Correction to This Article
A timeline with the article about the 50th anniversary of the introduction of the birth control pill incorrectly said studies show that the pill might prevent cervical cancer. Some studies have shown that it could increase the risk of that cancer.

Oral contraceptives have had broad impact but some seek alternatives to the pill

On May 11, 1960, 50 years ago today, the pharmaceutical company Searle received approval from the Food and Drug Administration to sell a tiny pill named Enovid for birth control. A simple combination of two hormones -- progesterone and estrogen -- the pill inhibited ovulation. If taken correctly, it promised a 99.7 percent effectiveness rate in preventing pregnancy. Enovid had already been on the market for three years as a treatment for menstrual disorders; its approval as an oral contraceptive marked the first time a medicine would not treat or prevent an illness, but would rather be prescribed to healthy people.

With the new pill, an advertisement claimed, women would be "freed from their chains at last." The ad showed a naked Andromeda, an Ethiopian princess in Greek mythology, bound against a rock as a sacrifice to an angry sea monster. Enovid, the ad suggested, would liberate her from those chains.

It was a bold promise.

So popular was Enovid that its descendants are referred to simply as "the pill," as if no other medicine came before, or after. It is the first, the last, the only pill.

Five decades on, little doubt remains of its impact: It is hailed as one of the 10 greatest public-health accomplishments of the 20th century. It allowed women to choose if and when they would have children. By 2002, 11.6 million American women were using the pill, according to a government-sponsored study, and today it has been taken by more than 80 percent of all American women.

After 50 years, however, its boastful promise to unfetter women rings hollow to some. Half of American pregnancies remain unplanned. Almost four in 10 women using the pill and other reversible birth control methods are not happy with them, according to the Guttmacher Institute, a nonprofit research group that focuses on reproductive health. And a small but vocal chorus of women calls for the medical field's reliance on the pill to be reexamined.

"It's handed out like candy," said Holly Grigg-Spall, a 27-year-old blogger who stopped taking the pill last year and encourages other women to do so at Sweeteningthepill.blogspot.com. "You imagine it's just this harmless little pill," she said, but she believes women do not think enough about the potential side effects.

An early vision

The revolutionary contraceptive was envisioned by a nurse, Margaret Sanger, who began working on the Lower East Side of New York almost 100 years ago and saw the results of many botched back-alley abortions. Sanger, who believed her own mother's 18 pregnancies led to an early death at the age of 50, talked of "a magic pill" that would allow women to control when they had children. Sanger, who went on to found the group that would later become Planned Parenthood, was 80 when the pill was approved, and her grandson Alexander, now chair of International Planned Parenthood, said his grandmother had only one thing to say: "What took so long?"

While Alexander Sanger continues to fight for the right to birth control, he cautions about the danger of overstating the impact of the pill. "It has done less than we dreamed and less than our opponents feared," he said. "Do we have the right contraception for every woman at the right stage of her life? No."

U.S. women use the pill more than any other form of contraception, according to the 2002 National Study for Family Growth, but Lawrence Finer, director of research at the Guttmacher Institute, said he anticipates that new studies will show an increase in the use of non-hormonal forms of contraception. Michelle Fegely, a gynecologist in Manassas, said that some of her patients are requesting copper IUDs because "they are purists; they don't want hormones in their body."

Changing times

Long mythologized as liberating women to have sex without the risk of becoming pregnant, the pill began by "saving the saved," according to Alexandra Pope, author of "The Pill: Are You Sure It's for You?" Its first adopters were middle-class women already in committed relationships and usually on another form of contraception: married women like Jan Nyenhuis, now 69, who meticulously used a diaphragm, stopping twice for planned pregnancies. But twice the method failed, she said and "nine months later . . . " After finding out she was pregnant for the fourth time, she fell into a depression. "I knew what I was going to be doing for the next six years," she said. After giving birth to her fourth child, she switched to the pill.

Five years after the FDA's approval, 5 million women had tried the pill, but many switched to it not as some declaration of independence, but because it was an easier, "less messy" option than the diaphragm. As one 79-year-old woman recalls, "It was not a revolt; it was a relief."