By Melissa Bell
Fifty years ago, on May 11, 1960, the pharmaceutical company Searle received approval from the American Food and Drug Administration to sell a tiny tablet named Enovid for birth control.
A simple combination of two hormones - progesterone and oestrogen - inhibited ovulation. If taken correctly, it promised a 99.7 percent effectiveness rate in preventing pregnancy.
Enovid had already been on the market for three years, treating menstrual disorders; its approval as an oral contraceptive marked the first time a medicine would not treat or prevent an illness, but would be prescribed to healthy people.
With the new Pill, women would be "freed from their chains at last", an advertisement claimed.
It was a bold promise.
So popular was Enovid that its descendants are referred to simply as "the Pill". Five decades on, little doubt remains of the Pill's impact: it is hailed as one of the 10 greatest public-health accomplishments of the 20th century. It allowed women to choose if and when they would have children.
After 50 years, however, the boastful promise to unfetter women rings hollow to some. Half of US pregnancies remain unplanned. Almost four in 10 women using the Pill and other reversible birth control methods are not happy with them, according to the Guttmacher Institute, which focuses on reproductive health. And a vocal chorus of women calls for the doctors' reliance on the pill to be re-examined.
"It's handed out like candy," said Holly Grigg-Spall, a blogger who stopped taking the Pill last year and encourages other women to do so at Sweetening thepill.blogspot.com.
"You imagine it's just this harmless little Pill," she said, but she believes women do not think enough about side effects.
The revolutionary contraceptive was envisioned by a nurse, Margaret Sanger, who worked in New York almost 100 years ago and saw the results of many botched back-alley abortions. Sanger, who believed her own mother's 18 pregnancies led to an early death at the age of 50, talked of "a magic Pill" that would allow women to control birth. Sanger, who founded the group that would later become Planned Parenthood, was 80 when the Pill was approved.
While her grandson Alexander Sanger continues the campaign for birth control, he cautions against overstating the impact of the Pill. "It has done less than we dreamed and less than our opponents feared," he said. "Do we have the right contraception for every woman at the right stage of her life? No."
Long mythologised as liberating women to have sex without the risk of becoming pregnant, the Pill began by "saving the saved", according to Alexandra Pope, author of The Pill: Are You Sure It's for You?
Its first adopters were middle-class women already in committed relationships and usually on another form of contraception: married women like Jan Nyenhuis, now 69, who meticulously used a diaphragm. But twice the method failed, she said and nine months later, after giving birth to her fourth child, she switched to the Pill.
Five years after the FDA's approval, five million women had tried the Pill. Many switched to it simply because it was an easier, "less messy" option than the diaphragm. As one 79-year-old woman recalls, "It was not a revolt; it was a relief."
That relief ushered in an era of dynamic changes in the American family. In 1970, according to the US National Centre for Health Statistics, the typical US woman married at 20 and had her first child at 21. Today, women have their first child about four years later and marry six years later.
Those statistics reflect another shift: more single women give birth. There has also been a dramatic increase in the number of women who are over 35 when they have their first child - from one out of every 100 in 1970, to one in every 12 in 2006.
Women now make up half the American workforce, and outnumber men at college.
"The Pill," said Elizabeth Kissling, professor of women's studies at Eastern Washington University, "had a profound effect on women's lives and their relationships" by allowing greater control over fertility.
However, the Pill has side effects. The earliest versions had 10 times more oestrogen than the equally effective contemporary Pill, and it could cause blood clots, strokes and, in rare cases, death. Barbara Seaman's book, The Doctors' Case Against the Pill, published in 1969, came to the attention of US Senator Gaylord Nelson who called for hearings on the Pill's safety. No women, not even Seaman, were invited to testify.
A group protested and the media attention eventually led to a lowering of the oestrogen in the Pills. A new wave of women, aided by the internet, has begun sharing experiences and seeking out contraceptive alternatives. Christina Hannah, of Indiana, had been prescribed the Pill to ease heavy menstrual pain. It helped control her periods, but within three months she was suffering from sleeplessness, nausea and anxiety. She Googled the name of her Pill, Yasmin, and found a "survivors' board".
Yasmin, it turned out, had become the subject of lawsuits against its manufacturer, Bayer, by women who had suffered strokes and blood clots. Bayer said that it stood behind the safety of its oral contraceptives and that the lawsuits focused on side effects that the company had warned about.
Laura Wershler, director of Sexual Health Access Alberta, said: "There's a huge distance between what women want and what (the medical community) is willing to provide. We're so used to - and comfortable with - this fast-food birth control, we don't want to take the time to think about fertility management."
From a medical perspective, the Pill is a success. Studies suggest it reduces ovarian cancer. Many doctors believe the risks of taking the Pill are much lower than the risks of unintended pregnancies: "The Pill is great... but we need ...different options. There's a new age of women, wary of taking hormones and accustomed to questioning medical advice, that wants just that". - The Washington Post
The Pill: a timeline:
1550 BC: An Egyptian manuscript called the Ebers Papyrus tells women they can prevent pregnancy by mixing dates, acacia and honey into a paste that is smeared over wool and inserted into the vagina.
1839: Charles Goodyear invents the technology to vulcanise rubber, turning it into a strong elastic material. It is soon put to use to manufacture rubber condoms, intrauterine devices and "womb veils" (diaphragms).
1921: Nurse Margaret Sanger founds the American Birth Control League, which became the Planned Parenthood Federation.
1936: Obstetrician-gynaecologist John Rock opens a clinic to teach the rhythm method.
1957: The FDA approves the use of Enovid for menstrual disorders. Three years later, the drug is approved as a contraceptive.
1970s: As concerns increase about safety, lower-dose pills are introduced.
1998: The FDA approves the "morning-after" pill.
2001: The FDA approves the birth-control patch.
2010: New contraceptive systems such as the Nuva ring dispense hormones without the need to take a daily pill.