraception methods, including coughing after sex to avoid conception. It's actually crazy that that's still Like we just Literally quoted something from B C that was a similar theory. Yeah, and now we're

Jumping that far ahead of the timeline. I mean, I can go on Instagram right now and find someone who tells I and find a reel of someone telling you to put your legs up against a wall if you want to have a girl rather than a boy. Like there's so much misinformation and like old wives' tales that still circulate on reels. Um a g if you're going to have a girl

You'll be ugly during pregnancy because she steals your beauty. People like genuinely she steals your beauty like a fucking Rapunzel. Like it's crazy. But yeah, there was so much misinformation like this, and these methods obviously didn't work, and in turn ultimately led to abortion-related deaths. From these botched situations. And we'll touch on abortion later in the chat because this is obviously going to filter through as a thread in all of the discussions we're having today.

But if we get back to the magic pill, the idea was born in nineteen sixteen, and most women obviously shared Sanger's desire for better out for better options and for better outcomes. But of course progress was slow. This would have been a very radical idea at the time. And it it it would take nearly fifty years, five decades of advocacy, research, controversy, and courage before that vision became a reality. It's actually

so hard to conceptualize a world pre. Oh my god. The contraceptive. No and the amount of Fear as a young woman to not have that option or like to have three, four kids already or whatever it is and not wanting to put your body through a another one. Yeah. And and also like my grandma talked to me about the introduction of the pill and remembers it, like distinctly remembers it as her experience, right? And

It kind of sometimes puts into perspective that, like, you know, we have very different political views. But I also remember the fact that she grew up in a world where she had no choices like this. Yeah. And She was expected to quit her job as a nurse and do all these sorts of things to like live the life that women had to live. Yeah.

And I al always think I try to bring that empathy when I'm kind of having a hard discussion with her politically'cause I go, I have also have so many benefits and privileges that you'll never understand. Yeah. Um, and it's just important to remind ourselves of that too.

But I think also we should quote Margaret Sanger because it really there's this particular quote that really helps I think paint the picture at the time. She said, No woman can call herself free who does not own and control her own body. No woman can call herself free until she can choose consciously whether or not she will be a mother. Wow. It makes me like want to cry. It's so impactful. And according to her writings,

Sanger believed that improved contraception measures could improve the lives of lower-income families by preventing the births of children that they couldn't afford to raise. And it's it's also important to note that in the early 1900s, It was a widely held view that a woman's place is in the home caring for her husband and children. And I think that's an interesting thing to say given that that's a resurging viewpoint now too. Yeah. You know?

And and Sangha wanted to change that, but obviously that wasn't easy. In fact, her first obstacle in trying to educate women about contraception was the Comstop Act. Uh, which was a law that basically made it illegal to share information about birth control. God, this is so irrelevant to literally today not BC.

It's just a lot of things that you've got to do. It's just like that constant relativity being itself. And I find what's interesting about the pill conversation, I know we'll get more into it, but like even talking to older women about doing this topic and them saying, It's so funny that To us, it was this big courageous act and it's like something we're so proud of. And as it should be filtered and like,

We should look back on it and be able to say, okay, what's actually in this pill? And like that's all really valid. But the way the tide turns again, it's interesting that just a generation, like it

It seems with history that you have like one generation in between and it's like th it like wipes the slate and you don't remember. Yeah. You know? The collective memory feels lost. Yeah. So To explain the Comstock Law a little, Congress passed it in eighteen seventy three And it's an anti-obscenity act that specifically lists contraceptives as obscene material and outlaws the dissemination of them via the Postal Service or Interstate Commerce.

So at the time the United States was the only Western nation to enact laws criminalizing birth control. Sanger hated this law. And so instead of backing down, she deliberately broke the law, knowing that it would spark a fight because she believed. The challenging it head on was the only way to force change. It's kind of interesting. It kinda speaks to the fact too that when there is an advocacy group often the first thing a government will do and this has been through a few big talks now

is enact a law against it that never existed otherwise. Actually what's interesting is that same sex marriage is a perfect example of this. In the uh like original kind of Australian law against who can get married so the in the original Australian legislation of who could get married, it actually didn't specify.

And I'm pretty sure it was the Howard government that specified it was between one man and one woman because same sex marriage became a conversation. So then it was we had to overrule and overturn a law that existed for decades but wasn't the original. I think it speaks to the power of these advocacy groups that only when it's questioned and actually raised Do they outlaw it? One way Sanger did this, though, was through her newspaper, The Woman Rebel, and in one issue in 1914, she wrote.

Is there any reason why women should not receive clean, harmless scientific knowledge on how to prevent conception? The woman of the upper middle class has all available knowledge and implements to prevent conception. The woman of the lower middle class is struggling for this knowledge. And this was because even though contraception was banned,

That didn't mean it didn't exist. So if you were a woman with the right connections and with a lot of money, then there were ways around it. You could pay for private care and you could often still get birth control or at least reliable information about it. It just happened quietly and behind closed doors. If you were poor, you didn't have medical connections.

or you couldn't afford a private physician, your options were very limited. This is so interesting because it also speaks to the limitations of the banning of abortion in the US. Because one thing that you will hear constantly is if someone like Melania Trump was to get pregnant, she would be able to access an abortion, but they legislated to control the lower classes. Yeah. They legislated to control bodies.

But it's actually actively available to those who can pay for it. So it's a r it's a class issue first and foremost. Absolutely.

So now we're gonna fast forward to when Sangha opened her own clinic. She was struggling to find any physicians or doctors to work with her, so much so that she had to use her sister, Ethel Byrne, who was also a nurse to fill a role. The clinic provided sexual education and birth control information And this is pretty impressive. During its first day of operation, the clinic served 150 patients.

Is like think of that outside of the social media era, outside of the internet. Think of just like the ability to actually service that many people, word of mouth. Like incredible. One of the flyers for the clinic read, Mothers, can you afford to have a large family? Do you want any more children? If no, why do you have them? Do not kill, do not take a life, but prevent. Yeah. Wow.

Cause I think they would have known at the time that abortion messaging would have been really controversial and complicated morally for people because we don't have the understanding we do now. And so to say like preventative

And to act kind of articulate that's not taking a life. Like that's a way to do that and to kind of get around that discussion, which is really would have been really complicated at the time. It also would have been di like that's a diabolical flyer for the time. Like it's really hard to put yourself in that time period. And how shocking that would have been. Yeah.

Sadly, the clinic was only open for ten days. So Sanger was then arrested for handing a birth control pamphlet to an undercover policewoman. Trader. Trader Sorry. But during those ten days, the clinic provided contraceptive information and sex education to Four hundred and sixty-four recorded clients. That is huge. It's massive. She made bail and then she went straight back to work. She continued to help women, and then she was arrested again.

So a month after the clinic first opened, the clinic was then shut down for good when police pressured the landlord to then evict her. I would guess that's a man. And this resistance and defiance went on for years, so much so that in nineteen seventeen, both Sanger and her sister were charged.

with distributing contraceptives in violation of New York state law and both ended up being convicted. During Sanger's trial, she argued that women had the right to enjoy sex without worrying about conceiving an unwanted child. But the judge wasn't convinced that They did, however, offer Sanger a more lenient sentence if she promised not to break the law again, but she refused, saying, I cannot respect the law as it exists today.

And she served thirty days in Queens County penitentiary in New York City and her sister was then sentenced to thirty days imprisonment and she began a hunger strike that garnered media attention. This queen is absolutely relentless.

I'm obsessed. Sanger's arrest also sparked discussions within the medical and religious communities about women's rights. So if we fast forward to the nineteen fifties when the pill really starts to come into action, Sanger teamed up with like Gregory Pincus and John Rock, the two key scientists behind the development of the first oral contraceptive pill, and private philanthropist and feminist Catherine McCormick to fund the research.

So now it's really important to understand how the pill was developed, because it took a very long time, and some of the reasoning behind this was not just politics or stigma, it was actually the science. To give you a a mini breakdown and I do refer to myself as a woman in STEM, I find this so seamless and easy to discuss. Female fertility depends on the maturation and release of an egg from the ovaries.

And so what that process is, well, it's controlled by a hormonal feedback loop. I get feedback loop. I love fe do we love feedback? We love you all love giving us feedback on the loop. A hormodal a hormonal one? I mean sometimes for me, and this feedback loop occurs between the ovaries, the brain, and the pituitary gland. It's kind of like a three way conversation happening inside the body.

every single month. Many scientists have explained this very well like this. Like this is not, you know, this is not my genius way of breaking it down. I'm not gonna claim that. Um, but the pill really comes in and interrupts the conversation. So what the pill communicates, what it tells the body is we've already ovulated, no need to release an egg. Then egg production is suppressed.

So it's disrupting that feedback loop and kind of communicating something incorrect to prevent pregnancy, if that makes sense. What the pill as a sort of physical act does, it also thickens the mucus at the cervix, which makes it much harder for sperm to travel. In turn, it then blocks pregnancy in more ways than just that communication cycle.

What's interesting, particularly interesting about this, I think all of it is, frankly, is by manipulating this hormonal feedback loop for contraceptive purposes, it's not a new idea. Some traditional medicines contain compounds that act in the same way as the pill, but people didn't really get the chemistry yet. There wasn't that understanding. And this is where clinical trials really start to come into play.

In the nineteen thirties, and again it wasn't until the nineteen thirties, that scientists conclusively showed fertility could be suppressed in rabbits when they received injections of progesterone. And that's a hormone normally produced by the ovaries during the menstrual cycle. Mm-hmm. So while this was a huge breakthrough at the time. The early experiments were also the early experiments were also incredibly inefficient.

The only source of progesterone was ovarian tissue from animals and thousands of ovaries were required to produce just a few milligrams. So it's obviously an incredibly complicated process. It makes me feel sad. Yeah, that's it. Makes me feel sad. But this problem's also quite quickly overcome in the early nineteen forties.

there's this method developed to extract large quantities of progesterone from a wild yam species native to Mexico. Fun fact, I'm sure that one's coming up a trivia. I hate So many fun facts in this And suddenly, progesterone could be produced in bulk, plus the new form could also be taken orally, no more injections. Great. Huge win. Huge win for the anti-needle girls. Huge win for those who faint.

There was also another unexpected bonus. The yam extract also contained small amounts of mestrinol, a form of estrogen. Earlier studies had shown that estrogen helped reduce breakthrough bleeding, which had been obviously a quite a common, frequent side effect of having the progesterone alone. So just like that. The scientific puzzle, the jigsaw, is getting filled. Yes. Great. Thank God. Thank God. But before it could be released onto the market, it needed to be tested on women.

And this is where clinical trials start in humans in nineteen fifty four. God, that would have been a terrifying one to start on. Yeah. Yeah. And I mean, do you sometimes see the clinical trials now and you go, I couldn't do it. I couldn't do it. No An initial plans to trial the pill in the US didn't last long.

Researchers struggled to recruit enough women. Again, this is the issue. And participants dropped out because of the side effects. I mean, we experience the side effects now. Imagine being the first to put your hand in the air. Holy shit. The trials this is also terrible what I'm about to say, right? So the US couldn't recruit. So they moved the trials to Puerto Rico.

There, the pill was tested on hundreds of women. And this is where the story takes a really dark turn because the women involved in these trials. were not told they were participating in an experimental drug trial and they weren't informed of the risks. I don't understand how that happens or how that gets green lit. It's like

It's so hard to even express any words about that because it's like also these women sacrificed so much and we have the contraceptive pill now that needed to be tested on people, but to do that coercively through misinformation and disinformation because you needed outcomes is fucking evil. Evil. Right? It's evil.

As a result, during the trial, two of the women died. Almost 20% of participants reported side effects. These included headaches, dizziness, nausea, weight gain. And this is because there was like in large part, extremely high hormone doses in the earliest versions of the pill. Also

Headaches, nausea, dizziness, weight gain, current side effects. Yeah. And I would suggest. But imagine being the first one to do it. You'd also feel like it's something like Yeah, you'd be so good. Consent to it. You know, informed consent about this. Years later, critics have condemned the trials as both imperialistic and unethical. Absolutely.

And they question the morality. I mean, I don't think we need to question it, it is immoral. Like I don't think we need it, but it specifically on poor, undereducated Puerto Rican women who were given minimal to no information about the experimental nature of the studies. Like These these trials in many ways also set the framework for informed consent. But that obviously we'll s we'll talk about that a bit more later. We'll also get into like the male contraceptive pill, but

So much of that wouldn't have been able to happen today, I don't think. And that's why I think it's It's virtually impossible to get a male contraceptive pill off the ground. Yes, I have lots to say about that, as I'm sure lots of listeners do too. But from a purely scientific standpoint, the pill worked because despite the raft of side effects, only one of the women in Puerto Rico became pregnant, and then the therefore the trial was obviously considered a success.

And in nineteen fifty-seven, the pill was then approved for use in the United States, but not as contraception. It was approved to treat, quote unquote, menstrual disturbance. That sounds like a horror film. And finally it became a contraceptive in nineteen sixty menstrual disturbance. A year later in nineteen sixty one, approval was

followed in New Zealand, Australia and the UK. And after 50 years, so nearly 50 years, Margaret Sanger's magic pill hadn't arrived, had come to be. And contraception, as we know it, changed forever.

Jumping back into informed consent though. The pill and those unethical human trials in Puerto Rico were part of a big reason informed consent on medications exist. And this is when patients participating in drug trials must be fully informed of any potential risk before receiving any treatment. So during this time there were really low standards for drug tests because the success of wonder drugs like antibiotics and cortisone, people had a lot of faith in the power of science and medicine.

But this started to change after the thalidamine tragedy in the early nineteen sixties. which sparked public outrage and quickly reshaped attitudes towards these experimental drugs. So the sedative prescribed to European women for pregnancy-related nausea was found to cause severe birth defects while still waiting approval in the US. And so in response, Congress passed a drug amendment in nineteen sixty-two, which introduced stricter rules for drug testing, for marketing and advertising.

The law also required patients to give informed consent before joining drug studies, fundamentally changing how Americans took part in clinical trials and their expectations for safety of drugs approved by the FDA. But by the time this amendment was in place, the birth control pill had already been approved by the FDA and was on the market for two years now.

And so in 1963, over 2.3 million women in the US alone had sought prescriptions for the pill. Then over the following six to seven years, with the thalidamine disaster still fresh in everyone's public memory. Reports of side effects began appearing in medical journals and spreading through the popular press and women's magazines. 1969 now, Barbara Seaman's book, The Doctor's Case Against the Pill. Also, can I just say horrible last name for her to have?

I could not let that go'cause I'm sure someone was thinking it. Barbara Siemens' book, The Doctor's Case Against the Pilf. Also, just for readers, just for readers, just for listeners, it's S-E-A-M-A-N, but like funny guys. So she writes a book, brought widespread attention to these side effects, and directly prompted Senate hearings in early 1970.

So hearing from experts about the risks, many women activists were outraged that doctors had not fully informed patients about the pill's potential dangers. They felt that they had been treated like guinea pigs. They had been. And their protests helped expand the concept of informed consent, which challenged the medical establishment's practice of prescribing drugs.

especially to women without adequate explanation. So thank you, Samen, actually. Yeah, and but also like what she's pointing out is the fact that it's kind of always women's stuff that this happens during. You know, it's the side effects are so extensive here. That there was new frontiers of informed consent because of how fucked up it was. Like that's always we are the guinea pigs. That's exactly the point. Go semen. Yeah. We love her.

Another go to book for women who wanted to know about and control their own fertility was Our Bodies Ourselves, published in 1971 by the Boston Women's Health Book Collective. And as a result of these women's movements, mostly in Western societies, the FDA required drug companies to include a patient information leaflet with every prescription, giving women the knowledge they needed to make informed choices about the pill.

While the Pill's clinical trials had met the FDA standards in the nineteen fifties, they fell short by the nineteen sixties expectations, and by nineteen seventy, the era of blind faith in drugs as perfect solutions to social, economic, and medical problems was over. And so people Came to understand that every medication carries risks, and in this new landscape, informed consent became a central principle of medical ethics and practice.

But then if we're to bring it to a local context, if we're coming back to Australia, the release of the oracle receptive pill called A Novela in Australia on the first of february nineteen sixty one ushered in this momentous change in our lives. Australia became only the second country in the world to gain access to the pill. What a leader. Just after the US.

But it could only be given but with a written prescription by a medical practitioner, and a lot of doctors at the time were against it. Some for safety reasons, others for religious. Does that sound familiar? And a quick side note here actually as well. So from the eighteen eighties, Australia's birth rate had been declining. Again, still definitely a story.

And that raised concern among doctors and government officials. There was this growing anxiety that women were deliberately limiting their fertility. Oh no, choice, question mark, exclamation mark. I was actually watching clips this morning about um Stephen Bartlett. Yep. And just like him and that

I can't even remember who whose guest was, but I was just seeing clips come up and I was like, these two childless men are very concerned about the birthday club. Yep. It's really terrifying. And uh in response to these concerns as well, the New South Wales government set up a royal commission.

In nineteen oh three to investigate the falling birth rate. What if you s economically supported people so that men and women were both culturally in the home and working? Anyway, I've got into that for a long time. Queensland University Associate Humanities Professor Dr. Lisa Featherstone wrote that the report of the Royal Commission unequivocally linked the use of contraception and abortion to the deterioration of the nation.

In particular, commissioners were vitriolic in their condemnation of women as selfish in choosing to limit families, saying that all key social, political and economic figures agree that reproduction was central to the maintenance of white Australia. And this is what we're talking about when we're talking about immigration as well. We should never talk about immigrants only in the context of labor and the economy.

But it's so interesting to see men, white men, argue against immigration when we're also talking about the fact that like birth rates are not going up in Australia. Because they say men are not providing the kind of we don't have the i economic security to have more children. And the immigrants are a central part of that. And it's just so interesting to see this white Australian narrative pop up here because it was so core.

to the entire discussion and remain so as well. Now, at first, the pill was only available to married women, which contributed to a drop in fertility within marriage, as many newlyweds took advantage of the opportunity to just delay starting a family. And on top of that, interestingly, the pill was hit with a twenty seven and a half percent luxury tax. And it's a luxury to choose what to do with your own body.

But I get it, they would have framed it, marketed it through the lens of sex is a luxury. And if you choose to risk that, like you can see how the messaging would have been. So the pill and the control over your own reproductive future was classified as a luxury like perfume or jewellery.

but it still gave women the freedom to avoid unwanted pregnancies and planned parenthood. And because of this increased control over their fertility, more women were able to enter the workforce. Oh no No, we had to work.

That increased participation in turn heightened social visibility, which became the foundation for broader social change. This really stimulated the next wave of feminism in many ways. Movements pushing for equal pay, for equal work, and legislation protecting women from discrimination.

When it comes to how the pill has provided equality for Western women, one study in the United States found that in nineteen seventy, before the pill was made legally available to single women, Female applicants to law and medical schools made up only 10% of the applicant pool, but then twenty years later, women made up fifty percent, showing how the pill gave women the ability to plan out longer term career goals and have more control over their lives.

In turn helping them to be financially independent from men or husbands. No, it's it like cannot be underestimated. Yeah. One of my favorite small talk episodes was with Dr. Jen Gunter. Yes, it's an amazing episode. And we did this last year, especially and we'll get into this Um I think this is in part two, but about conversation around women turning against the pill again.

It was so interesting to talk to her because I really thought she'd go on a journey explaining it. And she was just so black and white about it. She was like she is. She was like I could do my degree because I had the pill. Yeah. I had cramps and whatever else and I didn't have to worry about that and I was able to finish my degree.

I was able to do this, this, this, this, this and I wouldn't have been able to do that with done that without the pill. So what's your problem? I was like, so true, Coin. Yeah, it's really helpful to be kind of slapped out of it a bit, you know? Yeah. Then in nineteen seventy two, the pill was made available to all women, not just married women.

In the US and during the 1970s in Australia, single women started to gain more access to it through family planning clinics. But this wasn't the case for the more conservative or Catholic countries like Ireland, where contraceptives were illegal until nineteen eighty. Insane, isn't it? Nineteen eighty. Coming back to 1972, and Australia went through another major shift that occurred due to Prime Minister Gough Whitlam. Another big talk. Another big talk.

In his first ten days in office, Whitlam abolished the luxury tax on contraceptives altogether. He did a lot in those ten days. Oh my god. L Whitlam King Yeah, he did the most. He also placed the pill on the pharmaceutical benefit scheme, reducing its cost to just one dollar per month. Again, king. PBS amazing. That's huge. Amazing.

And in many ways, that decision cemented the pill's place, not just as a medical breakthrough, but as a catalyst for social transformation in Australia. So the combined oral contraceptive pill is still the most popular contraceptive in Australia. 'Cause it's made up with estrogen plus progesterone. And we know that the pill is less invasive than implants or devices that need to be fitted in the arm or the uterus, which makes it an attractive option for many people.

There's also the progesterone only version, which is called the mini pill, which is used when someone can't take estrogen. It works mainly by thickening the cervical mucus, which we mentioned before, but most people will keep having periods while still on it. In fact, There are actually more than 30 different types of oral contraceptive pills. Each brand contains varying sizes and doses of synthetic estrogen and progesterone.

So the pill is not a one size fits all. As we were saying, a lot of people have tried multiple until you find what works for you. How many do you reckon you've been on? Three. I think I would have been on three or four by now. Yeah. But the pill paved way for so many forms of contraception like Plan B.

implants, hormonal IUDs, and the ring, it also changed the way we speak about sex and consent as a whole. Five years after the pill became available, the first national health survey in Australia revealed just how quickly it had taken hold. About 20% of women aged 18 to 49 said they had taken the pill in the two days before being interviewed. And even that figure was probably conservative.

At the time, women were typically instructed to take the pill for three weeks out of every month, so a two-day snapshot wouldn't capture everyone who was using it. The highest uptake was among younger women. There was thirty-five point four percent of those aged between twenty and twenty-four, along with twenty-nine point one percent of women aged between twenty-five and twenty-nine.

And also in those early days, these pills had much higher doses of hormones than we're used to today. And so as a result, there was a lot more side effects. But they were removed from sale in nineteen eighty-eight and replaced with lower dose versions. And by nineteen ninety-five, birth control had become the norm for most Australian women of reproductive age. According to ABS, around two-thirds were using some form of contraception and forty percent were choosing the pill.

However, it is important to say that safe and effective birth control still is not available to everyone, and it's still a privilege to those who have access to it. In fact, the World Health Organization reported back in 2017 that an estimated 214 million women of reproductive age in developing regions are still not using a modern contraceptive method.

Now, I want to also briefly talk about the history of women's hormones and how we talk about them. And I'm actually really glad we're bringing in Sarah E. Hill now. Sarah is an associate professor of psychology and the author of How the Pill Changes Everything and the Period Brain. Now I've read How the Pill Changes Everything.

I don't think there's a book I've recommended more. Really? It was like a life-changing book for me to read. It is a scary book to understand how the pill works, but it was really helpful for me to understand my birth control choices. And she spoke at a lot about the idea that women have a history of being treated differently because of their sex hormones. often getting told that we're overly emotional or have a less rational way of thinking than men.

And there's been a lot of sexist rhetoric saying that because of this, women wouldn't be capable of holding important jobs, owning land. or voting. And a lot of it was due to this like claim of cyclically changing hormones making us completely irrational, right? But Sarah really breaks down how this is just completely untrue. Obviously.

And how it's simply just not backed by science, because yes, while women's hormones change cyclically, they're not unpredictable. Pointing out that all you need is a woman's age and the first day of her last menstrual cycle, you can predict exactly what all of our sex hormones are doing.

So if that woman is in the first half of her cycle, you'll find that the sex hormone estrogen is pretty high. She's in the second half, you can predict that you can predict that progesterone levels are pretty high. It's actually quite straightforward. Yeah. And when it comes to men whose primary sex hormone is testosterone, It's a totally different story, way less predictable actually.

Research shows that men's levels of testosterone change as a result of many different factors age, fatherhood, time of day, watching sport, political loss, being around attractive people, marriage, and even if they have weapons like guns. Like this is clearly, interestingly, actually a contrast to the claim that we're the irrational ones that shouldn't be trusted. Like, and again, this there's so much to consider here, but it's an interesting contrast to offer.

So if anyone has unpredictable hormones, it's actually male sex hormones. And she also points out. that the idea that our sex hormones influence our brains shouldn't be problematic if both men and women are impacted. Yeah. And if we don't have conversations about this, women suffer and in turn men suffer. It's so, it's so funny this conversation because

Yes, we go through cycles in ways that guys don't. Yeah. And yes, there are parts of my cycle that I'm not as into sex or whatever it is. But like, and yes, that does impact the way I think and approach. relationships or whatever throughout the month, right? Mm-hmm.

But the way their hormones mean that they are constantly thinking about sex. You know what I mean? Like everyone impacted by that so many frameworks and structures that tell us that men want sex and women don't want sex and all these things and actually

All of the things we're taught to believe I are not true. You know? And so by talking about this, it enables us to look at how we're impacted, understand it, and make decisions as a result of that adequate, accurate knowledge. Because they're a key part of the way our brains work. So, you know, we need to understand how the pill alters these and how we are actually changing the way our brain works. Let.

End episode one now. And um We're gonna come back for part two. It gets released on the same day now. So you can actually just immediately jump over. But if you wanna break it up, you can. We've we've given you that option. But I'm really excited because in part two we're gonna go through More of the modern day rhetoric around this, how we're seeing this conversation change online, and also more about the male contraceptive pill.