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MICHELE NORRIS, host:

Walk in to any drugstore and you'll find pills everywhere - Aspirin, allergy medicines, vitamins. But utter the words the pill and it's immediately clear you're talking about birth control. We're going to talk about the pill today, and how it gained such prominence in America.

Just last week, the FDA approved the first form of the pill that completely eliminates a woman's period. There have been other developments in contraception over recent years, and we'll talk about those in a few minutes. But we start with the pill because for more than four decades it's been the most popular method of contraception for American women.

Cynthia Pearson is the director of the National Women's Health Network, an organization that advocates for women's health issues here in Washington D.C. and she joins us here in our studios. Welcome, Cynthia. Thank you for coming in.

Ms. CYNTHIA PEARSON (Director, National Women's Health Network): Thank you.

NORRIS: Now, I want you to take us back to the early 1960s when the pill was first introduced. It was really seen as something that was absolutely revolutionary for women. Why was it seen as such a transformative pharmaceutical?

Ms. PEARSON: It was revolutionary as you say. Up until that time, women and men who were trying to control their fertility had to rely on methods that were used at the time of sexual intimacy. You know, they could be effective, but human nature being what it was or what it is, they weren't always effective. So there was a big, big need for more effective contraception that was separate from the time when sex took place.

NORRIS: So how was it marketed?

Ms. PEARSON: At first it snuck in. It's snuck in through the FDA, not that the FDA didn't know what it was going to be used for, but the company's first request was to approve it for menstrual cycle problems - heavy periods, painful periods. And it was to try and kind of sidestep that whole sex thing and get it out there and get it into doctors' knowledge, experience - but quickly, the pretense was dropped, and it was also approved for use as contraception. And it was marketed in the way that all medicine was in that day, which was strictly to doctors. There was no consumer advertising in the '60s, that's a recent phenomenon. But because it changed everything and it opened up this door to discussion about women's sexuality, it didn't need consumer marketing to be known by consumers instantly because it was the topic of conversation.

NORRIS: What do we know now - since the pill has been on the market for four decades - about the health risks associated with this normal birth control?

Ms. PEARSON: We know two things. One thing we know is that there are some serious and rare risks of the pill. Blood clots are a real risk of the pill. And blood clots - depending on where and how they happen - can cause heart problems; can cause brain problems. So that is a real risk. It's very, very rare.

The cancer risk is elusive and very small, if real. In some studies, it's associated with a slightly increased risk of cancer in women in the, sort of, perimenopausal years - that's not confirmed yet though because that's actually a relatively new way of using the pill.

For quite a long time, there were questions about an increased risk of breast cancer in young women who stayed on the pill a long time. That seems to be looking like it's not a significant risk with the most recent and the biggest studies.

NORRIS: What about the risk that comes with extended use, people who were on the pill for decades?

Ms. PEARSON: That is a question everybody would like to know better information. There are women who have been on the pill 10 years, even 20 years, maybe even longer, but they're not in any sort of organized study. So we only know what clinicians report, which can be helpful to us because that's sort of our early warning system - what the doctors, the nurse practitioners see in their offices. And so far, we don't see more problems with women who are long-term users.

NORRIS: How does the variety of pills that are on the market today compare to what was first introduced?

Ms. PEARSON: The most important thing to know about how pills today compare to the older ones is that these are lower dose and safer.

NORRIS: Lower dose meaning the dose of hormones?

Ms. PEARSON: Right. It turns out that the dose of hormones used in the original pills was 10 times more than needed. And as women's concerns about the safety of the pill bubbled up, there evolved a kind of society-wide agreement that women have the right to know about the risk of the pill, and because of that bubbling up and that sort of impetus to question the companies who are making pills sensibly and responsibly, look, can we make this better? Can we make this safer? And that's what they did and health risks dropped.

NORRIS: In 40 years, what's changed in terms of cost? And is it - is there insurance coverage that comes along with that?

Ms. PEARSON: Yes, and that's a gain that we have Viagra to thank. Insurance coverage for contraception always lagged behind. Women in Medicaid, actually, the low-income women, were better served. They always had contraception covered. And women who could qualify for state or federal-funded contraceptive is that through one of the clinics could get it covered, but women who are older, who are working, who had insurance, often found that their insurance didn't cover contraception. But once Viagra came on the market and was instantly covered, then we were able to get some contraceptive equity, and now most insurance plans do cover it.

NORRIS: There's so much we could say about the pill, but I guess, we'll have to stop there. Cynthia Pearson, thanks so much for coming in to talk to us.

Ms. PEARSON: You're welcome.

NORRIS: Cynthia Pearson is director of the National Women's Health Network.

While the pill is designed to be 99 percent effective, that rate drops to below 90s when you factor in typical use. That's because it's easy to forget to take the pill every day. And that's one reason women turn to other forms of contraception.

Dr. Carolyn Westhoff is medical director of the Family Planning Center at Columbia University. We asked her to tick through some of the other forms of contraception that people are using.

Dr. CAROLYN WESTHOFF (Medical Doctor, Family Planning Center, Columbia University): Sterilization, whether male or female, is overwhelmingly the most popular choice after the pill and is used by people in their 30s and 40s. After that, what we see are a lot of variations on hormonal methods that are very popular. The vaginal ring and the patch are delivery systems that deliver hormones like the pill but don't require daily use. These are increasingly popular. The implants have just come back to the U.S. market so usage is very low now, but these are extraordinarily easy, extraordinarily effective and safe. And then, of course, we have two IUDs on the U.S. market, and these deserve to be much more widely used because they are so safe and effective.

NORRIS: And I understand the IUD is the most popular method used globally, but in the U.S., it's only used by 2 percent of women. Does the IUD still carry some stigma here in the U.S.?

Dr. WESTHOFF: I think women and, in fact, doctors do not realize how very safe the IUD is. We have learned to use it more safely compared to 30 years ago. We now understand that we need to simply check women, screen them for asymptomatic infections prior to an insertion. And that, under those circumstances, IUDs have minimal risks of infection and, in fact, have dramatic, long-term safety.

NORRIS: And yet when you mention IUD, it often conjures up memories of the Delcon Shield scare.

Dr. WESTHOFF: Yes. Well, the Delcon Shield was a uniquely poor design. It was created in an era where there was no regulation of medical devices and therefore it didn't have adequate safety and efficacy testing before it was marketed. Now the FDA does regulate medical devices, and we have a lot of information before a new IUD can come to the market.

NORRIS: What methods do we not see in the marketplace that you think are actually needed?

Dr. WESTHOFF: There is certainly going to be room for male hormonal methods. I think that it's not something that can sweep the market. But there are now analogs, if you will, to the traditional pill for men that are in clinical testing, and so we are getting ever closer to this. Now a male pill, if you will, is not something that works instantly, nor can it be reversed instantly. Because of the male physiology, it takes about three months for it to start working and about three months for it to stop working. So there are many people for whom that is not going to be a terrific method, but for couples in a longstanding relationships, I think there are - based on survey data - many men who are willing to step up and take the responsibility for contraception.

NORRIS: Dr. Carolyn Westhoff, thanks so much for being with us.

Dr. WESTHOFF: Thank you.

NORRIS: That was Doctor Carolyn Westhoff, medical director of the Family Planning Center at Columbia University.

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