Presentation on theme: "The Taste of... The Pill The Taste of the Pill November 2007"— Presentation transcript:
1The Taste of... The Pill The Taste of the Pill November 2007 Jesus Estrada 2007
2The Taste of the PillNovember 2007The Controversial Use of Puerto Rico For the Development of the Contraceptive PillAs an historic example of how social, political and economical power shapes sexJesus Estrada 2007
3Doctor of Human Sexuality ByJesús EstradaDoctor of Human SexualityPresented at the SSSS 50th Anniversary ConferenceIndianapolis, Indiana 2007
4History of birth control in 20th century Puerto Rico- The Pre-Trial Phase- The Trial Phase- The Post-Trial Phase
5-The US government efforts to control Puerto Rican population The Pre-Trial Phase-The US government efforts to control Puerto Rican populationThe Trial Phase-Large-scale Pill trial performed inPuerto RicoPost-Trial Phase-Regret and protest for the trials and the way population was controlled in PR
6The Taste of the PillNovember 2007The Pre-Trial PhaseResident of a slum area Ponce, Puerto Rico (Jack Delano 1941) Library of CongressJesus Estrada 2007
7The Spanish regime left the Island in: Extreme poverty Famine The Taste of the PillNovember 2007The Spanish regime left the Island in:Extreme povertyFamineOverpopulatedAfter the Hispanic-American War (1898)The Island turns from a Spanish Americancolony into a United States property.Jesus Estrada 2007
8Overpopulation was a major concern for the United States regime in Puerto Rico.Efforts were made since the beginning of the20th 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.
9The Pre-Trial Phase-A Chronology United States officials in Puerto Rico expressconcerns about Puerto Rican overpopulation.Neo-Malthusianism and Margaret Sanger’sideas is sprouting amid those in social,economical and political power.
101917Inspired by neo-Malthusianism Americanindustrialists, scientists, social workers, andmiddle and high class Puerto Ricans trace apopulation control plan for Puerto Rico.1920United States government begins to promotebirth control in Puerto Rico.
11Using a false name future governor and political The Taste of the PillNovember 20071923Using a false name future governor and politicalleader Luis Muñoz Marín writes an article inLa Democracia newspaper defending bothMargaret Sanger and neo-Malthusianism.El Imparcial newspaper responds condemningneo-Malthusianism.Muñoz Marín at El Mundo newspaper:“Of all Puerto Rican ailments, overpopulation isthe worst.” (Translation of the Researcher)Jesus Estrada 2007
12San Juan’s Bishop Carvana at La Correspondencia newspaper: 1923San Juan’s Bishop Carvana atLa Correspondencia newspaper:“To accept neo-Malthusianism is like tosuicide the race.”(Translation of the Researcher)A native hut (1903) Detroit Publishing Co. no Gift; State Historical Society of Colorado; Library of Congress.
131925Formal birth control clinics start to besponsored in Puerto Rico with Federal funds.Dr. José A. Lanause Rolón founds thePonce Birth Control League .-Its approach is educational.-Social pressure makes it last less than ayear.
141932The Puerto Rico Control Leagueis organized and opens a clinic to gives outcontraceptive services (it last two years only).1934Sixty seven new birth control clinics are openedwith Federal funds.
151936The Maternal and Childcare HealthAssociation opens 23 other birth control clinicswith Federal funds too.Catholics pressure convinces FederalGovernment to discontinue the program.
161937Time magazine:- “…one basic remedy for the islander’sappalling poverty is to cut their appallingbirth rate…”Clarence J. Gamble allegedly pushes for thelegalization of birth control in Puerto Rico.
171937Law 136, The Eugenic Law, is approved onMay 12.Contraceptive advice or services to preventpregnancy is not a felony.Comstock Act is not applied in Puerto Rico.
18New 160 birth control clinics open Involuntary sterilization begins 1937New 160 birth control clinics openInvoluntary sterilization beginsLaw 136 of 1937The “eugenic law”.(Excerpt)
19United States continues to support birth The Taste of the PillNovember 20071939United States continues to support birthcontrol clinics and the distribution ofcontraceptives in Puerto Rico.Family in a slum area in Yauco, PR.(Jack Delano, 1942) Library of CongressJesus Estrada 2007
201940The Puerto Rico’s Health Commissioner,Dr. Eduardo Garrido, creates the Bureau ofMaternal and Infant Care.New 122 birth control clinics open.
21The United States Congress concludes: 1943The United States Congress concludes:- “Puerto Rico is one of the most denselypopulated parts of the world.”Widow and child of a farm laborer. San Sebastian, Puerto Rico (vicinity). Jack Delano (1942) . Library of Congress
221946Future governor Muñoz Marín:- “If population growth is not reduce norproductivity increased, unemploymentwill rise, even with the help of Federalfunds…” (Translation of the Researcher)1947A 6.6% of ever-married women are alreadysterilized.
231949The Puerto Rico’s Commissioner of Healthconcludes that:-Public hospitals should be used once ortwice a week to perform fifty sterilizationper day.
241954The Family Planning Association ofPuerto Rico is established.United Nations Demographic Yearbook:-Puerto Rico’s population per squarekilometer in 1953 is 31 times theaverage of ten Latin American countriesand 12 times the average of theUnited States.
25The Trial PhaseA family of the Río Piedras area Jack Delano (1942) Library of Congress
26Margaret Sanger dreamed of a contraceptive pill easy to take as an aspirin that could beused for contraceptive purposes.In 1951she met doctorGregory Goodwin Pincus.Implores him to take herquest for a pill.Margaret Sanger
27After receiving funds from Sanger’s friend, The Taste of the PillNovember 20071955After receiving funds from Sanger’s friend,Katharine McCormick (upon Sanger’srequest), Pincus needs a place to perform alarge scale trial of the Pill.Katherine McCormickJesus Estrada 2007
281955Since anti-birth control laws in Massachusettsand many other states make impossible forRock to conduct the large study in humans heneeds for FDA approval…Rock and Pincus look for a place to launch thefirst, large-scale clinical trial of the Pill.
291955Pincus visits the Island and see it as the perfectplace.There are no anti-birth control laws.There is an extensive network of birth controlclinics already in place.
30The Island is one of the most densely populated areas in the world. The Taste of the PillNovember 20071955The Island is one of the most denselypopulated areas in the world.Puerto Rico, being an island, offers them astationary population that could be easilymonitored.Island’s officials support the idea in the hopethat it would stem Puerto Rico’s endemicpoverty.Jesus Estrada 2007
31Allegedly in Pincus mind: 1955Allegedly in Pincus mind:-If he could demonstrate that the poor,uneducated women of Puerto Rico couldfollow the Pill regime, then, womenanywhere 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
32Searle Pharmaceutical provides the pills under The Taste of the PillNovember 20071955Searle Pharmaceutical provides the pills underthe brand name of Enovid.Rock selects a high dose to ensure nopregnancies would occur whilesubjects are in trial.EnovidJesus Estrada 2007
33Helen Rodríguez-Trías (1922-2001) The Taste of the PillNovember 20071955The Pill is 20 times stronger than the pill that willbe 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.Jesus Estrada 2007
34Family living in a slum area in Yauco, 1956Two trial strategies:-To take birth control outclinics (Home setting).-To start the Pill regimeshortly after having the first baby (Hospital setting).Family living in a slum area in Yauco,Puerto Rico. Jack Delano (1942) Library of Congress
35The Taste of the PillNovember 20071956On 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.”Jesus Estrada 2007
36The trial strategy selected by Pincus and Rock is to take birth control out of clinics.RockPincus
37To take it directly into women’s houses.Through female peers.Hired as social workers or nurses instructed toboth give women the Pill and seduce them to visitclinics.
381957Edris Rice-Wray is the medical director incharge of the Pill trials.She reports the Pill was 100% effective inpreventing pregnancy.She reports also the side effects.
391957Rice-Wray reports that many womencomplained of nausea, dizziness, headaches,stomach pain and vomiting.She reports that so serious and sustainedthese women’s reactions were that she thoughtthe Pill’s side effects were so uncomfortable asto be generally accepted by women.
401957Pincus and Rock decide to dismiss Rice-Wrayobservations.Both of them take no action to assess thecauses of the side effects.They prefer to believe that Puerto Ricansubjects’ complaints are psychosomatic, andthat side effects are minor effects compared tothe contraceptive benefit of the Pill.
411957Three Puerto Rican women die whileparticipating on the Pill trials.No autopsy or investigation is conducted toassess if the Pill is related to the deaths.No informed consent is required to subjects.
421958The total birth rate in Puerto Rico starts todecline.1959Rev. Truman B. Douglas- “This service to the cause of populationcontrol,” he says, “is a positiveexpression of Christian compassionand humanitarian concern.” (Time magazine, 1959)
43Searle is doing $27 million annually using 1960Searle is doing $27 million annually usingEnovid for menstrual disorders, and pushesFDA for its approval as a birth control.FDA approves Enovid as a birth control pillon May 11.Enovid. "Physician's professional sample.”(The package holding the Pills and insert.)October
44Studies relates the Pill to blood clots, heart 1961Studies relates the Pill to blood clots, heartattacks, and strokes.NorinylTabletsOrth0-Novum(Images accessed at
45The San Juan Star newspaper The Taste of the PillNovember 20071961“Birth Control Prepares the Ground forCommunism…”“…shameful that one part of the society and thegovernment support neo-Malthusianism.”The San Juan Star newspaper(April 26, 1964)Jesus Estrada 2007
46There is evidence of at least 11 deaths all 1962There is evidence of at least 11 deaths allallegedly related to the Pill.Picture byJack Delano (1941)
47Syntex pharmaceutical joins to the birth control 1963Syntex pharmaceutical joins to the birth controlmarket and the trial with a 10 mg pill namedOrtho- Novum.In the slum area called El Fangitto.San Juan, Puerto Rico. Jack Delano (1941)Library of Congress
48In the slum area. Ponce, Puerto Rico. Jack Delano (1941). 1964Wyeth Pharmaceutical joins to the Pill trials witha contraceptive pill composed of Norgestreland Mestranol.In the slum area. Ponce, Puerto Rico. Jack Delano (1941).Library of Congress
491964PR government endorses a new plan to turnexisting health centers into birth control clinics.Notwithstanding, an official policy is denied.From now on Puerto Rican government seems togive signs of ambiguity in relation to the Pill.(Karen L. Michaelson, 1981)
501964The San Juan Star newspaper headlines:-“Govt. Scored on Birth Control”.-“The Commonwealth Governmentwas strongly attacked yesterday at theInternational Planned ParenthoodFederation Conference for refusing tocarry out an active birth control programin Puerto Rico.” (The San Juan Star, April 21, 1964)
511964It suddenly seems that the once welcomed Pillstarts to be a menace for those in politicalpower.So, It is better to pronounce no officialconcern nor policy about population control.
521967Wyeth starts with Puerto Rican women a newpill trial with a continuous daily micro dose ofNorgestrel.The Family Planning Agency of Puerto Ricoreceives $750,000-$900,000 of its budget fromthe U.S. Department of Health, Educationand Welfare.
531967Up to now The Puerto Rico Family PlanningAssociation has already provided services to20,000 women: 10 % took IUD’s, 69% pills, and23% other methods such as vaginal foam andcondoms.1968British studies show an increased incidence ofblood clots among women taking the Pill
54There are 132 cases of premature death all 1968There are 132 cases of premature death allallegedly linked to Searle’s pill (Enovid ).Picture byJack Delano (1942)
55United States carries out studies that support 1969United States carries out studies that supportBritish findings in regards to blood clotting andthe Pill.Wife of a FSA (Farm Security Administration) borrower Manati, Puerto Rico (vicinity) Jack Delano (1941) Library of Congress
56A 35.3% of the Puerto Rican women are already 1969A 35.3% of the Puerto Rican women are alreadysterilized. (José Vázquez Calzada -Puerto Rican Demographer)(By 1947 it was only a 6.6%.)Picture byJack Delano (c )
57What was the problem between the Pill and the Government? The above mention of Puerto Rican governmentambiguity with the Pill trials may be explained.Governor Muñoz was a great defender ofpopulation control since the beginning of thecentury.What may be happening now?
58The Pill trials and Muñoz economic plan Operation Bootstrap -Governor Muñoz economic plan to turn the Islandfrom an agrarian, underdeveloped country into adeveloped one.-People were still walking barefoot, and lacking ofboth food and social aids.-PR would no longer be an underdeveloped,agrarian, culture and would be another developed,industrialized, and modern country.
59Operation BootstrapEconomical IncentivesEmploymentAn Estate to Build a HouseA Better Life
60The Pill was timely and extremely convenient to this economic plan for the plan entailed thereduction of population.Not for health concerns, but for the employmentconcern.Factories were about to come to the Island, andthere would be no jobs for many people.
61Textile factories were about to come from the United States.It was not expected that men were willing to sewas seamstresses in textiles factories.It was a must to make changes into the housewiferole, and take women out of homes to do factoryjobs.
62Sexual 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 toto take control of sex according to thisnew economic and political agenda.If reproductive sex lessens, children lessen.
63Women’s spare time would increase. They could play the role of that new workforceexpected by government.So, female duties, marital sex and conceptionshould not be the same.A contraceptive pill trial, then, is of avail to thenew plan and very welcome.Then Operation Bootstrap is an example of asocioeconomic agenda controlling sex.
64-Although the pill was in trial it began to On the one hand:-Although the pill was in trial it began tobe somewhat relegated for uninformed,non-voluntary or forced massive femalesterilization.-For many researchers this change wasbecause of Muñoz’s political agenda.-Or the emergency of having womenworking on factories.
65On the other hand, the Pill may gives us an explanation too:Its high-dosed side effects made ituncomfortable enough as to be generallyaccepted.This made many women to do bothnot to take the Pill according to the prescribedregime, or simply left the Pill.
66Facing this:-Un-informed, un-consented, non-voluntary female sterilization wouldbe a more reliable option of birth control.-A more reliable option to reach thatdesired new and less sexual workforce.
67Legally, 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 physicianthe choice to decide, on his or her own criteria,who would be involuntarily sterilized and whowould not.
68Who 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 themunable to take care of the raising andeducation of their children.” [Translation of the Researcher]
69And who in Puerto Rico was this “person whose poor social life conditions make them unable totake care of the raising and education of theirchildren?” [Translation of the Researcher]The answer was practically everybody.The Eugenic Law is an example of politicalpower shaping sex.
70All of this merge to put Governor Muñoz into a problem: -Catholic Church opposition.-Religious power enters again to shapessex.In the slum area called El Fangito San Juan, Puerto Rico. Jack Delano (1941) Library of Congress
71The Church founded its own political party (Partido de Acción Cristiana) to run for office.Its goal was to take Muñoz-who was running foroffice again-out of government in theforthcoming elections.The opposition was of such a magnitude that itbrought Muñoz face to face with the possibilityto loose elections for the first time.An action has to be made.
72Farmer's family. Caguas, Puerto Rico (vicinity). It would be better as a government tolet others manipulate sex if it is of avail to myagenda…Keep quiet, and stay ambiguous in order to notloose power.Farmer's family. Caguas, Puerto Rico (vicinity).Jack Delano (1941)
73Protests and regrets for the trials Post-Trial PhaseProtests and regrets for the trialsTwo Pill trial subjects (Humacao, Puerto Rico) giving interviews to The Puerto Rico Herald. (Picture by Ricardo Figueroa, Special to The Sentinel).
74There is no issue in regards to the use of Puerto Rico for the development of thecontraceptive pill as controversial as the issueof involuntary subjects.My opinion is that there is evidence to sustain,or to suggest at least, that there were bothvoluntary and involuntary subjects.
75-Anthropological studies Grounds For The Voluntary Participation OnThe Pill Trials And For The VoluntarySterilization:-Anthropological studiesAmerican anthropologists hired by lateGovernor Muñoz Marín to documentOperation Bootstrap.E.g., Morris Siegel (1946).
76Morris Siegel’s Findings A Puerto Rican Town (1946)-Women were seemed to be tired of sex.-To have sex was like an epidemics whichwould mean to have children in huge numbers and health problems.
77Anthropological 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 theirown responsibility.
78Anthropological Evidence Men were supposed to play the role ofbreadwinners only.The economic and social life conditions of thePuerto Rican women of the Pill era was ofextreme deprivation.
79Anthropological Evidence Their incapacity to afford for birth controlmethods and their... :-Lack adequate diet, lack of social aids,lack of medical services, diseases, andlack of food made them unable to take care of themselves.
80Anthropological Evidence In the slum area. Ponce, Puerto Rico. If difficult to take care of themselves, verydifficult to take care of a house, husband, herrole as housewife, and a huge amount of children.In the slum area Ponce, Puerto Rico.Jack Delano(1941).Library of Congress
81Morris Siegel’s Findings (1946) Women were reluctant to have sex.Many demanded their husbands to satisfy theirsexual urges out of wedlock.Sex was equal as to have a lot of children andto increase by far their health problems.Under these grounds, a contraceptive pill or avoluntary sterilization was something verywelcome.
82Barranquitas, Puerto Rico. Arguments favoring the involuntary subjectsissue:-Machismo and ReligionTobacco farm laborer.Barranquitas, Puerto Rico.Jack Delano (1941)Library of Congress
83MachismoMotherhood was linked to womanhood.For men to beget a lot of children was linked tomanhood.For the male it meant to personally and sociallyproof his sexual prowess.
84MachismoFor a Puerto Rican man to prevent his wifefrom becoming pregnant was to limit his ownsexual competence.Birth control and voluntary sterilization wouldbe unacceptable.
85For an extremely Catholic country to avoid ReligionFor an extremely Catholic country to avoidchildren was to commit a sin.In the slum area known as "El Machuelitto" in Ponce, Puerto Rico. Jack Delano (1941).Library of Congress
86Involuntary Sterilization and Eugenics Caguas (vicinity), Puerto Rico. A FSA (Farm Security Administration) borrower and his family.Jack Delano (1941)
87EugenicsNatural selection:-Means to terminate with useless people.-Must be replaced by birth control which ischeaper and more effective.
88EugenicsWhat gives strength to the eugenic stance:-The same Puerto Rican Eugenic Law.Under such a law:-It is difficult to believe that manyPuerto Rican females were not subjectedto sterilization involuntarily.
89Puerto Rican Eugenic Law of 1937 The strongest argument favoring theinvoluntary subjects issue.The Law was clear concerning eugenicprinciples.
90Puerto Rican Eugenic Law of 1937 By such a law involuntary sterilization becamelegal and adequate.Illegal and inadequate in the United States,but legal and adequate for Puerto Rico.Something you should submit to upon aphysician's criteria whether objective or not.
91TestimonialsA final argument about massive, involuntaryfemale sterilization is testimonials.A lot of women attest to be truly sterilizedinvoluntarily along the Pill trials era.Sterilized by deception or trickery.
92TestimonialsRequested by physicians to come to clinics toreceive treatment for a simple medical condition.But they got out of clinics unknowinglysterilized.Later in time they realized the kind of surgerythey were subjected to.
93Poverty and Lack of Education Physicians believed Puerto Rican women weretoo dumb, too stupid, not witty enough tounderstand a physicians’ explanation aboutbirth control.It would be better to do an uninformed consent,involuntary sterilization under the presumptionthat she was receiving treatment for anotherthing.
94What does this Puerto Rican experience show to us? -That sex, our sex, is a matter of power, economic, political, or any other butpower.-Not necessarily it is a matter of taste,even less it is a matter of public health.-Political and economical power decidewhat our sex could be, would be or will be.
95Those 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 sexshould not be for, when sex is good, whensex is not, when it is adequate.-When it is not, when it is free, and when itis not and will not.
96That is our Puerto Rican experience. In the slum area known as "El Machuelitto" in Ponce, Puerto Rico. Jack Delano (1941)Library of Congress
97Jack Delano (1941) Library of Congress Thank YouChild of a seamstress. Bayamon, Puerto Rico.Jack Delano (1941) Library of Congress
98Doctor of Human Sexuality Jesús EstradaDoctor of Human Sexuality(2007)
99The only Puerto Rican physician on the Pill trials. The Taste of the PillNovember 2007Appendix AThe only Puerto Rican physician on the Pill trials.Celso-Ramon Garcia, M.D (1922–2004)(http://creativescommon.org/licenses/by/2.0)OctoberJesus Estrada 2007
100The Taste of the PillNovember 2007Appendix BJack DelanoJack 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).Jesus Estrada 2007