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The contraceptive capsule: A story of sexual liberation and dubious research methods

Twenty per cent of Norwegian women between the age of sixteen and forty-four are on the capsule. The contraceptive capsule has been in use in Norway for 50 years, however there are nonetheless insecurity and myths associated to its use and negative effects.(Illustrative photograph: Colourbox)

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This article was initially revealed on Kilden – Information and information about gender research in Norway. Read the original article.

Today, twenty per cent of all fertile women in Norway are on the capsule. The reality that each one women have the suitable to details about and entry to the suitable sort of contraception is self-evident. But this has not all the time been the case. 

“I graduated from medical school the same year as the contraceptive pill appeared in 1967. I remember it so well, it was like a revolution!”

These are the phrases of Britt Ingjerd Nesheim, professor emerita and retired senior advisor on the Women’s Clinic at Ullevål University Hospital and University of Oslo.

“Having access to a contraceptive that was secure made it possible to decide not to have children if you didn’t want it. The opportunity to securely control your own sexuality and childbirths was something completely new.”

According to her, the brand new contraceptive was first met with scepticism.

“The medicines authorities, and health director Karl Evang in particular, were sceptical with regards to putting a pill out on the market that had been subject to so little research. And he was right too; frightfully little research had been carried out.”

When the capsule was launched, we knew little about unwanted effects and the consequences it may need on women’s long-term health.

“It would never have been approved under today’s system!”

It took seven years from the capsule was first launched as contraception for women within the US till Norwegian women might ask their physician concerning the new drugs. Norway was cautious, and waited longer than each Germany and the opposite Scandinavian nations. However, in 1963, the capsule reached the nation, however not as contraception.

“I haven’t been able to find out what the physicians’ desktop reference said about the pill at the time, but it was registered as a means for regulating women’s menstruation. Yet under the table, many were probably prescribed the pill as a contraceptive,” says Nesheim.

American feminine and male creators

Would the contraceptive capsule have been invented with out strain from the feminist motion? Nesheim doesn’t consider it might.

“Margaret Sanger deserves much of the honour for the pill, as does the financier Katharine McCormick.”

Margaret Sanger was one of eleven youngsters in a poor, Irish-American Catholic household in Corning, New York. She turned generally known as a women’s activist and advocate for contraception, and she based the organisation Planned Parenthood. Nesheim thinks her engagement in these instances had so much to do together with her background.” 

“She saw how her mother was exhausted from childbirths, and how the toil finally drove her to her death.”

Sanger was clever; she acquired a scholarship in an effort to research nursing. She ultimately began giving out unlawful details about contraception from her circle of relatives planning clinics, for which she needed to serve a jail sentence of thirty days.

“She was very passionate about family planning,” says Nesheim.

When Sanger came upon that there was a progesterone that would cease the ovulation in animals, she was wanting to create one thing comparable for people. 

“Sanger contacted the famous biologist Gregory Pincus.”

Pincus was, along with the physician John Rock, involved in copy and fertility. Rock was a Catholic, and there was quite a bit of resistance in the direction of contraception within the US on the time, notably from the Church. Rock was in favour of contraception, nevertheless, and he needed to take part within the improvement of this product. It concerned discovering the proper stability between hormones that may cease the ovulation. But they wanted cash.

“This is where then next woman enters the stage,” says Nesheim.

“Katharine McCormick was a biologist herself. She was enormously rich after inheriting from her diseased husband, and she wanted to finance the research.”

Scientific fraud and unsuspecting guinea pigs

Gregory Pincus and John Rock developed the primary contraceptive capsule, however the methods in use on the time, within the 1950s, wouldn’t have handed right now’s tips for research ethics.

“It’s a paradox,” says Nesheim.

“The pill is fantastic, but it has been created under dubious circumstances.”

Pincus and Rock experimented on animals, but in addition on women. They handed out the primary check drugs to poor women in Puerto Rico who needed to keep away from pregnancies. But additionally they examined the tablets on women in Boston who got here to see their physician about infertility issues. These women needed youngsters, however have been infertile.

“The women were childless for unknown reasons. The advantage for Pincus and Rock was that they menstruated regularly, and it was therefore easy to test whether the ovulation disappeared when they were given the new product.”

Rock wrote in an article concerning the experiment that different research had proven how giant parts of progestins is perhaps used as a remedy towards infertility. But when Nesheim appeared on the references within the article extra intently, she found one thing conspicuous: 

“He referred to an article ‘in preparation’. The article, and the research, was undocumented – in other words, he cheated.” 

Through the experiments with the childless women, Rock and Pincus have been capable of show that progestins hinder the ovulation, which enabled them to review what results this had on the womb lining. Among different issues, they discovered that the bleedings turned irregular when the women got so much of progestin, which they then tried to manage by including oestrogen.

“In this way, they tried out different combinations of the two hormones before they eventually ended up with the product that was launched as the world’s first contraceptive pill: Enovid.”

The unsuspected guinea pigs who had sought assist from the physician to be able to get pregnant didn’t obtain any help to that finish.

Side results and the event of a safer capsule

The capsule was accepted and launched to the American market on a really weak scientific foundation close to potential negative effects. In the start, a brand new experiment was carried out in Puerto Rico. But the outcomes of the experiment have been nugatory, based on Nesheim.

“What can you expect, really? The intentions were perhaps good, but at the same time, the researchers did not consider the women and their situation. The women failed to take the pills at the right time of the day, and many dropped out of the study. They had chosen Puerto Rico because the legislation there was weak. They could thus carry out experiments there that were difficult to get permission for everywhere else.”

A lot of research has been completed on the contraceptive capsule since then. Control-based research, register-based research and qualitative research might present information on how the capsule impacts the health of those that use it.

“In a way, all women have been guinea pigs for the development of the contraceptive pill,” says Nesheim.

After the capsule had been available on the market for some time, a number of women who used it suffered from blood clots, and some suspected that they could have been brought on by the brand new contraceptive. It was found that the hormones elevated the danger of blood clots, and the mixture was modified. The first capsule contained 150 micrograms of oestrogen; at the moment it solely accommodates between 20 and 40 micrograms.

“What do you know about the scope of serious side effects over the fifty years since the pill was introduced in Norway?”

“Nobody can give you any exact numbers. But the chances of blood clot increases by two to three times with the use of the contraceptive pill. The question remains how many would have suffered from blood clot without the pill. Since the women who use the pill are young and healthy in the first place, and those who are particularly prone to the condition are weeded out, very few actually suffer from blood clots.”

Mette Haase Moen, gynaecologist and professor emerita at Norwegian Univeristy of Science and Technology (NTNU) says the mixture of hormones, and notably the variant of the progestin hormone used, is decisive for the danger of blood clotting.

“Pills containing the progestins levonorgestrel and norethisterone have a lower risk. The greatest risk of a blood clot is with pills containing large doses of ethinylestradiol and antiandrogene progestins,” she says.

“At the same time, there are antiandrogene pills that treat blemished skin and acne problems in addition to being a contraceptive.” 

Antiandrogene progestins block the consequences of male hormones reminiscent of testosterone.

As regards the danger of coronary heart assault, Nesheim says this can be very low. She is extra interested by how the capsule could also be useful for the prevention of most cancers. 

“The use of the contraceptive pill protects against cancer in the womb lining, the ovaries and the colon. However, the risk of breast cancer slightly increases. When counterbalancing the chances, the total risk of cancer is basically zero.”

The danger she describes is estimated by means of research on women on the contraceptive capsule in comparison with management teams of women who aren’t on the capsule. Register-based surveys additionally contribute to the research of health dangers related to the use of the capsule. Possible psychological unwanted effects of the capsule are more durable to measure than the bodily.

“Many complain about mood swings. The fact that many feel depressed is difficult to measure. But a Danish register-based study appeared recently. This study shows that the number of suicides and suicide attempts are two to three times higher among women who use the pill. This particularly applies to young women. It thus appears that the depression that many women complain about is very real, and may have dire consequences.”

“You need to be aware of this possible side effect and stop taking the pill if it gets serious,” she emphasises.

Low threshold for younger women

The contraceptive capsule first bought little or no in Norway, however each the sale and the use of the capsule elevated in the direction of the 1980s. The share of women on the capsule has remained stagnate on roughly 20 per cent because the mid ‘80s.

“The intrauterine device, or the coil, appeared almost at the same time as the contraceptive pill, and was well received in Norway. Compared to other countries such as the US, Norway’s use of the coil was relatively high by comparison with the pill,” says Nesheim.

Many women who had already given start most popular the coil. Young women particularly have been advisable to make use of the capsule.

“It is great that they protect themselves in a good way against unwanted pregnancies.”

In 2002, the contraceptive capsule turned free of cost for all women between the age of sixteen and twenty. At the identical time, midwives and health guests have been authorised to prescribe the capsule. This made it potential for younger women to see the health customer at college about contraception quite than having to ask their physician. 

“I think it is very good that they made it easier, and especially that it became free of charge. It’s a good thing that those who have little money and who really don’t need an unwanted pregnancy receive the help they need,” says Nesheim.

She would have needed to go even additional.

“Already by the end of the 1980s, many people argued for making the pill prescription-free. I am still in favour of that. With enough information, women should be able to buy it over the counter.”

The cause why the capsule is just not prescription-free is, in accordance with Nesheim, that the producers have been fearful about being considered promoters of poor morals. They have been additionally afraid that they might be at an obstacle in potential compensation claims if there have been no docs as center individuals between the pharmaceutical corporations and the customers.

Although the capsule is an effective contraceptive, docs of right now advocate different means of contraception. If you overlook to take the capsule, you’re not protected towards being pregnant. The medical career now subsequently advocate so-called larc contraception, that’s, long-acting reversible contraceptives akin to contraceptive implant or coil.

Uncertainty and myths

If you search on-line details about the contraceptive capsule on Norwegian pages such Sex og samfunn, Underlivet or Kvinneguiden, you will see quite a bit of information, but in addition lots of questions. Will the capsule make you fats? Are temper swings widespread? Why have I misplaced my intercourse drive? Do I’ve to menstruate as soon as each month? Nesheim is just not stunned by the truth that women who contemplate making an attempt a brand new sort of contraception have questions. But some myths have confirmed more durable to kill than she had imagined.

“I thought the one about pauses was dead already. In the beginning, it was believed that you should have a few months’ break to see if everything worked as normal. That is just rubbish.”

“The monthly bleeding is another myth. When you’re on the pill, you don’t menstruate, because you have no ovulation. Those who created the pill thought that women like to bleed once every month in order to feel that their body works normally.”

Mette Moen explains:

“It is a common idea that menstruation is natural. The developers of the contraceptive pill thought it would be more easily accepted if it simulated the natural cycle.”

“From nature’s side, the purpose of the menstruation cycle is to form a new womb lining for the inseminated egg to enter into. With the contraceptive pill, a much smaller womb lining is formed, which generates less bleeding. If you use the pill over a long period of time, the womb lining will become so thin that there is nothing to bleed out from. The same applies when you use the coil or contraceptive injection, which are both pure progestin contraceptives.”

According to Nesheim, it’s about time that each one women know this: 

“We’ve said this for years now: there is no reason to menstruate when you’re on the pill.”

The significance can’t be overestimated

Elisabeth Lønnå is a historian and the writer of a number of books concerning the Norwegian feminist motion. According to her, the capsule has performed a central position within the historical past of Norwegian gender equality.

“The contraceptive pill appeared at the same time as some other important events in women’s history. The feminist movement flourished, and women entered the labour market and politics. In this way, women obtained an important place in society,” she says.

“I remember when the pill first appeared, and how important that was for us who were young students at the time. Yet it was a bit difficult in the beginning. In particular, I remember a doctor at the University of Oslo who refused to prescribe the pill to me because I was unmarried. Fortunately, I got it from another doctor who thought it was a good thing that I wanted to use it.”

“What role has the pill played for Norwegian women’s sexual life?”

“It meant everything! You couldn’t always be sure that a man would use a condom. You had the diaphragm, but it was difficult to use and not very romantic.”

“I remember a quote from the feminist Margarete Bonnevie, who said that there are ‘no married women who haven’t been afraid of getting pregnant’. So the pill had a lot to say, both inside and outside of the marriage.”

“How has the Norwegian feminist movement regarded the pill?”

“The feminist movement has always been positive. I don’t know about the women from the Norwegian Women’s Public Health Association or the deeply religious groups, but I cannot remember a single objection from the feminist movement.”

“In the 1960s and ‘70s, many were in favour of free love. It obviously became both freer and safer for women after the introduction of the pill. I also think it is fair to say that the pill is partly responsible for putting an end to the use of such horrible expressions as ‘bastard’ and ‘knock up’.”

Britt Ingjerd Nesheim agrees with Lønnå.

“It really was a revolution; the significance of the contraceptive pill cannot be overestimated!”

She emphasises that the capsule has liberated women from a life of many childbirths.

“Imagine all the married women who gave birth to a flock of children before. They experienced problems with prolapse of the uterus, serious incontinence – all these problems are gone, we’ve even forgotten that they existed,” she says.

Mette Moen agrees, however she additionally factors out one other aspect of the transition from contraceptives reminiscent of condom and diaphragm to hormonal contraceptives.

“It has given the woman freedom and control, but it also increases her risk of getting sexually transmitted diseases, in comparison to the use of condom.”

She believes that researchers will proceed to develop the contraceptive capsule. It just isn’t unlikely that the doses of hormones can be lowered, and that the researchers will uncover progestins which have fewer unwanted effects. Then the query stays whether or not this revolutionary capsule may also be out there for males?

“A contraceptive pill for men has been under testing. It contains progestin, which hinders the production of sperm cells. But it also reduces the production of testosterone, which then needs to be added. Whereas women’s pill contains progestin and oestrogen, the contraceptive pill for men will contain progestin and testosterone.”

After fifty years with the capsule that provides Norwegian women full freedom to regulate their very own copy, the contraceptive capsule for males is overdue. But in concept, the revolution might come, additionally for males.

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