Two women, standing in a public housing complex in San Juan, Puerto Rico, look puzzled. One of them, shy, describes some symptoms: “My world went away, my vision became blurred. The only thing I said was: ‘Virgen del Carmen, take care of my children.’”
Then, shaking her head no, the other comments: “They were experimenting on us without knowing it.”
The scene is part of the documentary “The Operation” (1982). The women, whose names are not mentioned, described their participation in the first clinical trial on a large scale in which the effectiveness of the anticonceptive pill in the 50s of the last century.
In the film, both affirm that they were unaware of being part of an investigation.
Like them, hundreds of other Puerto Rican women of humble origins, unknowingly, were patients of the study led by two American academics.
The medicine, which since its commercialization in 1960 allowed women to have greater control over their bodies, because they did not depend on men to plan motherhood, was tested in Puerto Rico thanks to a peculiar public policy to control overpopulation promoted by the government. local island and USA
In the middle of a boom of births during the first half of the 20th century, with many citizens in situations of extreme poverty, the solution of the politicians in power appointed by the US was to encourage Puerto Ricans they didn’t have children.
And their initiatives, explains University of Puerto Rico professor Ana María García, director of “La Operación,” were specifically designed so that this population reduction would occur among the poorest communities.
“They were aimed at the poorest, most racialized and least educated women in the country,” says Lourdes Inoa, from the Puerto Rican feminist NGO Taller Salud.
“Because they were the ones who had the least opportunity to know the repercussions of participating in these types of procedures. Consent, in this context, is highly questionable,” she adds.
With private financing, but also from the State, the island was “a great birth control laboratory,” García maintains.
And the women, Inoa adds, became “guinea pigs.”
Two scientists and two activists
The origin of the pill, which according to the United Nations is currently used by 150 million women around the world, took place far from Puerto Rico, within the walls of the prestigious Harvard University, in Massachusetts.
Those who developed the drug were two renowned professors of the institution: John Rock and Gregory Pincus.
The first, says historian Margaret Marsh, a professor at Rutgers University in New Jersey, was one of North America’s leading fertility expertsparadoxically Catholic, and who thought that married couples should have the right to decide when to have children.
The second was a biologist who on more than one occasion classified overpopulation as “the biggest problem for developing countries.”
Both were financed and closely supervised by Margaret Sanger, a nurse and health expert who founded Planned Parenthood, and by wealthy suffragette leader Katharine McCormick.
They, says Inoa, “sought for women to be inserted in various facets of society, so that they would have greater power.” Controlling motherhood was essential to achieve this.
But it is known that Sanger defended the eugenicsthe social philosophy that advocates the improvement of the human race through biological selection.
And that is why it was allowed to be experimented on poor women and in vulnerable situations.
“The birth control movement, in some ways, had two aspects. One was for women to make their own reproductive decisions and the other was the idea that birth control was good because poor people would have fewer children,” adds Marsh.
The first studies
The first research on the birth control pill in the US was conducted on rats and other animals.
Then, in an “unethical” decision, scientists administered the drug to a small group of patients at a public hospital for people with mental health problems in Massachusetts, says Marsh, who is an expert on the history of contraception in the United States. USA
“The patients’ families did give permission for the study to be carried out, but they themselves, because they were in a psychiatric hospital, did not consent. Although at that time this was legal,” he comments.
In this phase, Pincus and Rock discovered that the compounds they had created had the result of stopping ovulation. So They looked for a place to do a larger scale testso that American regulators would approve the pill.
In Massachusetts, explains Professor García, birth control was illegal. There were also legal limitations for experimentation on human beings.
That’s when scientists had to identify an “ideal spot.”
The laboratory island
They decided to go to Puerto Rico because sterilization, and in general experimentation to achieve contraception, had been legal there since 1937.
“A law was passed at a historic moment, when in the rest of the planet, including the US, widespread sterilization was not legal,” says García.
The legislation was signed by the governor Blanton C. Winshipa man who also publicly supported eugenics, and who – according to an article in the New York Times- He urged that population control be investigated in Puerto Rico, because for him it was the only “reliable means to improve the human race.”
In the 1950s, when pill researchers arrived on the island, 41% of Puerto Rican women of reproductive age had already tried some method of contraception, according to a study by the University of Puerto Rico.
This was possible thanks to The legislation allowed the creation of dozens of family planning clinics around the territory, even in the most remote towns, subsidized by the government and had personnel who promoted birth control among women.
The network of clinics also attracted the attention of Pincus and Rock, who thought they could use them to develop their project.
The team, however, decided to first focus on a single neighborhood in San Juan, the capital.
The women of Río Piedras
On the island, the experiment began in 1955 as a project in which medical and nursing students participated. But the study was too complicated and painful, so many did not finish it.
Furthermore, the pill tested in Puerto Rico It was a much higher dose. than the current one and caused strong side effects.
“It was necessary to perform urine tests, endometrial biopsies and other tests to determine whether they were ovulating or not. It is an uncomfortable procedure. If you have students who really don’t have a need for contraception, they weren’t going to be willing to continue,” Marsh says.
The medication caused nausea, dizziness, vomiting and headaches. Pincus, however, dismissed these side effects and claimed that they were a “psychosomatic” consequence.
“He believed in the pill so much that he was giving it to his relatives. “To his granddaughters, his daughters, his children’s friends,” says Marsh, who wrote a biography about Pincus’ co-worker Rock.
The team decided to continue the experimentation, but this time in Río Piedras, a suburb in the north of Puerto Rico.
Social workers and medical personnel visited the women door to door, offering them the contraceptive pill and, for some of them, they performed tests to collect data, without any monetary remuneration.
The rejection by various sectors of Puerto Rican society was immediate.
“There were press releases that classified the investigations as ‘Malthusian’. Also by doctors, even those who were in the process of recruiting women, who thought that side effects had to be taken seriously and that it was necessary to do more tests and not rule them out,” says Inoa, from Taller Salud.
Due to the side effects, many of these women, as in previous studies, decided to stop the treatment. Others, stricken by poverty, agreed to take the pill as a reversible method of birth control.
According to Marsh, three people in the clinical trial that was carried out on the Caribbean island died. However, an autopsy was never performed, so the precise causes of their death are unknown.
The approval
Despite the deaths, upon seeing that the pill had the effect of preventing pregnancies, the scientists extended their project to other towns in Puerto Rico, and later to Haiti, Mexico, New York, Seattle and California.
In total, about 900 women participated, of which around 500 were Puerto Rican.
In 1960, the US Food and Drug Administration (FDA) approved Enovidas the first pill was called, as a contraceptive method.
Its expansion was rapid. In just seven years, 13 million women in the world used it.
But after being approved by the FDA, the pill continued to cause strong side effects, such as blood clots, prompting lawsuits. On the island, despite legal actions in other parts of the United States, studies continued until 1964.
Even today, says Inoa, there is no “significant” research that seeks “other types of contraception methods that do not have the side effects of the pill that exists now.”
Meanwhile, studies to create an oral contraceptive drug for men have also not borne fruit, although they began 30 years ago.
“The greatest experiments have always been on pregnant people,” he concludes.
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