In The Birth of the Pill, Jonathan Eig tells the fascinating story of the four people whose combined efforts, arguably more than any others, made birth control effective, affordable, widely available, and perhaps most importantly (since it makes all the others possible), socially acceptable: Margaret Sanger, Dr. Gregory Pincus, Dr. John Rock, and Katherine McCormick.

At the time the contraceptive pill was being developed, human reproduction was still very poorly understood. Prudish attitudes and obscenity laws hampered scientific research, discouraged and in many cases prevented doctors from educating their patients, and kept women from having any significant degree of control over their own bodies or the decision to become pregnant. It took a few independent-minded, morally driven people of unusual character to achieve change in the arena of reproductive rights.

Two of these four had spent years caring for people whose unchecked fertility threatened their own life and health, and the well-being of their families. Women, especially poor women, found themselves pregnant again and again before their bodies had recovered from earlier pregnancies, had medical conditions caused or exacerbated by pregnancy and childbirth, or could not afford adequate food, clothing, shelter, and health care for their rapidly growing families. Many women also found too many pregnancies burdensome, as they were prevented from pursuing an education or a career, or suffered from exhaustion, depression, and feelings of hopelessness as they found themselves caring for more children than they could cope with.

Margaret Sanger and Dr. John Rock encountered all of these problems up close and personal; their birth control activism was the direct result of their experiences as reproductive health care providers. Sanger worked for many years as a nurse caring for the poorest people in the slums and tenements of New York City. She was so moved by the plight of these women that she risked fines and imprisonment to open the first ‘birth control’ clinic (as she coined the term). Countless poor women, who had often already fled starvation, poverty, and disease in their home countries, found themselves unable to escape the cycle of repeated pregnancies and deepening poverty as their own bodies weakened and their meager resources were stretched ever thinner in the face of anti-immigrant bias, pittance wages, and filthy, overcrowded, and dangerous living and working conditions. This was also an era when women had no right of refusal of sex to their husbands. They faced the awful choice of risking another pregnancy, injury or death by self-performed abortion, or being abandoned when few jobs were available to women, and few jobs paid women enough to live on themselves, let alone support a family. And charity organizations, try as they might, could not keep up with even a fraction of the demand for assistance. Despite repeated arrests and fines, Sanger continued to provide birth control devices and information to the who women flocked to her clinic, pouring out their life stories in person and in letters like this one (original spelling):

‘… I am thirty years old have been married 14 years and have 11 children… I have kidney and heart disease, and every one of my children is defictived and we are very poor. Now Miss Sanger can you please help me… I am so worred and and I have cryed my self sick …I know I will go like my poor sister she went insane and died. …the doctor won’t do anything for me … 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 than have another one. 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 …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.’

I can only imagine what Sanger felt as she read this letter as she worked with so many women struggling under these same burdens, while social mores and the law opposed her efforts to help them.

Dr. John Rock was an obstetrician and fertility specialist. While one of his main focuses was on helping women with fertility problems become pregnant, he also worked with many other women for whom pregnancy, childbirth, and child care was detrimental to their physical and mental health, for various reasons. He became a staunch activist for birth control, and worked to convince the public and the Catholic church, of which he was a committed member, that effectively planning families and regulating childbirth is not only practical, but of the highest moral worth, since it promotes bodily and spiritual health, and a loving family life in which all children can be well cared for. He thought he could convince the church hierarchy that the hormonal method of birth control is consistent with Catholic teaching, since it’s simply an extension of the natural cycle that occurs in a woman’s body, rather than a barrier method with was doctrinally forbidden; his rhythm-method clinic taught the only form of birth control other than abstinence that was sanctioned by his religion, but as he observed, neither worked very well. His efforts to help women control their rates of pregnancy would eventually prove effective, but his efforts to convince the Church, until this day, have been in vain.

Yet birth control was not only linked to beliefs in reproductive rights and health: it was linked to a change in sexual mores. Sanger, Pincus, Rock, and McCormick all held what we’d now call ‘sex-positive’ beliefs: they thought sex could and should be a wonderful thing, among the most joyous, intimate, and healthy means by which humans connect with one another. In a time when sex was often regarded as shameful, depraved, and for the sake of men (I would argue that while it’s re-branded, it still is, as ‘liberated’, ‘powerful’ women painfully squeeze themselves into bustiers and stilettos and straighten, curl, bleach, and cut their hair and bodies to fit into a few stereotypical male fantasy body types as possible, in our crudely sex-obsessed, tabloid, misogynistic culture — yes, I’m talking about you too, Beyonce), they thought it could and should be a loving, freeing, and transcendent experience for both partners.

Dr. Gregory Pincus, the scientist who would ultimately formulate the first effective, FDA-approved birth control pill, was an unusually independent-minded, freethinking, colorful personality from an early age. As a young researcher at Harvard, he was widely publicized for his frank and unapologetic views on the benefits of revolutionizing human reproduction through scientific intervention. The sensationalist, brave-new-world ‘news’ stories led to Harvard’s kicking him out of their faculty and their labs, as a reputation-defense measure. Pincus went on to found his own research institute,. where he continued his research into hormones and their effects in reproduction. Arguably, it was this very political and financial independence from any large mainstream establishment that enabled him to succeed in his goal to produce the first birth control pill.

It also took money, and lots of it, as it does with any new pharmaceutical. Planned Parenthood could only provide limited funding for Pincus’s work, so it dragged on slowly, until Katherine McCormick, wealthy heiress, came along. She had discovered, shortly after she married, that her new husband suffered from severe mental illness. McCormick was well-educated, an MIT graduate at the time of her marriage, and was fascinated by all things science. When she learned of her husband’s mental illness, she poured time, money, and research into finding a cure, especially in the fields of hormonal research and heritability. She was also dedicated to women’s rights causes, and by the time of her husband’s death, her interests and fields of study and activism led to her single-minded determination to aid in the cause of making birth control effective and widely accessible. It was she, more than any other, who provided Pincus the funds to pursue more lab research, and for he and Rock to conduct more clinical trials.