Two women, in a public housing complex in San Juan, capital of Puerto Rico, look on in bewilderment.
One of them, shy, describes some symptoms: “The world disappeared, my vision became blurred. The only thing I said was: ‘Our Lady of Mount Carmel, take care of my children’.”
Then, shaking her head, the other comments: “They were doing experiments on us without us knowing.”
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 that tested the effectiveness of the birth control pill in the 1950s.
In the film, both claim that they did not know they were part of research.
Like them, hundreds of other Puerto Rican women of humble origins were, without knowing it, patients in the study led by two American academics.
The medicine, which since its commercialization in 1960 has allowed women to have greater control over their bodies, as they do not depend on men to plan motherhood, was tested in Puerto Rico thanks to a peculiar public policy to control overpopulation promoted by the local government of Puerto Rico. island and the United States.
Amid a birth boom during the first half of the 20th century, with many citizens living in extreme poverty, the solution of US-appointed politicians at the time was to encourage Puerto Ricans not to have children.
And its initiatives, explains Ana María García, professor at the University of Puerto Rico and director of “La Operación”, were designed specifically so that this population reduction occurred among the poorest communities.
“They were aimed at the poorest, racial minority and least educated women in the country,” says Lourdes Inoa, from the Puerto Rican feminist NGO Taller Salud.
“Because they were the ones who least had the opportunity to know the repercussions of participating in this type of procedure. Consent, in this context, is highly questionable”, he adds.
With private funding, but also from the State, the island was “a great birth control laboratory”, says García.
And women, Inoa adds, have become “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, occurred far from Puerto Rico, within the walls of the prestigious Harvard University, in Massachusetts, USA.
Those who developed the medicine were two renowned professors at the institution: John Rock and Gregory Pincus.
The first was one of the most important fertility experts in North America, says historian Margaret Marsh, a professor at Rutgers University in New Jersey. Rock was paradoxically Catholic, and thought that couples should have the right to decide when to have children.
Pincus 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 specialist who founded the non-profit reproductive health organization Planned Parenthood, and the wealthy suffragist leader Katharine McCormick.
They, says Inoa, “sought for women to be included in the different facets of society, so that they would have greater power.” Maternity control was essential for this.
But it is known that Sanger defended eugenics, the social philosophy that advocates the improvement of the human race through biological selection.
And that’s why he allowed the pill to be tested on poor and vulnerable women.
“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 birth control pills in the US was done on rats and other animals.
Then, in a move considered unethical, the scientists administered the drug to a small group of patients at a public mental hospital in Massachusetts, says Marsh, who specializes in the history of contraception in the United States.
“The patients’ relatives gave authorization to carry out the study, but they themselves, as they were admitted to a psychiatric hospital, did not consent. Although at that time it was legal”, he comments.
At this stage, Pincus and Rock discovered that the compounds they created had the effect of stopping ovulation. So they looked for a place to carry out a larger-scale test, so that US regulators could approve the pill.
In Massachusetts, explains Professor García, birth control was illegal. There were also legal limitations for experimentation on human subjects.
It was then that scientists had to identify an “ideal location”.
The laboratory island
They decided to go to Puerto Rico because sterilization and experimentation for contraception in general had been legal there since 1937.
“A law was approved at a historic moment, when in the rest of the planet, including the USA, widespread sterilization was not legal”, highlights García.
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 — encouraged population control to be researched in Puerto Rico, because for him it was the 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 form of contraception, according to a study by the University of Puerto Rico.
This was possible thanks to the fact that legislation allowed the creation of dozens of family planning clinics throughout the territory, even in the most remote cities, subsidized by the government and with employees 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 country’s capital.
The women of Río Piedras
On the island, the experience began in 1955 as a project in which medical and nursing students participated. But the study was very complicated and painful, so many did not finish.
Furthermore, the pill tested in Puerto Rico had a much higher dose than the current one and caused strong side effects.
“It required urine analysis, endometrial biopsies and other tests to determine whether they were ovulating or not. It’s an uncomfortable procedure. If you have students who don’t really need contraception, they wouldn’t be willing to continue,” says Marsh.
The medication caused nausea, dizziness, vomiting and headaches.
Pincus, however, dismissed these side effects as a “psychosomatic” consequence (when a physical symptom is caused by emotional or psychological issues).
“He believed so much in the pill that he was giving it to his family members. His granddaughters, his daughters, his sons’ friends,” says Marsh, who wrote a biography about Pincus’ co-worker Rock.
The team decided to continue the experimentation, but this time in Río Piedras, a northern suburb of Puerto Rico.
Social workers and medical teams visited women door to door, offering them contraceptive pills and, for some of them, carrying out tests to collect data, without any monetary compensation.
Rejection from various sectors of Puerto Rican society was immediate.
“There were press reports that classified the research as ‘Malthusian'”, says Inoa, from Taller Salud. English economist Thomas Malthus (1766-1834) developed a theory about population growth and food production, and believed in the need for birth control to contain the rapid pace of population growth.
“[Houve críticas] also on the part of 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 needed and not disregard them.”
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 died in the clinical trial carried out on the Caribbean island. However, an autopsy was never performed on them, so the exact causes of their death are unknown.
Despite the deaths, seeing that the pill had the effect of preventing pregnancy, the scientists extended the project to other cities in Puerto Rico and, later, to Haiti, Mexico, New York, Seattle and California.
In total, around 900 women participated, of which around 500 were Puerto Rican.
In 1960, the FDA, the US drug regulatory agency, approved Envoid, as the first pill was called, as a contraceptive method.
Its expansion was rapid. In just seven years, 13 million women around the world used the product.
But after being approved by the FDA, the pill continued to cause serious side effects, including blood clots, which led to lawsuits. On the island, despite lawsuits elsewhere in the United States, studies continued until 1964.
Even 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 currently exists.”
Meanwhile, studies to create an oral contraceptive for men have also failed to bear fruit, although they began 30 years ago.