By Chris ChoGlueck
In January 1970, US Senator Gaylord Nelson began collecting testimony from “the experts” about oral contraception. His special hearings on the Pill were motivated by Barbara Seaman, who advocated in The Doctor’s Case Against the Pill for full disclosure of its many health risks — particularly fatal blood clots. While the British government had halted prescriptions for riskier dosages months earlier, the US Food and Drug Administration (FDA) maintained in their 1969 “Second Report on the Oral Contraceptives by the Advisory Committee on Obstetrics and Gynecology” that the Pill was still “safe within the intent of the legislation.”
Although women contributed to the Nelson hearings as experts and as protesters, sexist gender norms about expertise shaped who was seen as credible and who was thought to have disturbed the proceedings. Women participating in the hearings occupied different positions, some as doctors and scientists, whose judgment reinforced the status quo in male-dominated medicine, and others as lay experts, whose contributions were dismissed as being hostile or uneducated. In the background were widely shared racialized convictions about the Pill as a tool for population control.
Nelson’s hearings attracted media attention as well as protests from the radical feminist DC Women’s Liberation group led by Alice Wolfson. These feminists called out the sexist underrepresentation of women among the experts initially called to testify. The senators (all white men) patronized the protesters and dismissed them as “disturbances” and “disruptions.” Nelson even told the protesters that “you are prejudicing your own case” with their presence at the hearing. After the protesters contemptuously passed out pills for the men to take — asking them “to think of it circulating through their bodies while listening to testimony” — Nelson closed the hearings to the public.
Women participating in the hearings occupied different positions, some as doctors and scientists, whose judgment reinforced the status quo in male-dominated medicine, and others as lay experts, whose contributions were dismissed as being hostile or uneducated.
The DC Women’s Liberation group provoked the senators and the public to think more critically about expertise and gender. Out of 36 experts, only five who testified were women, invited by Nelson solely in response to the protestors. While some historians overlook these women as mere “medical experts,” others like Elizabeth Siegel Watkins argue that their contributions were limited primarily along class lines. In On the Pill, Watkins notes that “it would be too simple to categorize these women as ‘anti-feminists’,” and yet “their conception of ‘women’s best interest’ was clearly colored by their socioeconomic position as upper middle-class professional women and varied considerably from the ideas of others.” When compared with the men who testified, women were much more likely to have financial conflicts of interest: nearly all of them prescribed the Pill (and could be accused of medical malpractice) or crafted population policies involving birth control.
These women experts were situated in male-dominated medical fields, which directed their professional judgment away from women’s health. For instance, Dr. Elsie Carrington, an OBGYN professor at Woman’s Medical College of Pennsylvania, determined that the Pill’s social benefit of limiting population growth outweighed any risks for individual patients. She testified that glucose tolerance may be reduced by progestin in the Pill, although adverse effects and long-term implications were unclear. “Medical and social benefits of such effective contraceptive agents are undeniable,” she reasoned. “Continuance of their use is warranted and in fact essential for many of our individual patients and certainly for our society.” The global “population problem” had motivated the initial research for the Pill, and it continued to shape the regulation and use of contraception.
Interestingly, Carrington’s female body and her feminine gender went unmentioned by the senators as seemingly irrelevant, rendering her testimony sex/gender blind. The presence of women like Carrington increased the credibility of the Nelson hearings, undermining an easy takedown of the hearings as totally excluding women. Yet their participation at such small numbers functioned more as tokenism, and it strengthened the group consensus that the Pill was safe enough.
The sex and gender of other experts, however, did attract attention, in part because of racist concerns related to population policy. Take Dr. Mary Lane Cobb, the Clinical Director of the Margaret Sanger Research Bureau in New York, who was also the only black witness present. One Senator clumsily asked her to testify “to the women of America… whether or not you take the pill.” Cobb responded that yes, she had taken it, knowing the risks, because she simply could not tolerate another pregnancy. She described the decision as a “personal” one, highlighting its non-generalizability to other women.
Unlike with Carrington’s testimony, the senators did not take Cobb’s as sex/gender blind. Possibly due to her blackness, the committee saw Cobb as especially different from themselves. Thus, Cobb was made to testify as a hybrid expert-user, assuring them about the competence of doctors and the ability of users (like herself) to weigh the risks and benefits rationally. The senators welcomed this placation, as many experts voiced their fears of how poor women and women of color might overreact to learning about the risks of the Pill, create an epidemic of unwanted “Nelson babies,” and exploit the welfare system.
Cobb gave the only perspective from someone who used the Pill, yet her hybrid status limited her ability to represent non-expert users, whom Senator Nelson had promised but refused to question. Descriptions of lay users during the hearings painted a negative picture of women’s ignorance, irrationality, and emotionality. Dr. Alan Guttmacher, President of Planned Parenthood Federation, presented a condescending view of women’s intellectual abilities: “I do not think that you are going to be able to educate the American woman…. I think you can educate the American doctor. He is educatable.” (emphasis added) Guttmacher feared a “panic reaction” of discontinuation from users, so he suggested that it was better to withhold some information about the risks.
Contrasting the calm and informed judgments of women like Cobb and Carrington, the Senate hearings represented “normal” women as a group in highly stereotypical ways. This gendered duality created the impression that feminine emotions and “disturbances” from potential Pill users were out of place in this masculinized scientific and policy discussion. To the physicians, researchers, and senators, non-expert women on the Pill were either confused, simple-minded housewives susceptible to “mass hysteria,” or they were radical feminists “disrupting” the rational debate by prejudicing sound judgment with alarmism. This gendering reinforced the status quo much to the benefit of pharmaceutical companies.
While women have challenged patriarchal health policy in a variety of roles, their contributions continue to be limited by problematic gender norms about expertise.
These Senate hearings were monumental in part because they resulted in the FDA’s first insert for informing patients directly. While we take a patient’s right to know for granted today, it was not standard in research or clinical practice in 1970. Radical feminist protesters at the back of the proceedings also contributed a sense of public outrage and shame to the hearings. Their efforts pressured the FDA to make future meetings more public, and their persistence catalyzed the women’s health movement and set the stage for other patient movements in later decades.
While women have challenged patriarchal health policy in a variety of roles, their contributions continue to be limited by problematic gender norms about expertise. Even with issues related to women’s health, men continue to monopolize policy making. Women total over half the population, yet they hold merely 20-25 percent of elected offices in the US. And now, thanks to Twitter, we get regular, bite-sized reminders. In early 2017, US Senator Patty Murray, re-tweeted the photo of an all-cis male group of House representatives: “A rare look inside the GOP’s women’s health caucus.” Senator Murray was pointing out the irony that this group — which excluded anyone who could become pregnant — was proposing to eliminate maternity coverage. To reverse this historically entrenched problem and improve women’s health, policy making needs both a better representation of women and more critical attitudes about the gendering of expertise.
Author’s Note: Cited testimony in this essay comes from Competitive Problems in the Drug Industry Part 15 - 16, Vol. 1-3. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under grant no. 1342962. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation.
Lara V. Marks. Sexual Chemistry: A History of the Contraceptive Pill. New Haven, CT: Yale University Press, 2001.
Dorothy Roberts. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Vintage, 1997.
Anne M. Valk. Radical Sisters: Second-Wave Feminism and Black Liberation in Washington, D.C. Women in American History. Urbana, IL: University of Illinois Press, 2010.
Chris ChoGlueck is a philosopher and historian of medicine, particularly interested in pharmaceutical drugs and reproductive health. He studies how science is used for public policy, concentrating on the role of science at regulatory agencies and the ethics and politics of reproductive medicine.
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