Presentation on theme: "The Taste of... The Pill. The Controversial Use of Puerto Rico For the Development of the Contraceptive Pill As an historic example of how social, political."— Presentation transcript:
The Taste of... The Pill
The Controversial Use of Puerto Rico For the Development of the Contraceptive Pill As an historic example of how social, political and economical power shapes sex
By Jesús Estrada Doctor of Human Sexuality Presented at the SSSS 50th Anniversary Conference Indianapolis, Indiana 2007
History of birth control in 20 th century Puerto Rico - The Pre-Trial Phase - The Trial Phase - The Post-Trial Phase
The Pre-Trial Phase -The US government efforts to control Puerto Rican population The Trial Phase -Large-scale Pill trial performed in Puerto Rico Post-Trial Phase -Regret and protest for the trials and the way population was controlled in PR
The Pre-Trial Phase Resident of a slum area. Ponce, Puerto Rico. ( Jack Delano 1941). Library of Congress
The Spanish regime left the Island in: -Extreme poverty -Famine -Overpopulated After the Hispanic-American War (1898) -The Island turns from a Spanish American colony into a United States property.
Overpopulation was a major concern for the United States regime in Puerto Rico. Efforts were made since the beginning of the 20 th century to reduce overpopulation. None were effective as expected. Native Puerto Ricans (1903) (As a captioned on the original picture) Detroit Publishing Co. no Gift; (State Historical Society of Colorado; ) Library of Congress.
The Pre-Trial Phase-A Chronology United States officials in Puerto Rico express concerns about Puerto Rican overpopulation. Neo-Malthusianism and Margaret Sanger’s ideas is sprouting amid those in social, economical and political power.
1917 Inspired by neo-Malthusianism American industrialists, scientists, social workers, and middle and high class Puerto Ricans trace a population control plan for Puerto Rico United States government begins to promote birth control in Puerto Rico.
1923 Using a false name future governor and political leader Luis Muñoz Marín writes an article in La Democracia newspaper defending both Margaret Sanger and neo-Malthusianism. El Imparcial newspaper responds condemning neo-Malthusianism. Muñoz Marín at El Mundo newspaper: “Of all Puerto Rican ailments, overpopulation is the worst.” (Translation of the Researcher)
1923 San Juan’s Bishop Carvana at La Correspondencia newspaper: “To accept neo-Malthusianism is like to suicide the race.” (Translation of the Researcher) A native hut (1903) Detroit Publishing Co. no Gift; State Historical Society of Colorado; Library of Congress.
1925 Formal birth control clinics start to be sponsored in Puerto Rico with Federal funds. Dr. José A. Lanause Rolón founds the Ponce Birth Control League. -Its approach is educational. -Social pressure makes it last less than a year.
1932 The Puerto Rico Control League is organized and opens a clinic to gives out contraceptive services (it last two years only) Sixty seven new birth control clinics are opened with Federal funds.
1936 The Maternal and Childcare Health Association opens 23 other birth control clinics with Federal funds too. Catholics pressure convinces Federal Government to discontinue the program.
1937 Time magazine: - “…one basic remedy for the islander’s appalling poverty is to cut their appalling birth rate…” Clarence J. Gamble allegedly pushes for the legalization of birth control in Puerto Rico.
1937 Law 136, The Eugenic Law, is approved on May 12. Contraceptive advice or services to prevent pregnancy is not a felony. Comstock Act is not applied in Puerto Rico.
1937 New 160 birth control clinics open Involuntary sterilization begins Law 136 of 1937 The “eugenic law”. (Excerpt) Law 136 of 1937 The “eugenic law”. (Excerpt)
1939 United States continues to support birth control clinics and the distribution of contraceptives in Puerto Rico. Family in a slum area in Yauco, PR. (Jack Delano, 1942) Library of Congress Family in a slum area in Yauco, PR. (Jack Delano, 1942) Library of Congress
1940 The Puerto Rico’s Health Commissioner, Dr. Eduardo Garrido, creates the Bureau of Maternal and Infant Care. New 122 birth control clinics open.
1943 The United States Congress concludes: - “Puerto Rico is one of the most densely populated parts of the world.” Widow and child of a farm laborer. San Sebastian, Puerto Rico (vicinity). Jack Delano (1942). Library of Congress
1946 Future governor Muñoz Marín: - “If population growth is not reduce nor productivity increased, unemployment will rise, even with the help of Federal funds…” (Translation of the Researcher) 1947 A 6.6% of ever-married women are already sterilized.
1949 The Puerto Rico’s Commissioner of Health concludes that: -Public hospitals should be used once or twice a week to perform fifty sterilization per day.
1954 The Family Planning Association of Puerto Rico is established. United Nations Demographic Yearbook: -Puerto Rico’s population per square kilometer in 1953 is 31 times the average of ten Latin American countries and 12 times the average of the United States.
A family of the Río Piedras area. Jack Delano (1942) Library of Congress The Trial Phase
Margaret Sanger dreamed of a contraceptive pill easy to take as an aspirin that could be used for contraceptive purposes. In 1951she met doctor Gregory Goodwin Pincus. Implores him to take her quest for a pill. Margaret Sanger
1955 After receiving funds from Sanger’s friend, Katharine McCormick (upon Sanger’s request), Pincus needs a place to perform a large scale trial of the Pill. Katherine McCormick
1955 Since anti-birth control laws in Massachusetts and many other states make impossible for Rock to conduct the large study in humans he needs for FDA approval… Rock and Pincus look for a place to launch the first, large-scale clinical trial of the Pill.
1955 Pincus visits the Island and see it as the perfect place. There are no anti-birth control laws. There is an extensive network of birth control clinics already in place.
1955 The Island is one of the most densely populated areas in the world. Puerto Rico, being an island, offers them a stationary population that could be easily monitored. Island’s officials support the idea in the hope that it would stem Puerto Rico’s endemic poverty.
1955 Allegedly in Pincus mind: -If he could demonstrate that the poor, uneducated women of Puerto Rico could follow the Pill regime, then, women anywhere in the world could too. At the home of a farm laborer along the road in the hills near Yauco, Puerto Rico. Jack Delano (1942). Library of Congress At the home of a farm laborer along the road in the hills near Yauco, Puerto Rico. Jack Delano (1942). Library of Congress
1955 Searle Pharmaceutical provides the pills under the brand name of Enovid. Rock selects a high dose to ensure no pregnancies would occur while subjects are in trial. Enovid
1955 The Pill is 20 times stronger than the pill that will be used in U.S. 30 years later. Helen Rodríguez-Trías ( ) Puerto Rican physician and advocate against involuntary or forced sterilization. Argued the Pill ‘s dose was 20 times stronger than the pill used 30 years later. Helen Rodríguez-Trías ( ) Puerto Rican physician and advocate against involuntary or forced sterilization. Argued the Pill ‘s dose was 20 times stronger than the pill used 30 years later.
1956 Family living in a slum area in Yauco, Puerto Rico. Jack Delano (1942). Library of Congress Family living in a slum area in Yauco, Puerto Rico. Jack Delano (1942). Library of Congress Two trial strategies: -To take birth control out clinics (Home setting). -To start the Pill regime shortly after having the first baby. (Hospital setting).
On the month of April the large trial in humans begins. The Pill is tested on Puerto Rican women of great socio-economic deprivation who were living in a slum area used to be known as El Fanguito –“the little mud.” 1956
The trial strategy selected by Pincus and Rock is to take birth control out of clinics. Pincus Rock
To take it directly into women’s houses. Through female peers. Hired as social workers or nurses instructed to both give women the Pill and seduce them to visit clinics.
1957 Edris Rice-Wray is the medical director in charge of the Pill trials. She reports the Pill was 100% effective in preventing pregnancy. She reports also the side effects.
1957 Rice-Wray reports that many women complained of nausea, dizziness, headaches, stomach pain and vomiting. She reports that so serious and sustained these women’s reactions were that she thought the Pill’s side effects were so uncomfortable as to be generally accepted by women.
1957 Pincus and Rock decide to dismiss Rice-Wray observations. Both of them take no action to assess the causes of the side effects. They prefer to believe that Puerto Rican subjects’ complaints are psychosomatic, and that side effects are minor effects compared to the contraceptive benefit of the Pill.
1957 Three Puerto Rican women die while participating on the Pill trials. No autopsy or investigation is conducted to assess if the Pill is related to the deaths. No informed consent is required to subjects.
1958 The total birth rate in Puerto Rico starts to decline Rev. Truman B. Douglas - “This service to the cause of population control,” he says, “is a positive expression of Christian compassion and humanitarian concern.” (Time magazine, 1959)
1960 Searle is doing $27 million annually using Enovid for menstrual disorders, and pushes FDA for its approval as a birth control. FDA approves Enovid as a birth control pill on May 11.
1961 Studies relates the Pill to blood clots, heart attacks, and strokes. Norinyl Tablets Orth0-Novum (Images accessed at
1961 “ Birth Control Prepares the Ground for Communism… ” “… shameful that one part of the society and the government support neo-Malthusianism. ” The San Juan Star newspaper (April 26, 1964)
1962 There is evidence of at least 11 deaths all allegedly related to the Pill. Picture by Jack Delano (1941) Picture by Jack Delano (1941)
1963 Syntex pharmaceutical joins to the birth control market and the trial with a 10 mg pill named Ortho- Novum. In the slum area called El Fangitto. San Juan, Puerto Rico. Jack Delano (1941) Library of Congress In the slum area called El Fangitto. San Juan, Puerto Rico. Jack Delano (1941) Library of Congress
1964 Wyeth Pharmaceutical joins to the Pill trials with a contraceptive pill composed of Norgestrel and Mestranol. In the slum area. Ponce, Puerto Rico. Jack Delano (1941). Library of Congress In the slum area. Ponce, Puerto Rico. Jack Delano (1941). Library of Congress
1964 PR government endorses a new plan to turn existing health centers into birth control clinics. Notwithstanding, an official policy is denied. From now on Puerto Rican government seems to give signs of ambiguity in relation to the Pill. (Karen L. Michaelson, 1981)
1964 The San Juan Star newspaper headlines: -“Govt. Scored on Birth Control”. -“The Commonwealth Government was strongly attacked yesterday at the International Planned Parenthood Federation Conference for refusing to carry out an active birth control program in Puerto Rico.” ( The San Juan Star, April 21, 1964)
1964 It suddenly seems that the once welcomed Pill starts to be a menace for those in political power. So, It is better to pronounce no official concern nor policy about population control.
1967 Wyeth starts with Puerto Rican women a new pill trial with a continuous daily micro dose of Norgestrel. The Family Planning Agency of Puerto Rico receives $750,000-$900,000 of its budget from the U.S. Department of Health, Education and Welfare.
1967 Up to now The Puerto Rico Family Planning Association has already provided services to 20,000 women: 10 % took IUD’s, 69% pills, and 23% other methods such as vaginal foam and condoms British studies show an increased incidence of blood clots among women taking the Pill
1968 The r e are 132 cases of premature death all allegedly linked to Searle’s pill (Enovid ). Picture by Jack Delano (1942) Picture by Jack Delano (1942)
1969 United States carries out studies that support British findings in regards to blood clotting and the Pill. Wife of a FSA (Farm Security Administration) borrower. Manati, Puerto Rico (vicinity). Jack Delano (1941). Library of Congress
1969 A 35.3% of the Puerto Rican women are already sterilized. (José Vázquez Calzada -Puerto Rican Demographer) (By 1947 it was only a 6.6%.) Picture by Jack Delano (c ) Picture by Jack Delano (c )
What was the problem between the Pill and the Government? The above mention of Puerto Rican government ambiguity with the Pill trials may be explained. Governor Muñoz was a great defender of population control since the beginning of the century. What may be happening now?
The Pill trials and Muñoz economic plan Operation Bootstrap -Governor Muñoz economic plan to turn the Island from an agrarian, underdeveloped country into a developed one. -People were still walking barefoot, and lacking of both food and social aids. -PR would no longer be an underdeveloped, agrarian, culture and would be another developed, industrialized, and modern country.
Operation Bootstrap Economical Incentives Employment An Estate to Build a House A Better Life
The Pill was timely and extremely convenient to this economic plan for the plan entailed the reduction of population. Not for health concerns, but for the employment concern. Factories were about to come to the Island, and there would be no jobs for many people.
Textile factories were about to come from the United States. It was not expected that men were willing to sew as seamstresses in textiles factories. It was a must to make changes into the housewife role, and take women out of homes to do factory jobs.
Sexual patterns had to be changed. Families were rearing too much siblings (e.g., 10, 12, and 14 per family). In theory, the Pill would be an excellent help to to take control of sex according to this new economic and political agenda. If reproductive sex lessens, children lessen.
Women’s spare time would increase. They could play the role of that new workforce expected by government. So, female duties, marital sex and conception should not be the same. A contraceptive pill trial, then, is of avail to the new plan and very welcome. Then Operation Bootstrap is an example of a socioeconomic agenda controlling sex.
On the one hand: -Although the pill was in trial it began to be somewhat relegated for uninformed, non-voluntary or forced massive female sterilization. -For many researchers this change was because of Muñoz’s political agenda. -Or the emergency of having women working on factories.
On the other hand, the Pill may gives us an explanation too: Its high-dosed side effects made it uncomfortable enough as to be generally accepted. This made many women to do both not to take the Pill according to the prescribed regime, or simply left the Pill.
Facing this: -Un-informed, un-consented, non-voluntary female sterilization would be a more reliable option of birth control. -A more reliable option to reach that desired new and less sexual workforce.
Legally, both government and Pill researchers had an open door to do so. Law 136 (the Eugenic Law) make it legal. The Eugenic Law itself left on every physician the choice to decide, on his or her own criteria, who would be involuntarily sterilized and who would not.
Who can be sterilized according the Eugenic Law?: -“Any mentally abnormal…moron[s]… criminals…social degenerates…”, or “…persons whose poor economic state or poor social life conditions make them unable to take care of the raising and education of their children.” [Translation of the Researcher]
And who in Puerto Rico was this “person whose poor social life conditions make them unable to take care of the raising and education of their children?” [Translation of the Researcher] The answer was practically everybody. The Eugenic Law is an example of political power shaping sex.
All of this merge to put Governor Muñoz into a problem: -Catholic Church opposition. -Religious power enters again to shapes sex. In the slum area called El Fangito. San Juan, Puerto Rico. Jack Delano (1941). Library of Congress
The Church founded its own political party (Partido de Acción Cristiana) to run for office. Its goal was to take Muñoz-who was running for office again-out of government in the forthcoming elections. The opposition was of such a magnitude that it brought Muñoz face to face with the possibility to loose elections for the first time. An action has to be made.
It would be better as a government to let others manipulate sex if it is of avail to my agenda… Keep quiet, and stay ambiguous in order to not loose power. Farmer's family. Caguas, Puerto Rico (vicinity). Jack Delano (1941) Farmer's family. Caguas, Puerto Rico (vicinity). Jack Delano (1941)
Post-Trial Phase Protests and regrets for the trials Post-Trial Phase Protests and regrets for the trials Two Pill trial subjects (Humacao, Puerto Rico) giving interviews to The Puerto Rico Herald. (Picture by Ricardo Figueroa, Special to The Sentinel).
There is no issue in regards to the use of Puerto Rico for the development of the contraceptive pill as controversial as the issue of involuntary subjects. My opinion is that there is evidence to sustain, or to suggest at least, that there were both voluntary and involuntary subjects.
Grounds For The Voluntary Participation On The Pill Trials And For The Voluntary Sterilization: -Anthropological studies American anthropologists hired by late Governor Muñoz Marín to document Operation Bootstrap. E.g., Morris Siegel (1946).
Morris Siegel’s Findings A Puerto Rican Town (1946) -Women were seemed to be tired of sex. -To have sex was like an epidemics which would mean to have children in huge numbers and health problems.
Anthropological Studies Not every woman was health enough. They were part of a culture of poverty. All children (e.g., 10, 12, or 14) were of their own responsibility.
Anthropological Evidence Men were supposed to play the role of breadwinners only. The economic and social life conditions of the Puerto Rican women of the Pill era was of extreme deprivation.
Anthropological Evidence Their incapacity to afford for birth control methods and their... : -Lack adequate diet, lack of social aids, lack of medical services, diseases, and lack of food made them unable to take care of themselves.
Anthropological Evidence If difficult to take care of themselves, very difficult to take care of a house, husband, her role as housewife, and a huge amount of children. In the slum area. Ponce, Puerto Rico. Jack Delano(1941). Library of Congress In the slum area. Ponce, Puerto Rico. Jack Delano(1941). Library of Congress
Morris Siegel’s Findings (1946) Women were reluctant to have sex. Many demanded their husbands to satisfy their sexual urges out of wedlock. Sex was equal as to have a lot of children and to increase by far their health problems. Under these grounds, a contraceptive pill or a voluntary sterilization was something very welcome.
Arguments favoring the involuntary subjects issue: -Machismo and Religion Arguments favoring the involuntary subjects issue: -Machismo and Religion Tobacco farm laborer. Barranquitas, Puerto Rico. Jack Delano (1941) Library of Congress Tobacco farm laborer. Barranquitas, Puerto Rico. Jack Delano (1941) Library of Congress
Machismo Motherhood was linked to womanhood. For men to beget a lot of children was linked to manhood. For the male it meant to personally and socially proof his sexual prowess.
Machismo For a Puerto Rican man to prevent his wife from becoming pregnant was to limit his own sexual competence. Birth control and voluntary sterilization would be unacceptable.
Religion For an extremely Catholic country to avoid children was to commit a sin. In the slum area known as "El Machuelitto" in Ponce, Puerto Rico. Jack Delano (1941). Library of Congress In the slum area known as "El Machuelitto" in Ponce, Puerto Rico. Jack Delano (1941). Library of Congress
Involuntary Sterilization and Eugenics Caguas (vicinity), Puerto Rico. A FSA (Farm Security Administration) borrower and his family. Jack Delano (1941) Caguas (vicinity), Puerto Rico. A FSA (Farm Security Administration) borrower and his family. Jack Delano (1941)
Eugenics Natural selection: -Means to terminate with useless people. -Must be replaced by birth control which is cheaper and more effective.
Eugenics What gives strength to the eugenic stance: -The same Puerto Rican Eugenic Law. Under such a law: -It is difficult to believe that many Puerto Rican females were not subjected to sterilization involuntarily.
Puerto Rican Eugenic Law of 1937 The strongest argument favoring the involuntary subjects issue. The Law was clear concerning eugenic principles.
Puerto Rican Eugenic Law of 1937 By such a law involuntary sterilization became legal and adequate. Illegal and inadequate in the United States, but legal and adequate for Puerto Rico. Something you should submit to upon a physician's criteria whether objective or not.
Testimonials A final argument about massive, involuntary female sterilization is testimonials. A lot of women attest to be truly sterilized involuntarily along the Pill trials era. Sterilized by deception or trickery.
Testimonials Requested by physicians to come to clinics to receive treatment for a simple medical condition. But they got out of clinics unknowingly sterilized. Later in time they realized the kind of surgery they were subjected to.
Poverty and Lack of Education Physicians believed Puerto Rican women were too dumb, too stupid, not witty enough to understand a physicians’ explanation about birth control. It would be better to do an uninformed consent, involuntary sterilization under the presumption that she was receiving treatment for another thing.
What does this Puerto Rican experience show to us? -That sex, our sex, is a matter of power, economic, political, or any other but power. -Not necessarily it is a matter of taste, even less it is a matter of public health. - Political and economical power decide what our sex could be, would be or will be.
Those who have power may: -Who we sexually were, who we sexually are, and who we sexually can be. -Decide what sex should be for, what sex should not be for, when sex is good, when sex is not, when it is adequate. -When it is not, when it is free, and when it is not and will not.
That is our Puerto Rican experience. In the slum area known as "El Machuelitto" in Ponce, Puerto Rico. Jack Delano (1941) Library of Congress In the slum area known as "El Machuelitto" in Ponce, Puerto Rico. Jack Delano (1941) Library of Congress
Child of a seamstress. Bayamon, Puerto Rico. Jack Delano (1941) Library of Congress Child of a seamstress. Bayamon, Puerto Rico. Jack Delano (1941) Library of Congress Thank You
Jesús Estrada Doctor of Human Sexuality (2007)
Celso-Ramon Garcia, M.D. (1922–2004) (http://creativescommon.org/licenses/by/2.0)http://creativescommon.org/licenses/by/2.0 October Celso-Ramon Garcia, M.D. (1922–2004) (http://creativescommon.org/licenses/by/2.0)http://creativescommon.org/licenses/by/2.0 October The only Puerto Rican physician on the Pill trials. Appendix A
Jack Delano ( ), Office of War Information photographer. Delano was born in Kiev, Ukraine. He was one of the socially committed photographers gathered together by Roy Stryker in the New Deal-created Farm Security Administration to document the effects of the Depression and WW II era. He moved to Puerto Rico in 1941 as part of his work, but made the Island his home until he passed away. A fine artist, composer, and filmmaker, collaborated with his wife Irene illustrating the books she wrote. His work awesomely mirrors the Puerto Rican particularities. His documental photography is part of the extraordinary and outstanding contribution he made to the Puerto Rican culture. (Estrada 2007) (http://laborarts.org 10/2007).http://laborarts.org Jack Delano Appendix B