Last year, Virago republished Mary McCarthy's 1963 novel The Group, with a new introduction by the author of Sex and the City, Candace Bushnell. The Group is a novel which some of my dearest friends consider to be a) seminal and b) as racy, in its way, as Peyton Place, so I went out and bought the new edition, and read it over the course of a lazy weekend. Did I like it? Oh yes. The story of eight female graduates choosing careers and husbands (though not necessarily in that order) in 1930s New York, it is wonderfully funny, savage and piercing, with a gossipy kind of a plot that pulls you along rather in the manner of Carrie Bradshaw on the trail of a fine pair of spike heels. The travails of its characters – the wife who must shop for dinner before work in order that she can get straight to the stove when she comes home – still feel marvellously modern. But something else struck me about it, too: the detailed and intimate way in which it deals with the problem of contraception. For all the undoubted punch of her writing, there are moments down at the family planning clinic when McCarthy seems to be writing an encouraging manual as much as a novel.
Let us agree, for a moment, that there is such a thing as the women's novel. In women's novels of the late 20th and early 21st century, we see this aspect of women's lives only rarely. Of course characters still fall in love, and they have sex, plenty of it sometimes. But if they menstruate, no one ever mentions it; and if they visit a family planning clinic, they do it off the page, well out of sight of the gentle reader. In The Group, however, biology, and how to pull a fast one on it, are centre stage. Early on in the novel, one of the group, Dottie, goes to bed with a man to whom she is not married, Dick. She is a virgin – "she had never seen that part of a man, except in statuary and once, at the age of six, when she had interrupted Daddy in his bath" – and it shows. Too shy to mention contraception, Dick, more experienced, employs the oldest method of all, "coitus interruptus… a horrid nuisance". Afterwards, as Dottie is preparing to leave, he tells her to get herself a "pessary" (this is American for a diaphragm). "When you get yourself fixed up, you can bring your things here and I'll keep them for you," he says, a reference to the fact that in 1930s America, as in 1930s Britain, diaphragms were not the kind of thing unmarried women left lying around in their top drawers, where, depending on their circumstances, their staff, mother or girlfriends might find them.
Dottie, then, goes to a clinic to pick up her "new device", one discovered by the birth control pioneer Margaret Sanger in Holland and imported into the US for the first time. There follows a long and detailed account of the fitting of the diaphragm. Dottie is gung ho about getting herself "fixed up", but not so gung ho as to be entirely unruffled by the experience of squatting girdleless on a surgery floor in front of a complete stranger, and there is an embarrassing moment when, observed by both doctor and nurse, the diaphragm, covered in jelly, flies out of her hand, crossing the room like a tiny bat. Afterwards, nervously thrilled at the step she has taken, Dottie tries to call Dick. He isn't home. She leaves a message, telling him that she is waiting for him in Washington Square. But he doesn't come. Eventually, as dusk falls, Dottie discreetly places her precious packages beneath the bench on which she has spent her afternoon, and heads for Fifth Avenue and a taxi.
McCarthy's novel was published three years after the pill was approved by the US authorities in 1960, but several years before it was widely available (well into the 1970s, women in Britain and America were still pretending to be married in order to get a prescription; some used to pass around the same battered wedding ring in the doctor's waiting room). Its explicit descriptions, for the day, of jelly-covered discs of rubber thus foreshadow the coming openness at the same time as they reflect the widespread fear, ignorance and shame which many women, in 1963, still felt when it came to sex. From the late 1950s until the mid-70s, there were lots of novels like this, outwardly controversial and racy but also heavy with the misery and conflict that came with sex before the advent of the pill. Only then, in fiction as in the world, the anxiety, the unappetising "equipment" seemed suddenly to disappear. Now, 21st-century women's novels deal with the IVF clinic, not contraception.
Fifty years after its birth, we take the pill entirely for granted; we think about what it erased forever not at all. For sure, it is sometimes the subject of newspaper stories. But less often than of old, and only when it has been dubiously linked to yet another health scare. (From time to time, of course, the odd relic will bemoan its effect on our morals, usually at the behest of the Daily Mail. Last month it was the turn of Raquel Welch on CNN. The pill has destroyed marriage, she said: "Seriously, folks, if an ageing sex symbol like me starts waving the red flag of caution over how low moral standards have plummeted, you know it's gotta be pretty bad.") We do not talk about it; we do not celebrate it. In the 20-24 age group, two-thirds of British women take it every morning, as unthinkingly as they dial their boyfriends on their mobile phones. It is just another convenience, and what their grandmothers and great-grandmothers went through is straight out of the history books.
"Young women don't realise what hell it was [before the arrival of the pill]," says the fashion designer Mary Quant. "The perpetual anxiety. It was a real revolution." Was she an early adopter? "Oh yes, it was quite wonderful. Of course it was hellishly difficult to get hold of at first. There was a lot of pretending one was married when one went to the doctor, and a minor disadvantage was that the early pills made one put on a couple of pounds. But that was nothing! Who cared? The other forms of contraception were so hellish." She squeals at the memory. "I remember going to a doctor in Chelsea for a Dutch cap. 'It's quite easy,' she said. 'When you dress for dinner, just pop this in!'"
The novelist Margaret Drabble, whose 1967 novel Jerusalem the Golden also features a diaphragm scene, agrees that the pill changed everything; that the revolution associated with its arrival has not been mythologised down the years. "The other methods were quite remarkably unreliable," Drabble recalls, "and fairly repulsive, and the people who worked in the clinics fitting them were rather unfriendly and punitive. I remember going to be fitted for a cap, and I had a child in a pushchair, and the woman asked me why on earth I was there. By the time the pill was available I already had three children; I think I would have had a child a year if I hadn't started taking it. So, yes, it made a very considerable difference to one's life. You were able to make a choice, you were able to look after yourself, and I was pleased to do so.
Drabble says her generation had been afraid of getting pregnant. "People were very afraid of abortion; it threatened you. The pill also meant people were able to keep the integrity of the family. Of course people had affairs before the pill, but with more anxiety, and there were mixed children, and some told, and some didn't tell. Afterwards that was no longer the case."
In 1960, shame was still a powerful force, pill or no pill. In the same year, Lynne Reid Banks published her first novel, The L-Shaped Room. Considered shocking at the time, it tells the story of a failed actress, Jane Graham, who, having fallen pregnant and been turned out of the family home by her disgusted father, goes to live in a dingy, bug-ridden bedsit at the top of a squalid boarding house in Fulham. "When I wrote it I had never been pregnant," says Reid Banks. "I based the story on a girl who had the flat next to mine. But my mother was so worried about my reputation that she begged me to publish under an assumed name. 'Everyone will think it's you,' she said. I laughed merrily. But she was right."
Reid Banks never took the pill. By the time it was available she was married and busy having a family. "However, about the fear of unwanted pregnancy I can talk. This fear in itself was quite an effective contraception, even for our boyfriends, who, if they were the right sort, were as scared as we were of getting us into trouble. It meant that 'going all the way' was something many of us only did when either things got out of control, or in the course of what was called 'the search' – ie, affairs were morally justified when you thought he might be 'the one' or could deceive yourself into thinking so. We used to 'pet' like mad: by the hour, and very inventively, and inevitably getting ourselves into a fine old state. I followed the nothing-below-the-waist rule most of the time." What was that like? "It was pretty stressful, and probably very bad for us."
The story of the pill's development is well-rehearsed. But still, it bears repeating. That the scientist most strongly associated with the project, Gregory Pincus, was able to work on the drug at all was nothing short of a minor miracle. Among his more powerful enemies were both the Catholic church – then, as now, implacably opposed to contraception – and large sections of the political establishment (thanks to Joe McCarthy's war on communism, birth control was widely regarded as part of a Bolshevik conspiracy). Nor was the law on his side. In Massachusetts, where he worked, anyone caught providing contraception faced a possible prison sentence – a situation which persisted until 1972. Pincus's major problem, however, was money. The drug companies considered the idea of a contraceptive pill to be a (possibly dangerous) shot in the dark, and most universities were unwilling to risk damaging their reputations by backing such controversial research.
In 1950, Pincus met Margaret Sanger. Sanger was a Catholic whose mother had died at 50, after 18 pregnancies. "You caused this," she told her father, over the coffin. "Mother is dead from having too many children." After training as a nurse, Sanger began dreaming of a magic pill that would prevent pregnancy, and it was she who first coined the term birth control, in 1914. Three years later, at a suffrage meeting, she met Katharine McCormick, famously only the second woman ever to graduate from the Massachusetts Institute of Technology. McCormick was a rich feminist (she was married to the heir to the International Harvester Co fortune and, when he was declared legally insane, was awarded control of his estate), and one wholly committed to the cause of finding a way to help women limit their families, with or without their husbands' help. Sanger suggested that she bankroll Pincus, and she agreed. In the course of her lifetime she gave the project the equivalent of more than $12m.
By the time of his meeting with Sanger, Pincus, an expert on the process of reproduction, had already attracted attention with his work to create "fatherless rabbits" (he had succeeded in creating a rabbit embryo in a Petri dish). Spurred on by Sanger, he now began studying the effect of the oral administration of progesterone (synthesised by scientists in Mexico from wild yams) on animals. The results of these studies suggested that the idea of an oral contraceptive for humans was feasible, and it was this line of inquiry that McCormick, by now 76 years old, agreed to fund (not only that, but she moved from California to Massachusetts, the better to keep an eye on developments: "Freezing in Boston for the pill," she wrote in 1953).
But testing the administration of progesterone on humans would require someone with clinical experience. Pincus enlisted the help of Dr John Rock, then the US's leading infertility expert (Rock was a devout Catholic, with five children and 19 grandchildren). Rock had been experimenting with progesterone to help women conceive. The progesterone was used to suppress ovulation for four months. Then it was suddenly withdrawn, causing a kind of rebound effect. Using hormones to prevent pregnancy worked on the same lines: the progesterone prevented the release of an egg, only in this instance it would be used for a longer time frame.
Some of the clinical trials were carried out, controversially, in poor countries such as Puerto Rico, and later Haiti. As Lara V Marks points out in her 2001 history of the pill, Sexual Chemistry, this was complex work. Much depended on the instruction researchers gave to their volunteers. In Haiti, many of the women were illiterate and innumerate. To ensure they remembered their medication, researchers hit on the idea of giving them rosary beads, which they were to move individually each day after they had taken it. But even this was not foolproof: a number of the women wore the beads in the belief that they alone provided protection against pregnancy. Nevertheless, when women did remember to take it, the pill proved effective, and in 1957 it was approved for the treatment of "female disorders" (30 states still had laws forbidding the promotion of birth control, so for a while it wore a disguise).
In 1959 the pharmaceutical company Searle applied to the FDA for approval of a pill that would be marketed as a contraceptive called Enovid – this pill also contained a tiny amount of oestrogen, to prevent bleeding – and on 9 May 1960 approval was finally granted. Women were elated, and would not be put off either by its side-effects or by the rumours of the effect it would have on their long-term health. The poignant and beseeching letters that Pincus and his colleagues had received from women while they were still working on the pill ("I am 30 years old. Have six children, oldest little over seven… My health don't seem to make it possible to go on this way…") were replaced by joyful thanks. In Britain, more than one woman likened being prescribed the pill to winning the pools.
This is not to say that there weren't problems. The early pill was a blunt instrument and had side-effects including headaches, nausea, dizziness, bloating, even thrush. Early on, its use was linked to cancer and to thrombosis. (Over time, hormone levels were refined and its side-effects reduced. Nowadays the average pill's oestrogen content is a third of what it used to be, the progesterone a 10th or less.) Nor was every woman a fan. The American feminist Gloria Steinem has always insisted that the pill's effect on the wider sexual revolution was overstated, and perhaps she has a point (social mores changed for a variety of complex reasons, of which the pill was only one). Germaine Greer believes its advent meant that "a morally neutral reason" for refusing penetrative sex had ceased to exist: "Women no longer had an acceptable reason for refusing the kind of sex that was most likely to be brutish and short. Once they had made the investment in sexual activity by taking a daily medication in order to be available, there was no sense in being unavailable. Having accepted the idea of themselves as sexually active, they had to be sexually active or be failures." In other words, she believes that it benefited men far more than it did women.
Other women note that, in spite of the pill, unwanted pregnancies still occur. As she revealed in a recent BBC4 documentary series, Susan Brownmiller, the American feminist and author of Against Our Will, the classic book about rape, had several illegal abortions overseas during the 1960s; you might assume she would be strongly on the side of the pill. But no. "People are still getting pregnant," she says. "The pill only suits a woman who is on a regimen, who has a regular sex life. And who does have a regular sex life? Basically that means the middle classes. The rest [of the population], that's a lot of women. I just don't think the pill has reached, or will reach, everybody. I never used it because I was having an irregular sex life. Some people don't expect to have sex that often. Sex just… comes up [occasionally]. Those women don't take a pill every day."
For Brownmiller the issue now is increasing the availability of emergency (ie morning-after) contraception, and of abortion. "The issue then [in the 1960s] was abortion, and it is now. A lot of people are still afraid of having an abortion. They're more afraid of that than they are of having a child. I just don't think that the pill is the best form of birth control, and that's before we even get on to the question of STDs [sexually transmitted diseases, against which the pill is no protection]." Brownmiller feels that it is those who can't get pregnant who now dominate the media. "This pro-natalism. I haven't seen anything like it since the 1950s. Everything is baby, baby, baby." In this context, she believes, abortion rights become more vulnerable, and abortion itself more taboo.
The fact is, though, that the pill is used by an awful lot of women: some 3.75 million are currently using it in the UK alone (worldwide, more than 200 million have used it since it was first approved). Used properly, it is 99% effective. Most side-effects can be avoided by changing the type of pill you take. Best of all, in spite of what you read in certain newspapers, it is extremely safe, its benefits far outweighing the risks. The pill reduces the risk of cancer of the ovary, uterus and colon. It may also protect against pelvic inflammatory disease and reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease. Last March the Royal College of GPs published the results of research which studied 46,000 women over almost 40 years. It found that women who have taken the pill were also less likely to die from cancer, heart disease or stroke.
"It has so many benefits, from protecting against ovarian cancer to helping to alleviate painful periods," says Peter Bowen-Simpkins of the Royal College of Obstetricians and Gynaecologists. "In developing countries, where anaemia is a huge problem, the pill can help to reduce blood loss. Only smokers over 35, or the obese – those with a BMI of over 30 – are at increased risk from coronary heart disease if they take the pill, but we've known that since 1975."
Why, then, is it still associated, in some women's minds, with risk and side-effects? "Because the newspapers don't always look at underlying reasons," says Bowen-Simpkins. "I remember a story when a mother of seven dropped dead. The headline said: 'Judge blames pill'. But if you looked behind the story, she was a smoker and she was obese. Such things are incredibly rare anyway, but 3 million people read that, and it was bad publicity."
Bowen-Simpkins points out that some newer forms of hormonal contraception – in essence, the pill in another format – have even fewer side-effects than the pill because the hormones in them are of a lower dose. Moreover, because a contraceptive patch releases hormones straight into the bloodstream, its effectiveness is not reduced if you vomit or have diarrhoea (the hormones in the pill must be absorbed by the stomach). Ditto the contraceptive ring, which releases hormones into the bloodstream via the vaginal wall.
For my own part, when, if, I do stop to think about the pill, I cannot feel anything but deep gratitude. I started taking it when I went to university – Marvelon, in a pale blue blister pack – and it was blissful to be released, overnight, from the monthly dread, from the sickly, stomach-churning days of waiting and wondering and hoping. After college, when I was advised to stop taking it, my childhood migraines having unaccountably returned (there is an increased risk of deep vein thrombosis in migraine sufferers), I was devastated. This news ruined all sorts of things which I'd better not go into here. But then – oh, joy – a new brand of progesterone-only pill came on the market which was almost as effective as the traditional combined pill and suitable for migraine sufferers. I take Cerazette to this day, and thanks to a decade of doing without – the pill, I mean – I have never got to the point where I take it for granted. I'm not exaggerating. Popping it actually makes me cheerful.
But I also think about my grandmothers. Both of them came from large families and, as girls, both had to live with the sometimes harsh consequences of being, as Hardy put it in Jude the Obscure, "too many". My maternal grandmother was one of seven and, along the way, siblings were sometimes, well… lost. A brother went to Canada to seek his fortune and was never seen again. A sister died as a little girl, an event then so common my grandmother did not think to mention it for years and years, not even to her own daughter. My paternal grandmother, meanwhile, was the eldest of 10. She was clever and would have liked to have been educated, but her parents, needing her help at home, insisted that she leave school as soon as she turned 13. She spent the rest of her childhood dandling babies, stirring pans, and forcing sodden washing through the family mangle. I wonder: do the naysayers and doom merchants even know what a mangle is?
Rachel Cooke is a feature writer at The Observer
What the pill means to me…
Fay Pownall, 24, public servant I'm on a pill called Yasmin. As well as the freedom it's allowed me, it's had an incredibly positive effect on my hormone imbalance. Friends of mine have had contraceptive implants, but they don't appeal to me. It's the action of actually taking the pill that gives me a sense of security. Without it I'd have a much more nerve-racking life.
Katherine Jackson, 49, sole trader When I first went on the pill at 19, I felt slightly intimidated by what it stood for – it meant I was taking sex seriously. I took it again after the birth of my first child but didn't consider returning to it after the birth of my second. It seemed more sensible, since we had completed our family, to make a more permanent decision, so my husband had the snip. My youth would have been very different without the pill. It gave me sexual independence – it meant that I was allowed to make my own decisions.
Johanne Wang-Holm, 23, actor I started taking the pill, Femodette, when I was 16 – and I haven't looked back since. For me it's incredibly useful in that it controls my periods: it's less about contraception. I'd consider swapping to the injection at some point, as I like the idea of skipping periods altogether, but I doubt I'll ever go through with it. It does seem important to feel like my whole system's still working. I do wonder if sex with strangers is more common since it was invented, but I think society has changed around it. The most important thing is that it gave women a sense of control. A choice.
Nicky Anderson, 22, actor The pill is an incredibly positive thing – the element of control it gives women, over their sexuality and their life. It increases equality between the sexes, allowing women to concentrate on pleasure rather than reproduction. There are reports about the male pill, but even when it arrives I think women would prefer to be in control of their own contraception – men can still always walk away from a pregnancy. As much as people talk about how the pill's revolutionised women's lives, problems in gender relations still exist. The problems now, as opposed to before the pill, are just different; they've evolved. There are new games to play.
Philippa Hawghton, 22, student I broke up with my boyfriend, but I stayed with the pill. I'm on Microgynon, which, because it gave me really regular periods, has made my life so much easier. Before I started taking it I was slightly unsure – I was happy in myself, with my body, and didn't want that to change, but I didn't regret it. Now it's just part of my daily routine – I take it before brushing my teeth.
This article was amended on 20 September 2011 to remove one interviewee.
