Contraceptive trials in Puerto Rico

The first large-scale human trial of the birth control pill was carried out in Puerto Rico in the 1950s. Between conceptualization and legalization of the first birth control drug in the United States in 1960, there were many developments and trials of test drugs. One such trial happened in Puerto Rico in the 1950s. Before the drug was approved as safe in the U.S., many Puerto Rican women were tested on.^[1] The trials were conducted by Gregory Pincus and John Rock in 1955. These trials are a major component in the history of the development of female oral contraceptives, in between initial small trial testing on the east coast and the release of the drug for public consumption.

American testing surrounding the Puerto Rico trials

The first human trial of the female oral contraceptive was conducted by Gregory Pincus and John Rock in Massachusetts on a test group of 50 women.^[2] The trial was described as a fertility study to avoid state legal interruption of the trial. Massachusetts at the time had strong legislation against birth control. In the 1950s in Massachusetts it was a felony to "exhibit, sell, prescribe, provide, or give out information" on birth control.^[2][3][4] Rather than distributing birth control, women were receiving hysterectomies to avoid continuing to get pregnant and have birth.^[5] Pincus and Rock felt confident that the combined oral contraceptive pill they had developed was ready for consumers in the United States. Once the Food and Drug Administration approved, the drug could potentially be released in the U.S., but they could not get the approval of the FDA without a larger clinical trial. In 1955 they developed a larger clinical trial of the drug, and tested it on women in Puerto Rico. The pharmaceutical company G. D. Searle & Company created the pills for the trial.^[6] After the trials in Puerto Rico, the drug was approved in the U.S. in 1957 for consumer use as a medication to treat severe menstrual side-effects. The drug was approved as a female oral contraceptive, the first in the U.S., in May 1960.^[7] G.D. Searle and company profited greatly from widespread sales of the product, although the company was initially extremely hesitant to be associated with the trials in any way.^[8]

Drug

The drug used in this trial was known as Enovid. The drug was a combination of estrogen and progesterone, the same hormones used in modern combined female oral contraceptive pills.^[9]

Subjects

The women who volunteered as subjects for the trial were Puerto Rican women searching for an effective method of birth control. Many were not fluent in English, and many were illiterate. The researchers believed that this would be beneficial to their study, as it would reveal whether or not these pills could be used by anyone around the world.^[6] For people to participate, they had to be under forty years old, have two children minimum, fertile, and be in good health. Also, the women had to agree to give birth should they get pregnant during the trial.^[11]

The Puerto Rican women did not know they were experimental subjects. Contraceptives were illegal in the United States but not in the occupied territory so experiments were not regulated in the Island as it was in the mainland. The experimental dosages were many times higher than the legal dose today. Puerto Rican women were poor and many illiterate. This made it easier for researchers to conduct the experiment without the subjects understanding the risks. This avoided fear and reluctancy from the subjects. The effects of high doses of estrogen birth-control are understood today but the effects on Puerto Rican women have not been studied nor accounted for.

Side effects

Side effects of this high dose pill were similar to that of modern-day oral contraceptives, only more severe; these included nausea, bloating, weight gain, depression, loss of libido, severe mood changes, etc. Doctors did include patients in details of the study.

Blood clotting also became a major problem with women participating in the trial, and is the currently suspect cause of death for the three deaths that occurred in the subjects while the trials were being conducted. However, it took over a decade for official recognition that there was a link between blood clotting and the use of the drug, leading to multiple deaths within the trial itself.^[12][13]

Controversy

After the drug came into the American public, controversy over the ethical standards of the trial in Puerto Rico arose. Language barriers inhibited the Puerto Rican women from gaining access to answers about side effects and potential risks. The women were informed that they were being given a pill, free of charge, to prevent potential pregnancy. They were not fully informed that this was a clinical trial, or of the risks involved. Autopsies were never conducted on the bodies of the women that died during the trial, causing worry that drugs manufacturers were overlooking serious issues in order to quickly gain access to sales in the U.S.

There are many people who believe that "The Pill" at its current dosage is still a drug which poses a health threat to women.^[14] Alice Wolfson, a young activist who spoke at the Nelson Pill Hearings in the 1970s said "It must be admitted that women make superb guinea pigs. They don't cost anything, they feed themselves, they clean their own cages, pay for their own pills, and remunerate the clinical observer." ^[5]

A Gendered Perspective

Alice Wolfson is among the many advocates that critiqued and condemned the contraceptive trials conducted on Puerto Rican women. Not only were advocates challenging the bigoted and hateful outlooks of both liberal and conservatives within the United States, but also the systematic inferiorization of women through colonial, racial and gendered structures.

Feminist scholar and activist, Antonia Darder analyzed the various degrading policies that were enforced following World War II. As explained, women were seen as the means towards the advancement of imperialistic interests held by philanthropists and foreign policy makers. Notoriously, it was the exploitation of poor and working-class women’s sexuality and reproduction in which forged the crude occupation of the United States in Puerto Rico. Furthermore, feminist Catherine MacKinnon scrutinized the hierarchy of power between men and women as a key component in their encroached subjection. Such disparities within Puerto Rico constrained their advancement and rendered them as inferior citizens.^[15]

In addition, native Puerto Rican women were constantly targeted and discriminated based on derogatory stereotypes. Considered incapable of socio-economic achievement, they were often deemed as prostitutes, welfare abusers and incompetent mothers.

This stigma enforced the idea that low socio-economic communities had the moral obligation to limit and restrict the growth of families with inadequate capability to sustain themselves. This ideology was cultivated by the fears and biases of white pro-birth control groups in the United States who wanted to prevent abusive dependency on social welfare services by poor familial units.

Among those culpable in supporting this race-suicide discourse as explained by political activist, Angela Yvonne Davis, were white pro-birth control women like Margaret Sanger. Her public statement in support for the implementation of forced contraceptive trials in Puerto Rico is a direct example of the negative rhetoric that harmed minority women. As she argued, “morons, mental defectives, epileptics, illiterates, paupers, unemployables, criminals and prostitutes” should be forcibly sterilized or given contraception to limit their reproductive capabilities.^[16]

As Kimberlé Williams Crenshaw would argue through the theory of intersectionality, Sanger exclusively includes women in her hateful remarks since women are also victims of multiple conditions and societal strains at the same time. Due to this hateful discourse, minority women from Puerto Rico were coerced to undergo clinical treatments. In her film, La Operación, Ana Maria Garcia provides these women a platform to denounce the practices. Some women as seen in the film, were inadequately advised on procedures, and others argued that they did not have other choices due to the constant coercion.^[17]

Through a gendered perspective, it is evident that women are exclusively targeted due to their innate attributes such as their ability to reproduce. By forcibly restricting and removing their capabilities, women are actively being denied their fundamental right to parenthood. Not only is this hindering the progression of minority women, but also an attempt in annihilating “inferior” and “other” groups.

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