Governing the Female Body

Gender, Health, and Networks of Power

Lori Reed, Paula Saukko

• Publisher: SUNY Press
• Year: 2012
• ISBN:
  9781438429540
• Topic: Sozialwissenschaften
• Subtopic: Feminismus & feministische Theorie

Drawing on Foucault's notion of governmentality, this collection explores relations between the intimate governance of bodies and political governance. The contributors offer empirically grounded yet theoretically sophisticated case studies showing how gendered, racialized, and socioeconomic agendas structure medical and scientific practices. Developing and utilizing a poststructuralist feminist framework, the chapters investigate emerging gendered discourses and practices around health, such as breast cancer charities, lifestyle genetic testing, new reproductive technologies, and the development and marketing of various psychotropic and hormonal drugs. This will be a key reader for anyone interested in the social implications of cutting edge medical technologies.

PART III

Transnational Body Politics

7

The Pill in Puerto Rico and Mainland United States

Negotiating Discourses of Risk and Decolonization

LAURA BRIGGS

University of Arizona

IN 1962, STEROIDAL ORAL CONTRACEPTIVES—the various versions of the Pill—were at the center of a major controversy, one that was to have far-reaching effects. A growing number of reports cited blood-clot problems among women taking the Pill, including a number of fatalities. Some were calling for the Pill to be taken off the market. The pharmaceutical companies, with the support of the U.S. Food and Drug Administration (FDA), were hesitating and arguing that the evidence linking the Pill with thromboembolism was merely circumstantial. They undoubtedly had a strong financial incentive to wait for more evidence; in 1962 Searle pharmaceutical alone had sales of $56.6 million (Reed, 1983, p. 364). Physicians were split, with a minority suggesting that the well-known carcinogenic risks of estrogen alongside the emergent problems of an apparent correlation with thromboembolism argued at least for extreme conservatism in prescribing the Pill. This state of uncertainty persisted until 1975, when researchers agreed that a by then considerably modified pill was safe for healthy, nonsmoking women younger than age 35.

This was a foundational moment for the women's health movement in the United States. The controversy over the Pill proved in retrospect to be the beginning of the end of the unchallenged authority of physicians, researchers, and the FDA to pronounce about women's health. Journalists, physicians, and patients wrote a series of books about the unrecognized and unacknowledged dangers of the Pill, with titles such as The Bitter Pill (Grant, 1985), Pregnancy as a Disease (Merkin, 1976), and First, Do No Harm: A Dying Woman's Battle Against the Physicians and Drug Companies Who Misled Her About the Hazards of the Pill (Greenfield, 1976). Perhaps the best-known of these books was Barbara Seaman's (1969) The Doctors' Case Against the Pill. Out of this controversy activists founded the National Women's Health Network, which was and remains an important source of unofficial information and an organizing center for lobbying and activism around women's health issues (McLaughlin, 1982). This controversy was joined to others: the thalidomide tragedy of 1962, in which a tranquilizer given to pregnant women caused severe limb deformities in their offspring, and a subsequent disaster with another hormonal drug, DES, which was administered to pregnant women to prevent miscarriage and later discovered to cause significant reproductive health problems for girls born of those pregnancies. These events together marked the beginning of a kind of women's health activism that is still visible, for example in the legal and medical battle over silicone breast implants (and, as Samantha King argues in this volume, that has been co-opted in the philanthropists' campaign for funding for breast cancer research). Ironically, as Paula Treichler (1992) has noted, it was in and through these battles over women's health that the FDA established regulations that AIDS activists would work hard to undo).

I want to revisit this foundational moment and the events that led up to it because our essential paradigms for understanding what was at stake then are in important ways misleading. Where we have basically suggested that it was something to do with the dispensability of “women” as such—a lack of concern about (all) women's bodies—that allowed researchers and physicians to encourage healthy women to use an untried and potentially dangerous medication, this was only part of the story. It was a struggle constructed also by the belief that many risks could be taken with contraceptives for working-class and Third World women, a trajectory in which First World women were in some sense bystanders. The research on the Pill belonged to a particular cold war moment, in which technological and scientific interventions were quite explicitly meant to solve economic and political problems, in this case, Third World poverty and Communism. At a time when the health risks of estrogenic contraceptives were unknown and the argument for giving healthy women a potent steroidal medication was quite controversial, researchers and funders grounded the rationale for the development of the Pill in overpopulation, the belief that Third World poverty was caused by excessive childbearing, and that this poverty, in turn, caused nations to “go over” to Communism. Within a few years, U.S. forces would be distributing birth control pills in South Vietnam, even as they dropped napalm on civilian populations in the North (Sheehan, 1988). The pill's use by middle-class, First World women was an unintended and unforeseen consequence of that initial research, and was first prescribed in nonexperimental settings as an “off label” use of a drug that was approved by the FDA only for “menstrual irregularities.” This story got lost in the 1960s as researchers hastened to defend themselves against the charge that they had illegitimately used Puerto Rico as a laboratory of dispensable bodies for the benefit of First World women. Yet an exploration of the moment of the development of the Pill, the ways physicians and researchers described its benefits when it came under attack, and the history of birth control in Puerto Rico shows that the testing was done there because Third World women were the population for whom the Pill was intended. As we think these days about the ethics of AIDS drug testing by U.S. firms overseas, it bears remembering that the effects of the globalization of drug testing and medical research are never simply contained “over there,” but influence the treatment of working-class people in the United States, and sometimes even middle-class and affluent people.

My intent is certainly not to suggest that “over there” one has questions of race, colonialism, development, and poverty, while in places such as the United States, one encounters “women” and issues of gender and feminism. At the same time, to reiterate an argument of two decades of feminist scholarship on race, it is important to note how “women” are differentially imbricated in webs of meaning about race and nation. For example, one of the architects of the Pill research in Puerto Rico, Clarence Gamble, promoted very different policies and practices for women based on race, class, and region. He vigorously promoted “simple” methods for “simple” people, backing contraceptive foam in Puerto Rico rather than the diaphragm because, he believed, it was easier to use (Williams & Williams, 1978, p. 4). At the same time, he was writing articles for medical journals on the problem of the “college birthrate”—that college-educated men and women were having too few children (1947). He wrote of a project to promote birth control in Puerto Rico that it was:

designed to discover whether our present means of birth control, intensively applied, can control the dangerously expanding population of an unambitious and unintelligent group … it has been said that birth control has been injurious to the race since it has been used by the intelligent and foresighted. It seems to me that only by some … demonstration can this accusation be refuted and our nation protected from an undue expansion of the unintelligent groups. (C. Gamble to Youngs Rubber Corporation, personal communication, March 24, 1947)

He was flatly contemptuous of working-class people in Puerto Rico (and elsewhere) and their ability to help themselves. Of a contraceptive program carried out through home visits, he wrote that “the jibaroes [sic] may not have enough energy to use the method, but if this doesn't persuade them I feel that nothing will” (C. Gamble to W. Wing, personal communication, May 23, 1955). At the same time, he could urge the reproduction of the educated few as crucial to the well-being of the world. As Gamble (1947) wrote in the Journal of Heredity:

In this intricate technological age, highly trained specialists in large numbers are required to man the great complex of delicate organizations, industrial, political, educational, etc. that constitute a modern nation. The greatest single reservoir of those possessing the requisite abilities, the ability to plan, to guide, to execute with intelligence, is the group of college-trained citizens…. By reason of these considerations, the fecundity of this group is a matter of great significance. Since children tend to inherit the intellectual capacity of their parents, the average of the children of graduates will be above that of the nation as a whole. (p. 11)

With this kind of eugenic logic producing a bifurcated account of contraception, in which working-class and non-White people should use it a lot and affluent and well-educated people should use it very little, it confounds matters to think of the testing of the Pill in Puerto Rico as simply an experiment on women qua women, albeit particularly vulnerable ones. Rather, we need a more subtle account of what we might call “race/gender,” or more awkwardly but more accurately, race/nation/class/gender—the ways that in this case Puerto Rican women became a keystone in a narrative that held that people colonized for decades by the United States were impoverished, not because of international politics, tariffs, trade, and economy, but because of their reproduction.

Precursors to the Pill

Gamble and the Puerto Rican context were not unique. A tradition of thinking of certain birth control methods as more appropriate for some populations than for others, what Patricia Hill Collins (1999) describes as the eugenic rhetoric of birth control, stretches back to the second and third decades of the twentieth century. Currently in the United States, we find that contraceptives such as Norplant and Depo Provera are overwhelmingly used in clinics and hospitals that serve working-class people (Roberts, 1997). In the 1920s and 1930s, as Margaret Sanger, the American Birth Control League, and other organizations tried to popularize the diaphragm as the most effective method available, scientists and organizations such as the Rockefeller Foundation argued that for working-class and colonized people—who by definition were understood to be not very bright—spermicides and other similar methods would be simpler and easier to use. In the United States, a principle promoter of this position was Robert L. Dickinson and his National Committee on Maternal Health (NCMH). As Dickinson wrote, “The requests which our Committee receives from foreign lands like China, India, and the Near East and from some of the slum districts here stresses the need of protection much more simple than the vaginal cap [diaphragm], or even…jelly” (R. L. Dickinson to Hon. Mrs. M. Farrer, personal communication, July 19, 1927). As the Great Depression wore on in the 1930s, Clarence Gamble, also a member and supporter of the NCMH, took this orthodoxy to the working-class whites in the Southern Appalachians and Puerto Ricans on the island, arguing that spermicidal foam was the answer to their economic woes. In 1936, over the objections of members of the American Birth Control League, Gamble closed down diaphragm clinics in Puerto Rico and substituted house-to-house canvassing by field workers equipped with foam powder and jellies (Briggs 2002). Social workers who had previously worked in the program found the shift distasteful; Gladys Gaylord wrote him that “my experience in Puerto Rico leads me to believe that it would be unwise to use any but the most approved methods. When I was there, [we] were loathe to back anything that was not guaranteed a high percent of success … in the critical situations which come into the clinic.” As Gaylord noted, Gamble knowingly substituted a fairly effective method for one known to be much less so (G. Gaylord to C. Gamble, personal communication, October 26, 1936). Nevertheless, Puerto Rican physicians and birth control activists, unable to raise sufficient funds for clinics without help from the mainland, ultimately acceded to Gamble's wishes.

In the 1940s and 1950s, researchers' ideologies of what kinds of birth control were best for working-class and colonized people changed, although the notion of a two-tiered system of contraception did not. As eugenic fear of the feeble-minded poor gave way to anxiety over the explosive danger of overpopulation, the dominant characteristic of the birth control method needed shifted from “simple” to “strong.” During this period some physicians began to advocate sterilization, not merely for institutionalized women, but for working-class women generally (efforts in Indiana and California were made to vasectomize institutionalized men, but they were decidedly a minority of those sterilized (Kevles, 1985, p. 108). Puerto Rico, as the only place in the United States (and one of the few in the world) where sterilization was legal in cases other than of mental illness or “feeblemindedness,” was an early experiment in this respect. First in the private hospitals and then in the public hospitals, physicians in Puerto Rico began to perform a large number of la operación. It was a movement fueled in equal parts by physician pressure, public education campaigns blaming the island's “underdevelopment” on the profligate reproduction of working-class people, the massive movement of women into factory work that made caring for young children difficult or even impossible, and the history of bad and ineffective birth control on the island (Ramírez de Arellano and Seipp, 1983).¹

Besides sterilization, the other major initiative in the direction of “strong” contraception was the pill. During the cold war, addressing Third World poverty through economic development became a major priority for a U.S. government trying to stave off the threat of Communism. If poor people were not so poor, the logic went, they would not “go over” to Communism in a violent effort to alleviate their economic situation. As economist Elmer Pendell (1956) insisted, in language apparently designed to explain the dangers of overpopulation and Communism to third graders:

Population causes frequently lead to political consequences. Sometimes people have bartered their freedom for the promise of food. Sometimes people have rebelled against government because their poverty was too bitter. But neither the promise of food nor the struggle for freedom has often give[n] any sound basis for hope—because both food and freedom depend largely on conditions of reproduction. (p. 21)

For Pendell, then, not only does overpopulation cause poverty, which causes Communism, but birth limitation is the only road to both “freedom” and an end to poverty. Minimizing the “population explosion” was a significant goal of “development.” And, as a New York Times editorial put it, “if significant reductions in population growth are to be achieved there must be a technological breakthrough in contraception similar to that in food production” (quoted in Djerassi, 1992, pp.-118–119). Just like the “green revolution” in agriculture, technology could provide an answer to Third World overpopulation; the problem was simply to find it.

In this context, researchers began to look at contraceptive technologies that had been previously thought too dangerous to pursue: specifically, hormonal contraception. While physician-participants and journalists traditionally characterize the development of the Pill as the inevitable result of a series of scientific and technological discoveries, sociologist Adele Clarke (1998) has argued provocatively that one of the most interesting questions about the history of the science of contraceptive research is often why it happened so late (see also Diczfalusy, 1979; Goldzieher & Rudel, 1974; McLaughlin, 1982; Vaughan, 1970). The basic science of the estrogen-progestin contraceptive pill was well-known in 1940; why did clinical trials not begin for another 16 years? Indeed, the idea of hormonal, systemic contraception had been around since the turn of the twentieth century, and numerous studies in the 1920s and 1930s found that estrogen and progesterone were effective in inhibiting ovulation. German biologist Ludwig Haberlandt showed in the 1920s that material from the corpus luteum (the “yellow body” left on the ovary after ovulation has occurred) could induce sterility in rabbits, and proposed that this line of research could lead to a contraceptive for human women (Perone, 1994). In the early 1930s, Corner and Allen isolated an extract from the corpus luteum in crystalline form, which they termed “progestin” (Allen & Weintersteiner, 1934). A. W. Makepeace and his collaborators (Makepeace, Weinstein, & Friedman, 1937) conducted animal tests on the inhibition of ovulation with progestin in 1937 and found it worked.

Meanwhile, on the estrogen side of the equation, Raphael Kuzrock (1937) reported in 1937 that estrogen caused ova to remain in the fallopian tubes and not descend ...

Table of contents

• Title Page
• Introduction Governing the Female Body
• I. MEDIATED SELF-HEALTH
• II. PRIVATIZATION AND THE BODY PROPER-TY
• III. TRANSNATIONAL BODY POLITICS
• IV. SCIENCE, NATURE AND GENDER
• Contributors