Puerto Rico Was the Birth Control Pill’s Unwitting Laboratory
Women’s History Month is an opportunity to talk about the lesser known costs of the birth control pill, one of the most innovative medical inventions of the 20th century.
In Latinx families, the two most dreaded questions we receive as twentysomething women are “¿y tu novio?” which translates to “where's your boyfriend?” and “¿cuando te casas?” which means “when are you getting married?” Guess what question comes after that. For a woman like me, who is still exploring my goals and career, the birth control pill, as the iconic method of female contraception, symbolizes control and choice.
The pill was a revolutionary innovation. Aside from the huge role it played during the sexual revolution, the pill gave women the power to go after full-time careers, to live a way that had been unimaginable throughout history. It signified women's liberation.
But before the drug was validated for safety in the United States, it was unethically tested on over 1,500 women in Puerto Rico from the mid 1950s to early '60s. The women, mainly poor agricultural workers, were given the pill for free and told that if they took it regularly, they wouldn't get pregnant. What they weren't told was that they were test subjects, that taking the pill had risks and side effects and that it had only been tested on a handful of people, and primarily rats, before making its way to the island.
Although it's one of the most controversial programs in Puerto Rican history, it's discussed less in the American story of the pill, which often focuses on Margaret Sanger's contributions.
Creators Dr. John Rock and Dr. Gregory Pincus first tested the contraceptive, called Enovid, in Boston on 50 subjects. Due to the negative side effects, most of the women quickly dropped out of the trial.
The research team then decided to conduct the larger human trial in Puerto Rico. Many areas were poor and overcrowded, and Pincus was concerned with global population control. There were no anti-birth control laws and a clear desire for forms of contraception at the many clinics there. They also wanted to prove that uneducated women could use it successfully, to show that any class of woman anywhere could use it.
Researchers found their control group in the farming village of Humacao. The pills given for free to the women contained three times the hormones the pill has today. Although three women died in its early years, no autopsy was never done to confirm the cause of deaths. Women in the town still feel resentment over the lack of transparency of the pill testing years later.
In 2004, the Chicago Tribune interviewed then 60-year-old Delia Mestre, a hospital social worker who traveled to promote the pill at the time. She told the paper: “We all jumped on it quickly and didn't look back,” Mestre recalled. “Women were told this was medicine that would keep them from having children they couldn't support.”
Before the pill, the only other option was “la operacion,” a hysterectomy or tubal ligation procedure. Many women had no idea that the procedure was permanent, the idea of “tying tubes” made the patients believe that it was easily undone.
Of the research program and testing procedure, Mestre asked, “Why didn't anyone let us make some decisions for ourselves?”
Puerto Rican critics have compared the trials to the U.S. government–conducted syphilis research on African-American men, during which researchers purposefully failed to medicate black men with the disease in order to see what happens when it goes untreated.
On May 9, 1960, the pill was first approved as a contraceptive method by the U.S. Food and Drug Administration (FDA). After that, concerns began spreading about the drug's complications. Two years later, the FDA was informed that 26 women suffered blood clots, with six dying. By the 1970s, the pill was linked to deaths from heart attacks, blood clots and fatal strokes, which prompted congressional hearings. The Humacao tests led the FDA to enforce stricter guidelines for clinical trials to come after and became the foundation for a law requiring test disclosures.
As a woman of color, it stung to find out this signature medical achievement came at the expense of unethical testing on already marginalized women. During Women's History Month, it's important to remember that reproductive rights, sexual freedom, and women liberation's, in general, have before and still today come at a price. The women of Humacao risked their lives unknowingly in order for us to have the privilege to indulge in our pleasures and choices.