Simple Methods" and "Determined Contraceptors"

The Statistical Evaluation of Fertility Control, 1957-1968

Bibliographic Data

ID15025095
AuthorsMarcia Meldrum (0009-0009-2116-2766, corresponding author)
Year1996
Volume70
Issue2
Pages266-295
Publication date1996-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueBulletin of the history of medicine (JOURNAL)
Journal identifiersISSN: 0007-5140 • E-ISSN: 1086-3176
PublisherProject MUSE (PUBLISHER • US)
DOI10.1353/bhm.1996.0075
PMID8680258
OpenAlexW2003476338
LanguageEN
Citations received7
References cited9

“Simple Methods” and “Determined Contraceptors”: The Statistical Evaluation of Fertility Control, 1957–1968 Marcia L. Meldrum (bio) In the 1950s, the practice of contraception gained a measure of respectability, in the wake of endorsement by medical authorities and growing concern over world population growth. Yet a kind of moral stigma remained—the product of Catholic opposition, the public glorification of postwar family values, and the birth control movement’s early associations with radicalism. Several proponents applied the controlled clinical trial model to the testing of contraceptive methods, in an effort to redefine fertility control as a purely scientific problem. In this paper, I will discuss two examples: the field trials of (1) “simple methods” of contraception, and (2) intrauterine contraceptive devices (IUDs), sponsored by the Population Council and the Planned Parenthood Federation of America (PPFA). In the first set of trials, the Planned Parenthood Federation, with Council assistance, attempted to demonstrate statistically that the “simple methods” were as “use-effective” as the spring diaphragm, which had been its standard prescription for the previous thirty years. The goals of the project were both clinical and organizational. The ostensible objective [End Page 266] was the availability of more and better contraceptive methods. But the Federation sought as well to establish contraception as a scientific medical field and itself as an authoritative public health organization. Of the two, the organizational goal was the more decisively achieved. The Population Council, with Federation assistance, subsequently sponsored a major study to determine the safety and effectiveness of the redesigned IUD. The Council, in these trials, also had a double agenda: the improved availability of contraception, and the rehabilitation of the IUD, to legitimize its use in a program of global population control. Again the field trials produced a statistical result that contributed to the organizational goal more directly than to the clinical. The attempt to legitimize contraception through the authority of scientific research was hardly new: Margaret Sanger, at her early clinics and through the Birth Control Federation, PPFA’s predecessor; gynecologist Robert Latou Dickinson, on his own and through the National Committee on Maternal Health; and the philanthropic activist Clarence Gamble had all sponsored various tests and studies of contraceptive methods. The Federation budgeted some of its sparse funds toward basic research, and its Sanger Research Bureau regularly tested commercial spermicides for safety and effectiveness. Sanger herself in the 1950s had put her energies and Katherine McCormick’s money behind Gregory Pincus’s steroid research at the private Worcester Foundation. But none of these projects had had the backing or recognition of the academic medical leadership, which would have conferred legitimacy. The controlled clinical trial methodology, although it was not yet widely used in the 1950s, was a potentially powerful legitimating tool. As Harry Marks has demonstrated, medical elites at the AMA and the universities promoted the clinical trial in this period as the key to a standardized medical practice based on the impartial authority of statistics. The Salk polio vaccine trials of 1954 had not only shown the vaccine to be effective, but had also legitimated the status and programs of the National Foundation for Infantile Paralysis, a nonacademic, nonmedical organization of lay volunteers. The polio vaccine had also met specific clinical needs, thus supporting the claims of the trial methodology to provide a rational basis for medical practice. 1 [End Page 267] But fertility control is not analogous to infectious disease prevention. Disease is an abnormal event, defined by specific medical parameters, while the outcome of a successful prevention program is continued normal health. A woman’s fertility is a normal, but mutable, part of her life and health for thirty to forty years—at times welcome, at others problematic, occasionally provoking a crisis, but always interwoven with the complexities of her physiology, lifestyle, relationships, and social worlds. There are no precise parameters and there is no single optimal outcome: the desired outcome at any given time can best be defined only by the woman herself. The Federation and the Population Council attempted to use the clinical trial methodology to solve a set of organizational and clinical problems that appeared to be nearly congruent. The women enrolled as test subjects in the contraceptive

Birth control · Environmental health · Family medicine · Family planning · Fertility · Legitimacy · Political science · Politics · Population · Research methodology · Historical Studies on Reproduction, Gender, Health, and Societal Changes · Law · Medicine

Tools

Open DOI