Two women, standing in a public housing complex in San Juan, Puerto Rico, look on in puzzlement. One of them, shy, describes some symptoms: “The world disappeared, my vision blurred. The only thing I said was: ‘Virgen del Carmen, take care of my children’”.
Then, shaking her head no, the other comments: “We were being experimented on without knowing it.”
The scene is part of the documentary “La Operación” (1982). The women, whose names are not mentioned, described their participation in the first large-scale clinical trial testing the effectiveness of the birth control pill in the 1950s.
In the film, both affirm that they were unaware of being part of an investigation.
Like them, hundreds of other Puerto Rican women from humble origins were unknowingly patients in the study led by two American academics.
The drug, which since its commercialization in 1960 allowed women to have greater control over their bodies, because they did not depend on men to plan maternity, was tested in Puerto Rico thanks to a peculiar public policy to control overpopulation promoted by the government local island and US
In the midst of a birth boom during the first half of the 20th century, with many citizens living in extreme poverty, the solution of the US-appointed politicians on duty was to encourage Puerto Ricans not to have children.
And their initiatives, explains Ana María García, a professor at the University of Puerto Rico, director of “La Operación”, were specifically designed so that this population reduction would occur among the poorest communities.
“They were directed at the poorest, most racialized, and least educated women in the country,” says Lourdes Inoa, from the Puerto Rican feminist NGO Taller Salud.
“Because they were the ones who had the least opportunity to know the repercussions of participating in this type of procedure. Consent, in this context, is highly questionable,” he adds.
With private financing, but also from the State, the island was “a great birth control laboratory,” says García.
And the women, adds Inoa, became “guinea pigs.”
Two scientists and two activists
The origin of the pill, which according to the United Nations is currently used by 150 million women around the world, took place far from Puerto Rico, within the walls of the prestigious Harvard University, in Massachusetts.
Those who developed the drug were two renowned professors of the institution: John Rock and Gregory Pincus.
The first, says historian Margaret Marsh, a professor at Rutgers University in New Jersey, was one of the most important fertility experts in North America, paradoxically Catholic, and who thought that married couples should have the right to decide when to have children.
The second was a biologist who on more than one occasion described overpopulation as “the biggest problem for developing countries.”
Both were financed and closely supervised by Margaret Sanger, a nurse and health expert who founded Planned Parenthood, and wealthy suffragette leader Katharine McCormick.
They, says Inoa, “seeked that women be inserted in various facets of society, so that they would have greater power.” Controlling motherhood was essential to achieve this.
But it is known that Sanger defended eugenics, the social philosophy that defends the improvement of the human race through biological selection.
And that is why it allowed it to be experimented on poor women and in situations of vulnerability.
“The birth control movement, in a way, was two-pronged. One was for women to make their own reproductive decisions, and the other was the idea that birth control was good because poor people would have fewer children,” adds Marsh.
the first studies
The first research on the birth control pill in the US was done on rats and other animals.
Then, in an “unethical” move, the scientists administered the drug to a small group of patients at a public hospital for the mentally ill in Massachusetts, says Marsh, who is an expert on the history of US contraception. USA
“The families of the patients did give permission for the study to be carried out, but they themselves, because they were in a psychiatric hospital, did not consent. Although at that time this was legal ”, he comments.
At this stage, Pincus and Rock discovered that the compounds they had created had the effect of stopping ovulation. So they looked for a place to do a larger-scale trial, so that US regulators would approve the pill.
In Massachusetts, explains Professor Garcia, birth control was illegal. There were also legal limitations for experimentation with human beings.
That’s when scientists had to identify an “ideal spot.”
The laboratory island
They decided to go to Puerto Rico because sterilization there, and in general experimentation to achieve contraception, had been legal since 1937.
“A law was passed at a historic moment, when in the rest of the planet, including the US, widespread sterilization was not legal,” García points out.
The legislation was signed by Governor Blanton C. Winship, a man who also publicly supported eugenics, and who -according to an article in the New York Times- urged that population control be investigated in Puerto Rico, because for him it was the only “reliable means of improving the human race.”
In the 1950s, when Pill researchers arrived on the island, 41% of Puerto Rican women of reproductive age had already tried some method of contraception, according to a study by the University of Puerto Rico.
This was possible thanks to the fact that the legislation allowed the creation of dozens of family planning clinics around the territory, even in the most remote towns, subsidized by the government and with staff who promoted birth control among women.
The network of clinics also attracted the attention of Pincus and Rock, who thought they could use them to develop their project.
The team, however, decided to focus first on a single neighborhood in San Juan, the capital.
The women of Rio Piedras
On the island, the experiment began in 1955 as a project in which medical and nursing students participated. But the study was too complicated and painful, so many did not finish it.
Furthermore, the pill tested in Puerto Rico was a much higher dose than the current one and caused strong side effects.
“Urinalysis, endometrial biopsies, and other tests were necessary to determine whether or not they were ovulating. It’s an uncomfortable procedure. If you have students who don’t really have a need for contraception, they weren’t going to be willing to continue.” comments Marsh.
The medication caused nausea, dizziness, vomiting, and headaches. Pincus, however, dismissed these side effects as a “psychosomatic” consequence.
“He believed in the pill so much that he was giving it to his relatives. His granddaughters, his daughters, his sons’ friends,” says Marsh, who wrote a biography of Rock, Pincus’s work colleague.
The team decided to continue the experimentation, but this time in Río Piedras, a northern suburb of Puerto Rico.
Social workers and medical personnel visited the women door-to-door, offering them the contraceptive pill and, for some of them, performing tests to collect data, without any monetary compensation.
The rejection by various sectors of Puerto Rican society was immediate.
“There were press releases that classified the investigations as ‘Malthusian’. Also by doctors, even those who were in the process of recruiting women, who thought that the side effects should be taken seriously and that more tests were necessary. and not rule them out”, says Inoa, from Taller Salud.
Due to the side effects, many of these women, as in previous studies, decided to stop treatment. Others, stricken by poverty, agreed to take the pill as a reversible method of birth control.
According to Marsh, three people in the clinical trial conducted on the Caribbean island died. However, an autopsy was never performed on them, so the exact causes of their death are unknown.
The approval
Despite the deaths, seeing that the pill had the effect of preventing pregnancies, the scientists extended their project to other towns in Puerto Rico, and later to Haiti, Mexico, New York, Seattle and California.
A total of 900 women participated, of which around 500 were Puerto Rican.
In 1960, the US Food and Drug Administration (FDA) approved the Envoid, as the first pill was called, as a contraceptive method.
Its expansion was rapid. In just seven years, 13 million women in the world used it.
But after being approved by the FDA, the pill continued to cause severe side effects, including blood clots, prompting lawsuits. On the island, despite legal action elsewhere in the US, studies continued until 1964.
Still today, says Inoa, there is no “significant” research looking for “another type of contraceptive method that does not have the side effects of the pill that exists now.”
Meanwhile, studies to create an oral contraceptive drug for men have not borne fruit either, although they began 30 years ago.
“The greatest experiments have always been in pregnant people,” he concludes.
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BBC-NEWS-SRC: https://www.bbc.com/mundo/articles/c8058pj9r9jo, IMPORTING DATE: 2023-09-07 14:50:07
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