It’s not the speech we remember Enoch Powell for, but on 4th Dec 1961, in his role as Minister for Health, he confirmed in the House of Commons that ‘birth control pills’ could be prescribed on the NHS. This was in response to a rather pointed question from fellow Tory, Nicholas Ridley about the cost of the pills; at the going rate of 17 shillings a month, that meant a subsidy from the NHS of at least 15 shillings per prescription (about £15 in today’s money) and Ridley thought Powell should try to restrict access to the drug. Powell refused to lay down any rules about the prescribing of the Pill – aside, of course, from making it available only to married women.



The Birmingham Failure

The first trial of the Pill in the UK had taken place nearly two years earlier, in Birmingham in early 1960, and concerns about cost had made the first test a disaster. The trial was coordinated by the Birmingham Family Planning Association, and in an attempt to keep costs down, and reduce side effects, they opted for a low dosage regime, giving 2.5mg of a form of progesterone (norethynodrel) and what they thought was 0.05mg of an oestrogen (ethynyloestradol-3-methyl ether) – although later chemical testing showed that the drugs they had got from the pharmaceutical company Searle were a little lower in oestrogen.

The Birmingham FPA put out an appeal for volunteers, and recruited 48 women, all of whom had ‘proved fertility’ – that is they already had at least one child – and all of whom claimed they had an ‘average frequency of coitus not less than once weekly’. All the women were told the method might fail and they should be prepared for a pregnancy, and in each case they had to get their husbands to sign the trial form to give them permission to take part.

Three months later 14 of the 48 women were pregnant.

Lucky in Slough

A few weeks after the Birmingham trial started, a similar experiment began in Slough, also using just 2.5mg of progesterone – but in this study only one woman out of 38 became pregnant in the first few months, and the woman was blamed for this failure, not the pill, as apparently she had ‘taken her tablets only intermittently’. The difference between the Slough and the Birmingham experience was the amount of oestrogen in the tablets – the researchers concluded that if you reduced progesterone to 2.5mg, you needed to slightly increase the proportion of oestrogen, possibly in order to prevent ovulation. Literally breaking up commercially available tablets of 10mg progesterone into quarters, or 5mg tablets into halves didn’t work, even if it did save money!

laboratory mice & rats; not always great models for human reproductive function. Photograph: Zoonar GmbH / Alamy/Alamy

No one was certain whether or not the pill in these forms actually prevented ovulation. The only way to find out for sure was to perform a laparotomy, cutting into the abdomen in order to look for evidence of ovulation in the ovaries. As this is an invasive and painful procedure only about 17 women had been studied using this method (all in experiments led by the American endocrinologist Gregory Pincus) and the results from these examinations were inconclusive.

Animal models weren’t much help either; rats and mice only have sex when the female is in heat, so changing their hormonal balance often leads to the females rejecting the males, or males having no interest in sex; in rabbits, ovulation isn’t regular, but is actually triggered by the sex act. The best model would probably be monkeys, but, as two researchers from Birmingham pointed out in the November 1961 issue of Queen’s Medical Magazine, their “reproductive performance under laboratory conditions is not usually optimal”.



The Pill: for intelligent women only?

Not that human women were always ‘optimal’ as experimental organisms either; as the Slough example showed they did not always follow the pill regime exactly as directed. In Birmingham the women who had not accidentally become pregnant were switched to a new trial with a higher dose of progesterone and oestrogen, and in this test only one became pregnant. Glenys Bond, the medical officer for the Birmingham Family Planning Association wrote that this pregnancy ‘could not be attributed to failure of the tablets, but to the patient’s low IQ’.

To be fair, the method for using this pill, ‘Conavid’ was quite complicated (see the instructions at the end of this post), especially given the major side effect of the pill was to create irregular bleeding patterns. Doctors prescribing on the NHS were recommended to supervise their patients closely, seeing them after a month had passed, and then again regularly at 3 monthly intervals to make sure they were sticking to the regime. Professor F Lafitte, an expert in Social Policy at Birmingham University, noted in 1961 in the Queen’s Medical Magazine that



the present pill is likely for long to remain one of the contraceptives of an affluent and sophisticated society”

for “poor and simple people” a cheaper, easier method must be found.



Margaret L. Sanger in 1916; at this time she was being prosecuted for distributing ‘materials advocating birth control’ but these charges were dropped. Photograph: Bettmann/CORBIS

For British writers in the 1960s many of those ‘poor and simple’ people lived overseas. Population growth in developing countries was a hot-button topic, with fears that the developed world would be overwhelmed by growing nations who were benefiting from modern medical interventions and greater life expectancy, without yet achieving the economic prosperity of the West. The motive force behind the Pill, Margaret Sanger, an American birth control advocate and some-time eugenicist who organised funding for Pincus’ research, explicitly wanted a ‘magic pill’ to help poor women, as well as the wealthy and educated, control their fertility. Sanger’s motivation came from working amongst poor, largely immigrant, women in New York, watching countless unwanted pregnancies, the poverty of large families, and the deaths from botched abortions and traumatic births.

Powell and Sanger are an odd couple; both had controversial views about race, both were deeply invested in immigration and recent immigrants, albeit in quite different ways, and yet both also made contraception more widely available to women of all colours and classes.





Instructions for women on the Birmingham pill trial, 1961

1. The first course of tablets should be started after a monthly period

2. Counting the first day of bleeding as Day 1, take the first tablet on Day 5. Take one tablet every night for twenty days. A normal monthly period usually starts 1 to 4 days after the last tablet.

3. The next bottle should be started on day 5 of the new cycle (counting the first day of bleeding as Day 1 as previously)

4. If slight staining or spotting occurs, continue to take the tablets. If bleeding as in a monthly period occurs before the 20 tablets have been finished, stop taking the tablets and begin the next course of 20 tablets in the usual way on Day 5 (counting the first day of bleeding as Day 1 as previously).

5. If the expected monthly period does not occur, allow five clear days then start the next course of tablets.

6. It is important that the tablet should be taken regularly.If you forget to take a tablet any night, you should take it next morning.

from Glenys M Bond, “Clinical Trials of an Oral contraceptive conducted at Birmingham Family Planning Association”, Queen’s Medical Magazine, Winter 1961.