Dear Mrs. Sanger

      I received your pamplet on family limitation.... I am 30 years old have been married 14 years and have 11 children the oldest 13 and the youngest one year. I have kidney and heart disease, and every one of my children is defictived and we are very poor. Now Mrs. Sanger can you please help me. I have miss a few weeks and I dont know how to bring myself around. I am so worred and I have cryed my self sick and if I dont come around I know I will go like my poor sister she went insane and died. My Doctor said I will surely go insane if I keep this up but I cant help it and the doctor wont do anything for me. Oh Mrs. Sanger if I could tell you all the terrible things that I have been through with my babys and children you would know why I would rather die then have another one. Please help me just this once and I will be all right. Oh please I beg you. Please no one will ever know and I will be so happy and I will do anything in this world for you and your good work. Please please just this time. Doctors are men and have not had a baby so they have no pitty for a poor sick Mother. You are a Mother and you know so please pitty me and help me. Please Please.

Sincerly yours
[J.M.]

p.s. Please tell me how to get the pessary rubber womb cap. Not even the Doctors here know about them that is what thay tell me.

CHAPTER ONE

The Conception

Victory has a hundred fathers,
but defeat is an orphan.

—Count Galeazzo Ciano, diary, September 9, 1942

At a neighborhood supermarket in the university town where I live, now and then I see a man shuffling through the checkout line, smallish, bald, stooped with age but spry. He grips a paper bag that droops with a grocery item or two, scarcely enough for a single meal. His dark brown suit jacket doesn't match his darker pants, and a pair of solemn eyes dart this way and that, stirred by some restless hunger. I wonder, looking around the huge store, if a single shopper among the young collegians and profs and townies has any sense of how this almost invisible ninety-two-year-old has touched their lives intimately and has helped redirect moral beliefs and sexual practices in most of the nations of the world. Since Russell E. Marker lives alone and avoids cultivation of friends, remarkably few townsfolk know who he is or what he has done. At the mention of his name, those who know something of him are likely to look distantly into their memories and say, "Marker. Isn't he the one they call the Father of the Pill?"

    Indeed many do, but they are not quite right. Fifty summers ago, Marker, a chemist who never earned a Ph.D. and whose name is scarcely known beyond a small circle of scientists, took a creaky overnight bus to where a small bridge spanned a lethargic river in a tropical wilderness of Mexico. From that desiccated soil he dug out cartloads of stinking thick roots and hauled them away until he had piled fifty tons of the grimy brush behind a potter's shed he had rented to use as a crude lab. Then, during weeks of sweltering, lonely drudgery, Marker extracted from those roots a syrupy potion. That substance led, along a roundabout path, to one of the life-changing inventions of the century. Without his discovery and his toil, the birth control pill as we know it could not have been created.

    Russell Marker did not invent the Pill. He has repeatedly tried to make that clear, but his denial refuses to take root among people who talk of him. Again and again he has said that prevention of pregnancy as a goal never crossed his mind. His quest was simpler: a low-cost elixir in a new family of medicines called steroids. As in many of the great detective stories of science, Marker, with no thought of creating anything like a social revolution, discovered something on a path to something else, which provided someone else with a clue to something else, each goal along the way smaller, far less ambitious than the final breakthrough.

    Nor did a pill to prevent pregnancy enter the thoughts of another ambitious scientist, young Carl Djerassi, who soon deciphered a puzzle that became the next essential step on the way to chemical birth control. But although some loosely label him too the "Father of the Pill," Djerassi, like Marker, has said again and again that he did not dream of contraception as a goal of his work.

    Nor did it occur to one Frank B. Colton of a Chicago drug company who solved the same puzzle as Djerassi in an almost identical way at the almost identical time.

* * *

The contraceptive pill was born unplanned—at least by the scientists most widely named as its parents—and it has lived a life full of surprise. Of many consequences that its creators never imagined, one is symbolically more remarkable than any other: To identify this extraordinary drug among all the thousands of potions, powders, capsules, caplets, tablets, and nostrums for sale at any pharmacy anywhere, all you need to do is spell the word pill with a capital P.

    Over the past thirty years, the Pill has been swallowed as a daily routine by more humans than perhaps any other prescribed medication in the world. Its takers have counted in the scores of millions, and they have now downed the Pill by the hundreds of billions. Yet its eager consumers are, in general, quite well. Most take it neither to cure an illness nor to guard against one. The Pill has been called "the first medicine ever destined for a purely social, rather than a therapeutic, purpose."

    The short, paradoxical, twist-and-turn history of the Pill is never more elusive and fickle than when we try to answer the most ironic question of its existence: Who brought the thing into the world?

    And why?

    During the 1960s, the first decade of the Pill's life, the surest answers were sounded by voices of religion: The Pill was conceived by the devil to sow wickedness.

    By its second decade, the Pill, having become swiftly and hugely profitable, broke out with a marked rash of medical side effects, inviting a new explanation of its existence: The Pill was a plot authored by greedy drug companies with the compliance of submissive doctors. That reading, however, does not sit well with a retrospective look at the facts. When drug companies were first presented with the prospect of a contraceptive pill, scarcely without exception they couldn't run from it fast enough. Furthermore, the men who ran those drug houses (yes, virtually all men) could not believe that many women would choose to swallow chemicals to prevent babies. But one company, then another, did dare market the Pill, and they were soon happy to discover how to reduce its active chemicals so that earlier side effects largely disappeared.

    And in its third decade, recently ended, the Pill aroused perhaps the most surprising resistance of all. Many daughters of the post-1960 women's revolution, which is almost exactly as old as the Pill itself, began demanding to know why it must be the woman who is called upon to swallow exotic concoctions and take medical risks. Those wonderful men of science who so ardently committed themselves to seeking a chemical "liberation" of women, why have they not troubled themselves to invent a pill for men?

    Good questions, not yet satisfactorily answered, but they too harbor a factually incorrect assumption. The vision of a contraceptive pill was not men's in general or any individual man's, although at least five men of science have been publicly designated "the Father of the Pill."

    Even the "father" who could stake the strongest claim of deliberate paternity, a man named Gregory Pincus, didn't think of inventing a birth control pill until the arresting scheme was proposed to him by two women who had a clear vision of exactly what they wanted—a "perfect contraceptive"—and who plunked down hard cash for producing it.

    Those two women "stand by themselves as the indisputable mothers of the pill," in the words of Loretta McLaughlin, the biographer of a fifth frequently named "father," Harvard gynecologist John Rock. "From the moment they came on stage in the saga of its development, they took command of the scene. They did no less than commission the eminent male scientists who were to be the principals in its emergence, to make or find them an oral contraceptive. The women made it plain that what they wanted was a pill—like an aspirin—that would be cheap, plentiful, and easy to use. Moreover, the women virtually directed the men to be quick about it."

    Of those two women, one had devoted a long life to transforming her personal cause into a public crusade; the other cherished and guarded her obscurity.

    Margaret Sanger at the age of thirty-four coined a radical and inflammatory expression—birth control—and went on to found the International Planned Parenthood Federation. In 1950, after turning seventy-one, Sanger, still in full battle dress, joined forces with seventy-five-year-old Katharine McCormick, and together they set out to enlist science in their bold quest for a contraceptive that could be swallowed. Within a decade after commissioning that minute technology, it was physically produced, field-tested for effectiveness and safety, and approved by government. Thereafter it changed how human beings behave.

    Millions today embrace the Pill as a salvation, while other millions shun it as sinful or a time bomb of dormant cancers. As a new century approaches, the tiny Pill persists in driving wedges between major religions, schools of medical opinion, factions of feminists. The Pill has brought the Roman Catholic Church into its most threatening confrontation with science since Galileo and its hierarchy into its most embarrassing defeat. Many attribute to the Pill more than to anything else the sexual revolution of the 1960s, although that judgment is far from secure. Perhaps more than any other influence, the Pill helped prepare the ground for later battles, both legal and moral, that have surrounded abortion, battles that clearly will continue to flare for many years.

    As it was intended to do, the Pill has disconnected fear of pregnancy from the pursuit of sexual pleasure. But, intended or not, it has done far more. The Pill has led each of us, women and men alike and in a most personal sense, into a new era of potential mastery over our bodies and ourselves. As the first systemic contraceptive, it altered the routine functioning of the healthy human body. It opened the gateway to what I shall call the Era of BioIntervention, which is already taking us beyond reregulation of the human reproductive system. It is taking us beyond medicine into an eventual ability to modify—genetically—other body functions as well as our physical form itself. Perhaps the story of science's accomplishment in creating the Pill, and of some of its social repercussions, may help us better understand the ramifications of what we are poised on the rim of being able to do.

    Already we know how to bring forth a baby from a mother who provides the womb while another furnishes the egg. We rapidly progress toward dispensing with fathers—seeming to need only their sperm deposited in plastic vials. Now that we can ascertain the sex of a baby before its birth, how far ahead lies the advance choice of its sex? Will humans want to—and be able to—resist that gift of science? And how soon will our new ability to splice and rearrange our genes—in a sense, the reinvention of ourselves as a species—offer us exotic choices, thus inviting social, religious, and ethical trials, conflicts, and crises that we cannot yet comprehend?

The moment of conception of the Pill is most often pinpointed as early 1951 at a dinner in New York arranged by Margaret Sanger. Her guests were an ally in the birth control movement since the 1920s, gynecologist Abraham Stone, and Dr. Gregory Pincus of Shrewsbury, Massachusetts, a research scientist of minor notoriety. Pincus, the world's foremost authority on the female component of fertility, the mammalian egg, had once managed the fertilization in a test tube of the eggs of a rabbit, and the eggs started dividing as they would in a uterus. His friends called the process "Pincogenesis." No one succeeded in reproducing the experiment independently, a standard requirement for proof of a claim in science. (Pincus acquired even more sinister fame—as "America's Count Frankenstein"—when a typographical error in a newspaper report of the rabbit experiment omitted a vital word: "Dr. Pincus said emphatically that he is [not] planning to carry it on to find out whether human babies can be made by test tube methods.") Pincus had since started and now directed a small, struggling, private research laboratory grandly titled the Worcester Foundation for Experimental Biology.

    In the common way of history, nobody at the dinner was fully aware of the importance of what they were doing. Nobody connected with the event noted it in a journal or diary or transmitted word of it in any known surviving letter. For that reason, nobody knows exactly when the fateful meeting took place, although there is general agreement among those who have tried to track it down that it was in January or February. Nor does anyone know just where it was. Previous writings have placed the meeting in Margaret Sanger's New York apartment. The problem with that is that in 1951 she had no New York apartment. Perhaps it was at the Waldorf-Astoria, where Sanger usually stayed when she visited New York from her home in Tucson, Arizona, or perhaps at the Carlyle Hotel, where she sometimes occupied an apartment kept by her son's wealthy mother-in-law.

    The meeting, wherever it was, seems to have been spurred by a letter Sanger had received a few weeks earlier from Katharine McCormick, the daughter-in-law of Cyrus McCormick, inventor of the mechanical reaper. Mrs. McCormick was, in the words of the Harvard gynecologist John Rock, "as rich as Croesus. She had a vast fortune. Her lawyer told me she couldn't even spend the interest on her interest. She built dormitories, she built churches, she built hospitals. And she was hepped on birth control. So, inevitably, Mrs. Sanger got in touch with her."

    Actually, it was McCormick who got in touch with Sanger. Their paths had crossed casually over the years, but in October 1950 McCormick wrote earnestly to Sanger to address "two questions that are much with me these days: A) Where you think the greatest need of financial support is today for the National Birth Control Movement, and B) What the present prospects are for further birth control research, and by research I mean contraceptive research."

    No dawdler, Sanger fired back a reply that might disconcert a good many who revere her: "I consider that the world and almost our civilization for the next twenty-five years, is going to depend upon a simple, cheap, safe contraceptive to be used in poverty stricken slums, jungles and among the most ignorant people. I believe that now, immediately there should be national sterilization for certain dysgenic types of our population who are being encouraged to breed and would die out were the government not feeding them."

    Sanger suggested a start-up research fund of twenty-five thousand dollars "definitely to be applied for contraceptive control." She said it should be divided among five or six universities "in this country, in England or in Germany." (Germany so soon after World War II? Because of that country's experience in sterilizing undesirables? Sanger would soon be persuaded to drop sterilization of "dysgenic types" from her pronouncements.)

    In conversation with her dinner guests, Sanger chose her moment to look directly at Pincus and pose the question of the evening: What would it take to enlist science in finding the perfect answer to contraception?

    His reply, while forever unrecorded, clearly encouraged her. Before long, Sanger and her friend Katharine McCormick were visiting Pincus in his laboratory in a redbrick box of a building on a winding, tree-shaded avenue of Shrewsbury, a suburb of Worcester.

    They made a contrasting trio. Pincus's dense bush of graying hair and piercing black, ominously shadowed eyes almost a caricature of the menacing scientist's, played against his gentle and observant look of sympathy, a private brooding that bespoke his Russian-Jewish forebears. Except for those luminous dark eyes, he wore a remote, almost haughty air. Pincus was described by a young French scientist who met the famous endocrinologist during a Paris conference, Étienne-Émile Baulieu, who would one day develop an abortion pill called RU 486, recalls: "We all crowded into the hall for a look.... Pincus merely nodded his Einsteinian head. His thick, bushy eyebrows bunched in a frown. He was not tall, but he stood ramrod straight, hardly noticing anyone around him. After a few perfunctory handshakes, he was gone.

    Had Pincus not already met Sanger and McCormick separately, he might easily have mistaken one for the other, as a colleague did, taking the one who stood almost six feet tall with the military shoulders, swooping-brim hat, and ankle-length matron's skirt to be Sanger, the embattled lifelong radical. But that one was Katharine McCormick, whose tastes in clothing had frozen almost a half-century earlier, in 1904, the year she had married. Pincus was aware that at about the time of that marriage she had become one of the first women to earn a degree in biology at the Massachusetts Institute of Technology, although she never used her training professionally. Standing beside her, the visitor with the elegance and restrained aura of wealth was the one who had molded herself from poverty, indeed from shame. Margaret Sanger was slight, scarcely five feet tall, with a striking crown of auburn hair that permitted confessions of gray, a cautious gaze through wide-apart gray eyes, and a subdued voice that drew her audience close. "But woe be to him," once warned Mabel Dodge, an early birth control ally and hostess of a famous New York salon, "who was misled by this calm exterior into ignoring the tremendous fighting spirit, the self-generating energy and the relentless drive that lay beneath it."

    Could Pincus and his coworkers, the women asked again, produce a physiological contraceptive—not just a physical barrier between sperm and ovum—that would be safe and be available soon?

    What, Pincus inquired, did they mean by soon?

    One sees McCormick deferring to Sanger: The next few years.

    Pincus hedged: Yes, probably, he could do it, but nobody could guarantee it.

    Could he come close to guaranteeing it if he were assured of adequate money for laboratory staff, for supplies, for gathering and reinvestigating every scrap of relevant information from the scientific literature?

    Known for his file-cabinet mind and index-card memory—and by his coworkers for reading mystery novels at the rate of almost one a night—Pincus silently riffled through possibilities, then speculated aloud that the perfect answer to Sanger's "perfect" contraceptive probably lay in clever use of a hormone. The trouble was, he knew some of the formidable obstacles blocking that path to the perfect. If it was intended to be used by many women, where was a large supply of the hormone to come from at a cost that even the rich among them could afford? And how was a woman to take it?

    That, pressed Sanger, was what she was hoping Pincus might become interested in finding out.

    Mrs. McCormick unabashedly pointed out that she was prepared to pay for finding it out—soon.

    The suggestion had a tantalizing providential undertone. In 1951 Pincus's most absorbing mission was to keep his Worcester Foundation for Experimental Biology financially afloat.

    That was a very severe word, guarantee, Pincus responded. But yes, he thought so.

    Would he commit himself and his foundation to it if he got the money?

    Pincus replied: Yes, he would.

    Then a barrage of discomforting questions: What would it cost? When would he get started? When would he deliver?

    Science, resisted Pincus, does not work that way.

    Mrs. McCormick's life had taught her that most human undertakings do work that way. She pressed for an estimate.

    According to a recollection years later by his widow, Pincus surrendered to a guess: "Right off the top of my head, I'd say one hundred twenty-five thousand dollars to start."

    Mrs. McCormick drew a checkbook from her purse. Writing a draft for forty thousand dollars, she explained, "This is the end of the fiscal year. I'll talk to my financial man, and you'll get the rest."