When: 1961
Where: USA
Why: The invention of the contraceptive pill gave women around the world control of their sexuality and was a major step forward in family planning
How: Much prior research into hormones was aimed at improving fertility, but the combination of oestrogen and progestin produced an effective contraceptive
Who: Carl Djerassi, Frank Colton
Fact: In the UK, a quarter of 16- to 49-year-old women take contraceptive pills, which come in 32 different forms
Since its launch half a century ago, the contraceptive pill has been credited with everything from triggering sexual anarchy and torpedoing family values to transforming the complexion of the workplace, in allowing women to enter board-level corporate positions for the first time. Some believe it increases a woman’s risk of contracting cancer; others believe it provides a crucial defence against this disease.
Everyone, it seems, has a different take on the Pill’s social impact. What is not in doubt, however, is its importance as a commercial idea. More people have taken the Pill than any other prescribed medicine on the planet; today, more than 100 million women use it regularly. In 2010 the contraceptive pill market was worth more than $5bn, and this figure could rise further still as the morning-after pill gains traction in the developing world.
Many experts believe that, for all the revolutionary advances made by the Pill so far, its full commercial and social potential has yet to be realised. In 2010, one influential female commentator said that the provision of oral contraceptives in the developing world could save the lives of 150,000 women, and 640,000 newborns. With researchers making excellent progress on a male contraceptive pill, it’s safe to assume the market for this product will change dramatically in the years ahead.
It was in the 1930s that hormone researchers first observed that androgen, oestrogens and progesterone inhibited ovulation in women. The development of a practical medication based on hormone therapy was delayed because of the high cost of obtaining these chemicals, so one of the principal goals was to find a way of synthesising them so that they could be manufactured in bulk.
During World War II, Russell Marker, an organic chemist at Pennsylvania State University, founded Syntex in Mexico City to exploit his discovery that Mexican yams could be used to synthesise progesterone. Syntex became the focus of the commercial development of the essential raw materials for pharmaceutical contraception, attracting three of the most significant figures in the history of the Pill.
The first of these was George Rosenkrantz, who took over from Marker in 1945 and retraced Marker’s process steps. He was aided by Carl Djerassi, a chemist, novelist and playwright who joined Syntex in 1949, and the Mexican chemistry professor Luis Miramontes, who joined the following year. Though Djerassi is sometimes called the father of the contraceptive pill, it took a team effort along with Rosenkrantz and Miramontes to synthesise the first orally highly active progestin norethindrone in 1951.
During World War II, Russell Marker, an organic chemist at Pennsylvania State University, founded Syntex … to exploit his discovery that Mexican yams could be used to synthesise progesterone.
That was 10 years before the launch of Enovid by D. G. Searle. Frank Colton had joined Searle as a senior research chemist in 1951; the following year he synthesised the progestin norethynodrel, an isomer of norethindrone, which combined with the oestrogen mestranol. The resulting drug, Enovid, was approved by the US Food and Drug Administration (FDA) in 1956 for menstrual disorders, and gained further endorsement in 1960 as the world’s first oral contraceptive following trials initiated in Puerto Rico by Dr Gregory Pincus and supervised by Dr Edris Rice-Wray in 1956. It is clearly difficult to decide whether Colton or the Syntex team should take the credit for inventing the contraceptive pill, but Colton’s efforts earned him induction into the USA’s National Inventors Hall of Fame in 1988.
Marketing of the Pill started in the USA and the UK in 1961. The Combined Oral Contraceptive, as well as many other methods of birth control, was legalised in Canada in 1969. The market was ready to embrace this liberating new technology. In the 1960s, women liked the Pill because it provided a reversible method of birth control that was, and still is today, almost 100% effective when taken as directed.
After gaining approval from the FDA in 1960, the Pill quickly gained traction in the American market. By 1964, 6.5 million American women were on the Pill; and this figure had almost doubled by 1968. Although the authorities initially tried to put a brake on the spread of oral contraceptives by permitting access to married women only, this just resulted in creating a thriving black market. Far from being deterred, young, single women came to see the Pill as alluringly edgy, and the oral contraceptive soon became an essential accessory for women caught up in the hedonism of the mid-1960s. Meanwhile, in Britain, the story was similar: the number of British women using the Pill rose from 50,000 in 1962 to over 1 million in 1969, as the Beatles-led revolution of youth took hold.
By 1964, 6.5 million American women were on the Pill; and this figure had almost doubled by 1968 … the number of British women using the Pill rose from 50,000 in 1962 to over 1 million in 1969.
Other countries were more reluctant to embrace the oral contraceptive. In Japan, for example, the country’s Medical Association prevented the Pill from being approved for nearly 40 years, citing health concerns. The world’s Catholic population has remained reticent on religious grounds – this is perhaps most clearly evident in Italy, where just 20% of women aged 15 to 55 use any kind of contraception. However, despite these pockets of resistance, the morning-after contraception market has continued to expand steadily. Today the Pill provides the cornerstone of the global contraceptives market, which, according to analysts, is growing at an annual rate of 4%.
The growth of the birth-control pill has certainly changed the shape of the contraceptive industry, with several alternative products suffering a drop in market share as a result. The diaphragm was an early victim of this trend: in 1940, one in three American couples had used a diaphragm for contraception; while in 1965, this figure had fallen to just 10%, and continued to plummet thereafter. By 2002, it was just 0.2%. The move towards oral contraception has also had severe repercussions for the condom industry. Although in Britain condoms remain the most popular form of contraception because of their protection against sexually transmitted infections, sales have been gradually falling worldwide: in India, for example, condom usage has fallen dramatically in recent years, largely because the country’s young people believe the Pill offers greater convenience and a better sexual experience.
A far more wide-reaching consequence of the Pill has been the enhancement of female opportunities in education and business. It is widely accepted that oral contraception has given women more control over when they have children, allowing them to plan high-powered careers before marriage and motherhood. According to a 2002 study led by Harvard University, the number of female graduates entering professional programmes increased substantially just after 1970, and the age at which women first married also began to rise around the same year. Progress has remained steady since then; in fact, the proportion of women on the boards of Europe’s top companies increased from 8% in 2004 to 12% in 2010. If the current rate of growth is maintained, gender parity could be achieved by 2026.
A far more wide-reaching consequence of the Pill has been the enhancement of female opportunities in education and business … According to a 2002 study … the number of female graduates entering professional programmes increased substantially just after 1970.
It is difficult to put a financial value on the impact of women in the workplace. However, no one could deny that women have invigorated the world of business with talent, enthusiasm and a fresh perspective. In 2006, The Economist claimed that women had contributed more to global GDP growth over the preceding 20 years than either new technology or the new economic super-powers, China and India. Given that some of the world’s top companies, such as Yahoo!, Pepsi Co, Kraft Foods and DuPont, now have female CEOs, it’s easy to see why women have had such an impact.
The landscape of the contraceptive pill market is currently changing dramatically. As patents begin to lapse, the three major players – Bayer, Johnson & Johnson and Warner Chilcott – are having their dominance eroded by the emergence of new, generic contraceptives. Bayer continues to lead the market, having achieved sales in excess of $1.5bn last year. However Bayer’s patents in both Europe and America have recently expired and the company has been involved in an expensive monopolisation lawsuit in the US – a clear sign that its dominance is under threat.
With over-population becoming increasingly problematic in Third World countries, use of the contraceptive pill seems set to increase further.
Furthermore, the market is continuing to expand, with more and more women in the developing world turning to the Pill to avert unwanted pregnancies. In 1960, fewer than 10% of unmarried women in the developing world used contraception; this number had increased to 60% by 2000, and the Pill was firmly entrenched as the most popular contraceptive method. With over-population becoming increasingly problematic in Third World countries, use of the contraceptive pill seems set to increase further.
This increase is sure to bring controversy. Indeed it has been suggested that the world’s deadliest killer, HIV/AIDS, has spread faster as a direct result of oral contraceptive programmes in those countries where it is endemic. The Population Research Institute says that, to date, more than 50 medical studies have investigated the association of hormonal contraceptive use and HIV/AIDS infection. These studies show that hormonal contraceptives increase almost all known risk factors for HIV: upping a woman’s risk of infection, increasing the replication of the HIV virus, and speeding up the debilitating and deadly progression of the disease. A medical trial published in the journal AIDS in 2009, which monitored HIV progression according to need for antiretroviral drugs (ART), stated: ‘The risk of becoming eligible for ART was almost 70% higher in women taking the (contraceptive) pills. ’
Furthermore, the link between contraceptive pills and abortion remains a source of contention. Perceived wisdom holds that the rise in use of the Pill has led to a fall in abortion rates; however, many contemporary studies dispute this. A study carried out in Spain, published in January 2011, found that the use of contraceptive methods increased by over 30% from 1997–2007, and that the elective abortion rate more than doubled over the same period. This throws fresh doubt over the Pill’s ability to control procreation and avert unwanted pregnancy.
However, it seems that these controversies will do little to diminish the Pill’s popularity. Researchers are thought to be on the brink of unveiling a new male pill, which will work by inhibiting sperm output, to the point of temporary infertility. Indeed, in July 2011, researchers at Columbia University in the USA claimed they had found a solution that mimics vitamin A deficiency, a common cause of sterility. The development of the male contraceptive has attracted widespread concern, with many experts raising the possibility of negative reactions to alcohol; but it seems that a product will arrive on the market in the not-too-distant future.