Coerced Contraception: A Bitter Pill

The Politics of Contraception, by Carl Djerassi, New York: W. W. Norton, 1980, 274 pp., $10.95.

Birth control—family planning—fertility regulation—contraception. Almost everyone uses it at some time, even those who don't usually have opinions on who should be allowed (or forced) to use which method. Many books, a few of them accurate and unbiased, have been written about what Carl Djerassi calls "hardware": the methods themselves and how they work. In The Politics of Contraception Dr. Djerassi has concentrated on the "software": the how and why of research and marketing.

Djerassi is both a respected scientist—one of the early developers of the pill—and the president of a pharmaceutical firm. He is thus in a unique position to understand and report on the effects of increasingly stringent controls imposed on researchers by the Food and Drug Administration.

Since 1962, when it began to concern itself in an organized way with the protocols leading up to clinical trials of new drugs, the FDA has grown more and more responsive to those consumer advocates who are bent on eliminating risk while still demanding technological advances. The drug companies, meanwhile, are less and less willing to invest in expensive, time-consuming research unless the end result is likely to be a marketable product.

We may rage empathetically at descriptions of the extraordinarily long critical path all pharmaceuticals must now travel on their way from theory to consumer, and we may applaud suggestions to improve bureaucratic procedures by acknowledging that "in drug research, the absence of risk is equivalent to the absence of progress and time is the most expensive commodity," (in terms of lives that might have been saved or suffering that might have been averted). Unfortunately, Djerassi's cure is worse than the disease: a new government agency to oversee and stimulate (fund?) the research leading to FDA approval of new drugs as they are ready to enter the marketplace. Perhaps worse is the recommendation that, because of the "global" nature and importance of fertility control, contraceptives should be regulated not by the FDA but by an international agency such as the World Health Organization.

The book is clearly and engagingly written; topics that appear almost unrelated at first glance have been tied together by a man who obviously understands that the world is not a simple, divisible place: anatomy, chemistry, the role of the press, prolonged lactation and urbanization, contraceptive practices in China. Again and again, Dr. Djerassi points out that both hardware and software needs are different where there is no running water and where the maternal mortality rate may be as much as 200 times higher than in the industrialized West. There is an occasional note of exasperated defensiveness, especially when the pill is being discussed; but given his connection with its development, the presentation is relatively free of bias.

In view of suggestions from other quarters that the solution to the population problem is compulsory fertility control, it's a relief to be told that, including the male pill, there will be no radically new methods widely available in the next decade. Djerassi takes obvious enjoyment in pointing out the technical difficulties that preclude adding contraceptives to water or to staple foods such as rice or salt; it may be possible to encroach on individual rights within the next 25 years via such immunization programs if the software problems can be solved. Bernard Berelson is quoted as saying, "Some costs…are too high, for population control is not the final value." Djerassi's agreement with that statement is implied throughout the book. I only wish he had made a similarly straightforward statement of his own.

Lou Villadsen has been working for Planned Parenthood in Santa Barbara for several years.