On 20 January 1961 Searle & Co wrote to the Chief Medical Officer of the Ministry of Health to ‘give advance notice of our plans for the introduction of an oral birth control tablet’. 1 This hormone-based product had already been on the market in the UK for three years, but under a different name and for more palatable gynaecological use. It was to be sold under the name Conovid. Whereas earlier contraceptive pamphlets were sent in to the government as items of concern, Searle & Co were reaching out to the government themselves.
By February 1961 it was reported that full details of Conovid had been sent out to more than 20,000 manufacturers 2. At this time, the UK did not have a system for the pre-approval of such drugs. Whether the government liked it or not, change was coming. This development framed the start of the new decade that was to become known as the ‘Swinging Sixties’. Prolific fashion designer Mary Quant described life before and after the pill: ‘The perpetual anxiety. It was a real revolution.’ 3
The advent of modern birth control
The pill had originally been developed in America, where it was licensed as Enovid from 1960 (availability was determined at a state level). The same pill had been undergoing trials with several hundred married women volunteers in Birmingham and Slough. By October 1961, the British Family Planning Association had added the pill to its Approved List of Contraceptives – a significant move, as they were the primary provider of family planning services in the UK.
Government records reveal a significant amount of behind-the-scenes discussion and concern about getting their approach to this new contraceptive right. As you may expect, there is a notable lack of women’s voices in these files.
While the pill didn’t require a medical approval process for sale, it did raise many questions. Was this something that should be provided on the NHS? If so, to who and at what cost? Prior to this point the NHS essentially didn’t involve itself in the administration of contraceptives, but hormonal contraceptives required more medical advice to be given. The pill caused controversy for many reasons: firstly it was a preventative pill essentially offered to healthy people. Secondly, one of the biggest concerns was the potential cost. One government memorandum recorded that prescription charges would be about £11 per person per annum: ‘If this became really popular as a contraceptive the annual cost at this price could soon match the rest of the drug bill.’ 4 As this was a new product, demand was unclear, but it was anticipated to be significant.
Furthermore, it opened up moral debates and concerns about the role of sex in society and explicitly made sex about more than just procreation. Comments in a Ministry of Health file from May 1961 highlighted some of the more moral concerns: should these more reliable contraceptives be available to both married and unmarried women? Would the government essentially be encouraging a more permissive and potentially promiscuous society if unmarried women were offered the pill? A government official noted: ‘a woman has, I suppose, precisely the same rights under the NHS whether she is married or living in sin.’ 5
Pressure was mounting for the government to take an official line. Throughout the summer of 1961, letters from the British Medical Association repeatedly requested government clarity.
Contraceptives on the NHS
After much behind the scenes discussion, on 4 December 1961 Enoch Powell, Minister for Health at this time, announced that the pill would indeed be available on the NHS. The pill was to be given to women whose health was put at risk by pregnancy and this was at the doctor’s discretion.
Labour MP Marcus Lipton asked Powell a pertinent question:
Mr Lipton: ‘Is it left to the doctor to decide whether these pills shall be prescribed both for married and single women?’
Mr Powell: ‘It is always for the individual doctor to decide in each case what are the medical requirements.’ 6
As noted in the days after this announcement, ‘clear cut, medical reasons are very much in the minority.’ 7 In practice, only a limited number of married women generally received the pill in these early days; nevertheless this was the first step towards wider change. It indicated an important shift in the government’s approach to sex and contraceptives.
While earlier birth control methods were commonly used and visible in society, the pill:
- put women primarily in control of conception, and their bodies;
- was preventative, and didn’t need to be applied at the last moment;
- and most importantly, if used correctly, it was far more reliable than most other forms of contraceptives.
This all happened at the beginning of the 1960s, a decade that was to eventually see homosexual law reform, the mini-skirt and the Beatles. For women, it was the decade that would bring divorce and abortion reform. And the pill certainly played a part in this shift towards a more permissive society.
‘Sex on the State’ – further legislation
The initial House of Commons announcement was only the beginning. 1967 brought the NHS Family Planning Act, which enabled family health clinics to give contraceptive advice to unmarried women, giving many more women access to the pill. Despite this, there was significant stigma for unmarried women accessing it. Anecdotal stories talk of unmarried women passing around rings in doctors’ surgeries, in an attempt to appear married or engaged so as to be more likely to be prescribed the contraceptives that they were entitled to.
From 1 April 1974, a reorganisation of the NHS meant all contraceptive advice and supplies became accessible free-of-charge, regardless of marital status. Sir Keith Joseph, Secretary of State for Health and Social Services, announced the government’s decision that ‘family planning will become a normal part of our health arrangements’ 8. Pockets of public backlash remained, with the Telegraph running with the headline ‘Sex on the State’, speculating that free birth control for all would cost the tax payer £1 million 9. There was also a legitimate worry about hospitals and clinics not being able to meet the demand of all the extra medical appointments that would be generated.
‘It was a real revolution’
The pill has since been widely accepted in society. While other contraceptive methods have been developed, it remains the most popular contraceptive in England, with approximately 3.1 million women taking it 10.
It is hard to quantify the huge impact such a small pill has had on women’s lives, ultimately giving women greater certainty and choice. As a more effective birth control option, it has enabled women to choose when, or if, to have children, to increasingly move in to the workforce, to be more financially stable and to prioritise their careers. Significantly, it has also given people greater sexual freedom: to have sex for reasons other than child birth. The approval to give the contraceptive pill on the NHS 60 years ago also illustrated a significant shift in the role of the government and its involvement in issues concerning sex and family planning.
The pill continues to be debated and at times still attracts controversy. While the male contraceptive pill remains elusive, it is important to remember what the contraceptive pill initially gave women: greater control over their own bodies. At the time it was significant that this control was put in the hands of women.
- Oral contraceptives: policy. The National Archives, MH 135/108. ↩
- MH 135/108. ↩
- Fifty years of the pill | Sexual health | The Guardian. ↩
- MH 135/108. ↩
- MH 135/108. ↩
- HC Deb 4 December 1961 vol 650 cc922-3922, Birth Control Pills (Hansard, 4 December 1961) (parliament.uk). ↩
- Letter by R E Ford, 8 December 1961, MH 135/108. ↩
- Family planning: provision of free services and contraceptives, 1973-1974. The National Archives, T 227/4153. ↩
- Sex on the State’, Telegraph, 1 April 1974. T 227/4153. ↩
- ‘Revealed: pill still most popular prescribed contraceptive in England’ | UK news | The Guardian. ↩