828 



THE ORAL COXTRACEPTIVE (THE PKJL.) 



Of all the methods of inhibitmg conception, the ingestion of syn- 

 thetic hormonal compounds has perhaps received the most attention 

 in recent years. 



The oral contraceptive, generally known as "the pill,'' is the most 

 effective means of conception control known today, apart from 

 sterilization. When taken faithfully according to medical instructions, 

 it is virtually 100 percent effective. 



The pill regimen involves the oral administration of estrogen, the 

 female hormone, and progestin, a synthetic substance chemicallv 

 similar to progesterone (a natural substance produced by a woman s 

 ovaries), taken either sequentially or in a combined form. It is pre- 

 sumed that the pill acts to suppress ovulation. Taken daily for 20 or 21 

 days of a normal 28-day cycle, it will commonly regularize the men- 

 strual cycle of a woman who may never have had regular cycles before. 



The pill may have unpleasant side effects in 20-25 percent of the 

 instances in which it is used. These resemble some of the symptoms of 

 pregnancy, such as nausea, retention i>f fluid, headaches, weight gain, 

 and swelling of the breasts. The side effects do not appear to inhibit 

 the use of the pill to a si^iificant degree in the developed countries. 

 What may in time have this effect, in Doth developed and underdevel- 

 oi)ed countries, however, is the question of whether or not the pill 

 causes cancer or embolisms. A number of inquiries have been launched 

 to look into the pill's safety, and some of them have been completed. 

 Studies conducted in this country by the Food and Drug Administra- 

 tion ctmcluded that there was no proof of any causal connection be- 

 tween the dangers attributed to the pill and its actual use. The same 

 conchision was reached by the World Health Organization, and by a 

 liritish research committee. It has been generally recognized, how- 

 ever, that all the evidence is not in, and that the pill must continue to 

 be examined. A study sponsored by Planned Parenthood of New York 

 showed that certain "precancerous" changes in the cervix were more 

 common among women using oral contraceptives than in a control 

 group using diaphragms. Yet the condition involved did not always 

 precede cancer oi the cervix, and in any event is curable, so the results 

 of the study were inconclusive. Studies in England did indicate that 

 women over 3.5 who were using the pill had a significantly higher 

 chance statistically of dying of thrombophlebitis or pulmonary em- 

 i)olism than women of the same age not using the pill. The FDA now 

 requires that the pills be labeled so as to carry a warning of potential 

 hazard to women with a history of venous disorders. The risk is less 

 than half as high for women under 35. In both age groups, however, 

 the risk of death is far less from using the pill than it would be from 

 pregnancy.^"^ 



In underdeveloped countries there is another drawback to the use of 

 Ihc pill than the (jue^tion of its safety. That is the fact that it must 

 bo taken each day, for most of the cycle. For a woman in the LDCs to 

 submit to this discipline requires a higher degree of motivation than 

 she may ordinarily have. According to the Indian Planning Commis- 



"^- Ehrlich and Ehrlich. "Populatinn, Rpsonrcop, and Environment," op. clt.. pajre 216. 



