Lara V Marks, Sexual chemistry: a history of the contraceptive pill, New Haven and London, Yale University Press, 2001, pp. xi, 372, illus., £20.00 (hardback 0-3-08943-0).

In May 1960 the United States Food and Drug Administration approved an oral contraceptive, a pill containing oestrogen and progesterone that offered women a highly effective method to prevent pregnancy. In the four decades since 1960, the oral contraceptive—popularly known as “the pill”—has been marketed to women around the world. As Lara Marks makes clear in this book, strikingly large proportions of women, especially in developed countries, have taken the pill at some time in their reproductive lives. Even in the less industrial nations, no other birth control measure, other than the condom, has been so widely distributed and used in so many countries. Given the importance and implications of this medical and social innovation, the pill has not lacked historical attention. In recent years, a number of historians have examined the development of oral contraceptives, especially in the United States. But what Marks does in this important book is to place the scientific development of the pill, together with its economic and regulatory dimensions, in a much-needed international perspective. In clear and convincing fashion, Marks lays out the influence of the European sex hormone industry in the interwar period, analyses the impact of the emigration of refugee scientists to American laboratories, and traces the myriad national contexts in which clinical trials of various oral formulations were conducted. In so doing, she significantly enhances our understanding of the pill's development and diffusion in comparing the British and North American experiences with the contraceptive. One of the reigning historical interpretations that Marks challenges is the depiction of the women who participated in early trials of oral contraceptives as “unwitting guinea pigs” of male scientists. Marks joins other historians in noting that important research on an oral contraceptive was stimulated and funded by prominent American women, including the philanthropist Kathleen McCormick and the birth control advocate Margaret Sanger. McCormick's extensive funding made possible not only the animal studies to screen drugs for toxicity and efficacy, but also the clinical trials of the new formulations that necessarily involved large numbers of women to test the drug. But where could such women be found, especially for research that violated the societal norms about sexuality? Marks described how researchers recruited nurses to serve as volunteers (a good choice since they were able to follow the detailed instructions required in the early tests). But other women were also pressed into service, including patients suffering from severe mental disorders in a Massachusetts psychiatric hospital. Another major locus of clinical trials on the pill was the American controlled island of Puerto Rico, where large numbers of impoverished women participated in clinical studies. Marks mostly dismisses charges that Puerto Rican women represented a readily accessible pool of available research subjects. She argues that researchers took considerable trouble to monitor the safety of these women and the wellbeing of the babies that resulted from the failure of the drugs (or from lack of compliance with the regimen). Perhaps because we hear so little from these women subjects or from activists who protested the exploitation of these women, Marks is less than persuasive that certain sociocultural factors, especially racism, did not make these women more attractive research subjects than middle-class white women. Unlike Marks, I don't find the lack of a signed consent form among the most troubling features of these early trials. Although some investigators in this period, including researchers who were infecting children with hepatitis virus, did obtain written permission, this was hardly conventional practice. More troubling was the risk, both short-term and long-term, that women experienced, despite the physicians' care to minimize dangers from the drugs. Marks's extensive research and numerous interviews with participants in the development of the pill are impressive. She offers a nuanced analysis of the medical controversies that the pill created; her discussion of the relationship between oral contraceptives and cancer is especially useful for the light it sheds on the persistent uncertainties that have shaped medical and popular responses to the risks and benefits of the pill. In the 1960s the oral contraceptive was hailed as a “dream come true,” freeing women from the burdens of unwanted pregnancy. As Marks convincingly shows, freedom is seldom free or without risk.