Developed in the United States in 1956, the birth control pill has since spread to the rest of the world. Today it is the third most used form of contraception, but its biggest success has been in France.
With names such as Liloo, Diane 35, and Jasminelle, the pill is a daily routine for one in two French women who use contraception1. However, this is an exception given that the world’s leading forms of contraception are sterilization (30% of couples) and the intrauterine device, or IUD (22%). In the United States, where it was first invented, the pill is only the second most popular form of contraception after sterilization for both women and men (43%).
Sexual Creation and Revolution
First developed by U.S. doctor Gregory Pincus in 1956, the pill was approved by the Food and Drug Administration (FDA) in 1960 and marked the start of a “sexual revolution” in the United States. It was first marketed as a way to ease discomfort linked to menstruation, before being authorized as a contraceptive for married women. Single women were only granted access to the pill in 1972 after a decision from the Supreme Court. This change enabled women to wait longer before marrying and encouraged them to go to university.
Women in France were not legally allowed to take the pill until the Neuwirth law was passed in 1967 legalizing contraception, and the French Family Planning organization promoted its use. “The pill is still very much rooted in French culture because it is associated with a feminist victory,” says sociologist Cécile Thomé. “For activists in the 1970s, it represented major progress”. In 1974, another law was passed requiring a 65% reimbursement of the pill by the social security system.
The pill then became the most popular form of contraception in France during the 1980s. A “French contraceptive norm” took shape, with women using condoms when first becoming sexually active, the pill when they were in stable relationships, and the IUD after having the desired number of children. The same pattern still exists today.
The pill was criticized soon after its creation in the United States. In 1969, activist Barbara Seamen published The Doctor’s Case Against the Pill in which she highlighted the dangers of this form of contraception – high rates of estrogen that could lead to heart attacks, blood clots, cancer, and depression – that doctors were failing to warn their patients about. The Nelson Pill Hearings of 1970 raised awareness of these concerns before the Senate and encouraged public debate on the issue.
In France, it was not until a young woman died in 2012 that the so-called “third-generation” pill2 was accused of causing thrombosis (blood clots in the veins). “This heralded the start of a “pill scare” the likes of which had long been seen in the United States and England”, says Cécile Thomé. In the wake of national panic, almost 18% of French users changed their contraception.
During the crisis, the Diane 35 birth control pill was taken off the market for a few months. Its main component (cyproterone acetate) was not sold in the United States, but this did not prevent another scandal surrounding pills containing drospirenone, a substance linked to an increased risk of blood clots. The FDA did not ban the sale of these pills, but modified the usage guidelines to raise awareness among doctors and patients.
The low price of the pill also contributed to its popularity in France. “Reimbursement by the social security system helped to increase the number of users. An increase in access driven by low prices,” says gynecologist Danielle Assoune. A woman rarely spends more than 15 euros per month on the pill, whereas prices range from 15 to 50 dollars per month for American women. The products from the second generation2 are reimbursed and teenagers under the age of 15 can access them for free. Since 2001, they can also be prescribed by doctors without parental consent.
The other major difference between France and the United States is that French women had to wait for a 2001 law on contraception and abortion for sterilization to be legalized. “Until then, it was considered a violation of bodily integrity,” says Danielle Assoune. “French women believe that contraception should be reversible.” Just 4.5% of women of reproductive age used sterilization as a form of contraception in 2016. The same method was used by 43% of the same demographic in the United States over the same period.
Since 2010, and even before the “pill scare,” the birth control pill has been increasingly abandoned in favor of other forms of contraception that appeared in the 2000s such as the ring and the IUD, and with the reappearance of condoms. The use of IUD by young nulliparous women (who have never been pregnant or given birth) has contributed to this shift in preference.
1 According to the monthly information bulletin published by the French National Institute for Demographic Studies, n° 549, November 2017.
2 There are four “generations” of the pill. They contain varying levels of progesterone (a hormone that regulates fertility) and estrogen. The “second generation” was created in the 1970s and 1980s. The “third generation” of the pill was first sold in the 1980s and was supposed to have fewer side effects while also reducing acne and weight gain. However, they also carry more risks than the pills from the second generation.