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The women who paved the way for the contraceptive pill

May 07, 2019

Female contraception has changed the world – Margaret Sanger & Katharine Dexter McCormick fought to make it a reality.

When 200 leading historians discussed what had the strongest impact on society in the 20th century, they concluded it was not Einstein’s theory of relativity, not the nuclear bomb, nor even the power of computers and the internet. It was the contraceptive pill.

By giving women the ability to decide whether and when to have children, the contraceptive pill redefined ideas of the family – and of women’s role in society. By empowering women to have greater control over their bodies, the contraceptive pill helped give rise to the sexual revolution and modern feminism, as well as having a significant impact on maternal health and child mortality.

And the dedication, determination and unyielding belief of two remarkable women, Margaret Sanger and Katharine Dexter McCormick, played a pivotal role in the development of the Pill.

Margaret Sanger
Margaret Sanger

From personal tragedy to social revolution

“It’s your fault. Mother is dead because she had too many children.” So said the 19-year-old Margaret Higgins to her father at her mother’s funeral in 1899. Born in 1879, as the sixth of 11 children in a strict Catholic Irish-American, New York family, Margaret had seen in her mother’s life a tragedy of destitution and illness, brought on by the pressures of a large family.

There was no obvious remedy. Not only were contraceptives not available for women, but thanks to the public decency laws of the day, set by the 1873 Comstock Act, even talking about sexual health could see you prosecuted. Margaret decided to set about changing that.

“Women need a reliable contraceptive pill that is as easy to take as aspirin.”

– Margaret Sanger

Changing the narrative

Soon after her mother’s death, Margaret became a nurse and married the architect and political radical William Sanger. In 1912, she began a regular newspaper column in New York entitled “What every girl should know,” educating women on the menstrual cycle, reproductive health and openly advocating for reproductive rights for women – though some were banned under the Comstock Act due to using the words ‘syphilis’ and ‘gonorrhea’.

Two years later, in 1914, she started “The Woman Rebel”, a radical periodical in which Sanger asserted that every woman had a right to be the “absolute mistress of her own body.” In 1916, as well as publishing a collection of her columns in book form, Sanger set up a clinic that offered contraceptive information and fitted diaphragms for women. It attracted more than 400 women in its first nine days of operation.

Sanger and her associates continued to be prosecuted for their work – so they began working to change the law as well. In a series of court cases, Sanger fought for the right of women to have access to birth control information. All the while she continued to expand her original clinic into a network of women’s health centers, 25 of which existed by 1920. This network ultimately laid the foundation for modern institutions such as Planned Parenthood.

But Sanger’s role was not just limited to social advocacy – she also had a direct impact on developing the birth control pill itself.

Paying for the pill

“Women need a reliable contraceptive pill that is as easy to take as aspirin,” Sanger had said after seeing the plight of women overburdened with large families. Her vision was for an effective, safe method of contraception that would reduce unplanned pregnancies as well as often connected problems. It was a vision shared by many women, none more so than Katharine Dexter McCormick.

From her days as a biology undergraduate at MIT, Dexter McCormick, was an active advocate of women’s rights. In 1904, she married Stanley Robert McCormick – heir to the International Harvester fortune. Sadly only a couple of years later, Stanley was diagnosed with schizophrenia and by 1909 was declared legally incompetent. After this, Dexter McCormick focused her attention on supporting philanthropic projects.

She first met Sanger in 1917 and the two worked together on efforts to promote the legalization of birth control in the United States, including McCormick helping smuggle diaphragms from Europe to Sanger’s U.S. clinics. But it was not until 1950, when Sanger met the American physiologist Dr Gregory Pincus, a leading authority in the field of reproductive biology, that her vision of an easy-to-use contraceptive pill could become a reality.

Sanger asked Pincus how much it would cost to develop an effective oral contraceptive – he estimated to start with at least $125,000. Sanger turned to McCormick, who not only funded the effort but used her scientific background to closely monitor the research process. In total, McCormick provided $2 million to support Pincus and his colleague’ work.

In 1960, the FDA approves the first oral contraceptive pill and in 1966, the U.S. Supreme Court legalizes birth control for married couples.

The Pill becomes a reality

The roots of the contraceptive pill actually began in 1921 when Austrian physiologist Ludwig Haberlandt showed that menstruation is regulated by hormones produced centrally in the brain and the ovaries. By 1929, biochemist Adolf Butenandt had succeeded in isolating estrone, the first female sex hormone, and in 1938, Hans Inhoffen and Walter Hohlweg developed ethinylestradiol, the first orally active estrogen worldwide.

These discoveries were pivotal to Pincus and his teams’ work, as well as the work of a contemporary - Carl Djerassi. In 1951, Djerassi synthesized norethindrone, the first synthetic orally active progestogen. Pincus and his colleague Dr Min Chuh Chang subsequently successfully showed that it worked in animals. And in 1956, together with Harvard gynecologist Dr John Rock, they conducted the first human trials.

Ultimately, it took until 1960 for the FDA to approve the first oral contraceptive pill and its commercialization met with outrage from those who felt it would undermine traditional values, but its spread was not to be stopped.

Infographic showing how hormones work in contraception
Infographic showing how hormones work in contraception

A profound legacy

Margaret Sanger died in 1966 – just months after the U.S. Supreme Court legalized birth control for married couples. But the pioneering work that Sanger and Katharine Dexter McCormick began continues to have a profound impact. In 2017, 63% of married or in-union women worldwide were using some form of contraception.

Today, there are many different birth control methods – including hormonal pills, implants, injections and intrauterine delivery systems (IUS). All are available in order to meet the individual contraceptive needs and lifestyle of each woman. But just as in Sanger and Dexter McCormick’s day, a lot of work still needs to be done – the number of unintended pregnancies remains high at around 40% worldwide. There continue to be many myths, misperceptions and misinformation in connection to contraception. For example, a lack of understanding over the difference between the typical and perfect use of contraceptive effectiveness can lead women to not using the method most suitable for them.

Providing women with access to education on family planning remains as important today as it did when Sanger fought so hard for change. Knowledge is power and key to reliable family planning.

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