A New Haven activist, Yale doctor, and Yale lawyer won Americans the right to oral contraceptives as apart of a liberating—and eugenic—movement. Today, patients and doctors still confront the tension between autonomy and coercion.
In the spring of her senior year of high school, Asha Goyal ’27 made an appointment with her doctor at home in Los Angeles, CA. Each month of that year, she had spent five days out of commission. She was nauseated. Her temperature fluctuated. She had joint pain, and back pain, and stomach pain. Her period could not be subdued by any amount of Advil or number of hours spent clutching a heating pad to her abdomen. She told her doctor. He told her to tolerate the pain—to wait until she was 25, when her body would “mellow out.” Asha, 18 at the time, did the math: she would spend 84 weeks of the next seven years in pain. “That’s nearly two full years of my life that I’m going to be miserable,” she said on the patient table. “And I’m supposed to wait it out?” Her doctor was silent.
In the absence of satisfying medical advice, Asha’s mother made a common suggestion: might she try a birth control pill to regulate her cycle? Asha figured it was worth a shot. She knew friends who were taking oral contraceptives. Some took pills with both estrogen and progestin—hormones that suppress ovulation and regulate menstrual bleeding—and some took pills with only one of the two hormones. In February 2023, during Asha’s freshman year as a mechanical engineering major at Yale, her new doctor at Yale Health prescribed an estrogen pill.
Then Asha got her period. It lasted 14 days. Her doctor said to give her body three months to adjust to the pill, and suggested skipping the five placebo pills at the end of her pack, which typically induce a period. But Asha got her period again in April. It lasted 35 days, until the end of May. She had worse mood swings, pain, and acne than ever. When Asha went back to her doctor before leaving for her summer study abroad program, her doctor said to give it six months. A week after the appointment, she had another painful, fourteen-day period. “I think I spent like 40 percent of last year bleeding,” Asha says.
She spent about the same proportion of her time crying. Three weeks in, as Asha packed for spring break, she was overcome by a foreign, persistent sadness. She cried through her study abroad program in July, through time with family in August, and through the first two months of her sophomore year. “I physically could not cope with life. I just couldn’t move.” She loved her classes, her friends, her comedy group, yet the tears came every night. Asha could never predict when her body would start bleeding, or crying. “I just did not feel like myself,” she says. Her body and her mind felt like those of a stranger.
According to a study published by the National Library of Medicine, 83 percent of participants said their doctor had not mentioned the possibility of psychological side effects when prescribing a birth control pill. Of those who experienced such changes, over one-fifth felt that their provider did not address their concerns. Asha’s doctor had said that mood swings and bleeding between periods could be a side effect of the pill. But was her depression a “mood swing”? The term felt inadequate, and she felt unprepared for her debilitating symptoms.
Every day she asked herself, “What if tomorrow I take the pill and it’s all better. What if I stop today, and then six months of depression have all been for nothing?” Was three months long enough? Six months? Six months and one day? “I really just should have stopped,” Asha says in retrospect, pausing. “I hoped that they would be able to fix me.”
Anabel Moore ’25, a senior at Yale, had hoped the same. When she was 17, her period cramps were so painful, she fainted in the bathroom of her Woodinville, WA high school, smacking her head on the white tile floor. Birth control seemed like the obvious course of action.
Her doctor prescribed a birth control pill with only progestin and no estrogen. This pill would have fewer side effects than estrogen pills, he said, and would not increase Anabel’s risk of blood clots, which ran in her family. Anabel also couldn’t risk the weight gain, fatigue, or depression that her friends warned her about. She was playing elite club soccer.
The side effects came anyway. Two months after beginning her oral contraceptive, she had brain fog and memory problems. Her hair—usually unmanageably thick—fell out in clumps. As an aspiring doctor, Anabel had pored over medical journals before going on her pill. She still felt unprepared by her doctor and shocked by her side effects.
“Autonomy and health had always gone hand in hand,” she says. “But I felt like I was sacrificing my physical and mental health for my sexual health, as in, those three couldn’t all coexist at the same time.” Her contraceptive pill accomplished what it was supposed to for sexual health. But at what cost?
“It is designed to give women agency, but it feels as though, in order for us to be agents, we have to forego our own basic needs,” she says with matter-of-fact acceptance.
The decision to take any medication is a cost-benefit analysis. For Anabel and Asha, the costs seem high in hindsight. The costs also seem hard to calculate. Should they have considered the weight gain they both experienced and that is the most commonly reported reason American women discontinue the pill? Or, that not a single medical study has found a correlation between oral contraceptive use and weight gain? Should Asha, who was taking an estrogen pill, skim the World Health Organization’s list of Group One carcinogens, where she would see that estrogen-containing birth control pills increase current users’ risk of breast cancer by 24 percent, and, if taken for more than five years, increase risk of cervical cancer by 60 percent? Or should she have prioritized the 30 to 50 percent decreased risk of ovarian and endometrial cancer that the pill can offer? Anabel and Asha might be alarmed by the articles in the New York Times, Washington Post, New York Post, and more that reported on a trend of women quitting the pill “en masse,” as the New York Times wrote in 2024. Anabel might read the increasing number of negative posts about birth control on X, especially about oral contraceptives. Asha might search “birth control” on YouTube, where 74 percent of the videos feature a woman quitting her pill because of side effects, according to a decade-long study published in 2019 by Harvard Medical School researchers. Anabel and Asha could also be reassured by reading that doctors are prescribing the pill at all-time highs in 2023, according to health analytics firm Trilliant Health.
The decision to take the pill turns into a paradox, one that feels impossible to solve even for two women churning out mechanical engineering problem sets and MCAT practice tests. Anyone who wishes to solve the pill paradox must navigate several tensions: between social and medical trends, between reported symptoms and studied outcomes, between the promise of autonomy and the costs of control.
Anabel and Asha are not the first generation to perform this cognitive dance. Sixty years ago, a New Haven activist and a Yale doctor won Americans the right to oral contraceptives, in a movement for progress that also inflicted pain. For the promises of science and the experiences of individuals have seldom aligned in the history of the birth control pill.
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“Police to decide the fate of birth control clinic,” reported the Yale Daily News on November 7, 1961. The Planned Parenthood clinic on Trumbull Street had been open for three days, headed by Yale School of Medicine’s C. Lee Buxton, chairman of obstetrics and gynecology, and Estelle Griswold, a 61-year-old gray-haired, firecracker feminist from Hartford. The clinic operated in direct violation of an 1879 Connecticut law, introduced by a New Haven senator, that effectively criminalized contraception. It was a more restrictive version of the federal Comstock Act, nicknamed the “chastity laws,” which, by the beginning of the 1960s, many states treated as “mere dead words,” as a Supreme Court justice wrote in June 1961. Forty-three states had no legislation on birth control or varying restrictions on advertising the pill. Not Connecticut. The sale and advertisement of contraceptives was strictly prohibited, although affluent, married women could typically obtain medication illegally.
Griswold and Buxton were arrested in their clinic. In the four years following, their case was argued appeal after appeal, all the way to the Supreme Court—first by Yale Law School graduate Catherine Roraback LAW ’48, then Yale Law professor Fowler V. Harper, and finally Yale Law professor Thomas I. Emerson LAW ’31. In 1965, the Yale-led team won. Griswold v. Connecticut was one of the most influential cases in modern constitutional history and set a precedent of citizens’ right to privacy, later leveraged in Roe v. Wade. The pill got a new nickname: “Freedom in a tablet.”
The tablet which Griswold freed from back-door clinics and underhand prescriptions does not have a simple relationship with liberty. Estelle Griswold’s inspiration and national counterpart Margaret Sanger, the founder of the Planned Parenthood World Population Organization, built the American contraceptive movement on a foundation of eugenics.
Three decades before Griswold’s Supreme Court battle, the Yale Daily News interviewed Sanger. The “proletariat,” she said in 1934, willfully refused to employ contraceptive knowledge she claimed they did, in fact, possess.
“Did you ever realize that the lower classes are in that position on the ladder of society just because of their deplorable lack of control and ignorance in vital matters of how to cut down the birth-rate?” Sanger asked. “This condition of over-production could be done away with in one generation by proper birth control going hand in hand with sterilization of mental defectives.” Asked about sterilization programs in Nazi Germany, she expressed admiration for the “courage” of governments who sterilized because of “physical or mental defects,” but deplored governments which sterilized based on race or religion.
Margaret Sanger was a champion of science and women’s rights. Behind eugenicists’ mathematical illustrations and methodical texts, racism became a kind of science too. It was this science—of population control—by which doctors and activists promoted the pill as the drug of the future.
Between the 1930s and 1960s, Yale welcomed this movement to its campus. Among other speakers, they hosted Guy Irving Birch, director of the American Eugenics Society and founder of the Population Reference Bureau (still active today)to discuss sterilization and his self-coined term “population explosion.” Dr. John Rock, co-developer of the oral contraceptive pill, also lectured at Yale. To an audience of three hundred male students in Harkness Hall, Dr. Rock, the News reported, spoke about the “male coital urge” and impending population crisis and food shortages. He did not speak about women’s health.
Nine years before his lecture at Yale—and five years before the Food and Drug Administration approved his pill—Rock and his research partner performed the first large-scale clinical trials on Puerto Rican women in April of 1956. The U.S. territory was one of the most densely populated areas in the world, and, luckily for Rock, had no laws against contraceptives. Sign-ups filled quickly. The women, eager to try this alternative to sterilization, did not know that they were participants in a trial.
After one year of the experiment, doctors running the operation reported back to Rock: the pill was found to be 100 percent effective, but side effects were too debilitating for the pill to be considered “generally acceptable.” Women were overcome by nausea, migraines, blood clots, pain, symptoms Rock waved away as psychosomatic. Three young women died. Their deaths were never investigated. In 1960, the pill was approved by the FDA, which continued its support of the pill even after a 1961 report raised concerns over deadly clotting in pill-users. They reasoned that the frequency of such clotting was lower than deaths from pregnancy.
The pill was the future. The pill was control—but of whom and by whom was less clear.
Dr. Megann Licskai GRD ’22, Lecturer of History of Science, Health and Medicine at Yale, teaches about contraceptives, as two-headed technologies: tools of the feminist fight and tools for manipulating women. Margaret Sanger embodies this contradiction. She responded with compassion to countless letters of women begging for contraception care. She also lectured to the Ku Klux Klan. She opened health centers on the El Paso border. She funded them by stirring concern among wealthy families about the economic and racial threats of migrant reproduction.
“I think the most generous reading of Margaret Sanger is that she was a one-issue woman,” Licskai says, sighing. “She was an extreme opportunist, and she was going to get her message out whatever way she could.”
Perhaps Dr. Rock made a similar calculation: women might suffer on his pill, but their circumstances would improve. The pill was a means to this end.
“The problem,” says Licskai of this thinking, “is when we use the pill as answers to social or systemic problems, when the answer is just, ‘don’t have the family that you want,’ because we lack these broader social structures to support that family.”
A small pill in a plastic sleeve that promised to solve poverty was a miracle to a generation of progressive scientists. Sanger and Griswold’s names are uttered upon the lips of constitutional scholars and reverent feminists. Far less remembered are the women sterilized on the El Paso border and killed in the Puerto Rico trials of that small pill.
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“Contraception is never ideal for the patient. It will always change something about your body,” says Dr. Meredithe McNamara, adolescent gynecologist and Assistant Professor of Pediatrics at the Yale School of Medicine. This is a fact doctors do not routinely acknowledge, she says after a long exhale. “Overwhelmingly, I find that it is not an easy or joyful decision for a young person to opt for any method of menstrual control.”
The changes that occur to women’s bodies when using a birth control pill can be divided into two categories: preventing pregnancy and everything else. The pill’s contraceptive function is highly reliable, at 99 percent when the pill is taken as directed. Other changes vary widely in frequency, and range from regulated menstrual cycles to sleep disturbances, libido loss, and migraines. The side effect sheet enclosed in each pill package unfolds to several feet long. In one popular Tik Tok trend, women wear the sheet as a shirt or blanket. Some women also experience few side effects or even mood improvement.
The pill’s history, says McNamara, can explain the discrepancy between its reliable ability to prevent pregnancy and unpredictable effects on other aspects of health. “Medicine has not existed historically to serve the needs of the patient only,” she says. Doctors, researchers and political actors have historically taken interest in the first change the pill produces: preventing pregnancy. The other effects—like those Dr. John Rock deemed psychosomatic—impact only the person consuming the pill, and those close to them.
“I think there is a quickness to prescribe the birth control pill that goes back to its history,” says McNamara. “The field of contraception came about in part to accomplish eugenics, to prevent people from procreating who some people deemed should not procreate.” Oral contraceptives, specifically, were thought of as a miracle solution, a fix for “all of society’s ills,” she explained. The same miracle is sometimes promised to patients.
Even though the pill was not created to relieve period pain or regulate bleeding, doctors frequently prescribe it to do so. Like Asha, 82 percent of women aged 15-19 who take a birth control pill employ it for non-contraceptive reasons, according to a 2011 study conducted by sexual health NGO Guttmacher Institute. Like Anabel, 58 percent of adult women take the pill for both contraceptive and non-contraceptive reasons. Dermatologists prescribe the pill to treat hormonal acne, with more than an eighth of oral contraceptive users relying on the medication for this function. Intrauterine devices (IUDs), patches, and implants are rarely prescribed to regulate heavy periods and certainly not prescribed or inserted by dermatologists.
Patient satisfaction may also be suffering because contraceptive care is a political—as well as medical—issue.
“There are lots of competing political interests that guide whether or not people get good information about contraception,” says Dr. McNamara. “There are people who think that contraception is immoral, and so they’re trying to take research down. There are people who over emphasize the benefits and effects of it, so that certain groups of people do not have children. None of that has to do with the individual.”
In February, the Trump administration removed CDC- and FDA-produced research about contraception, along with information about adolescent and LGBTQ health. The administration republished the information after a lawsuit.
Dr. McNamara cannot control politics or social media tides, but she can provide her patients with thorough contraceptive counseling—something many patients do not receive. According to a survey conducted by leading health policy organization Kaiser Family Fund, only 30 percent of women felt that they received all the information they needed from their doctors before choosing a birth control method. That number dropped to 12 percent among Asian and Pacific Islander women and 28 percent among Black women. 80 percent of women like Asha and Anabel experienced multiple side effects that were worse than they expected.
Before McNamara practiced autonomously, she completed a fellowship in adolescent medicine, a pediatric residency, and an additional fellowship in adolescent gynecology—disciplines which center counseling as part of medical care, she says. The vast majority of doctors prescribing birth control, like primary care providers, adult gynecologists, and dermatologists did not receive this counseling-centric training. “Most people in medicine are not taught how to offer neutral, thorough, and open contraceptive counseling,” she says. “I think it’s at the root of a lot of dissatisfaction with contraception.”
Several days before we spoke, one of McNamara’s residents had treated a teenage girl with menstrual cramps so severe she was vomiting and missing school. The resident prescribed a birth control pill. Why not a patch, ring, or well-timed Naproxen, a pain killer effective in treating menstrual cramps, McNamara asked her resident? Had the patient expressed interest in a birth control pill? She had not.
“The way that we’re taught to care for patients is very much, ‘I’m the expert. You do what I tell you to do,’” McNamara says. Days before the incident, McNamara had even taught a lecture on shared decision-making in contraceptive counseling. The resident was not a bad doctor, McNamara insists. She was simply following her prior medical training that ingrains, according to McNamara, a paternalistic directive to offer medications.
Dr. Sangini Sheth ’03, another gynecologist at Yale Health and professor at Yale School of Medicine also pointed to the “paternalistic” mode of counselling most doctors provide as a source of patient dissatisfaction.
Dr. Aaron Lazorwitz, Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine researches contraceptive side effects. During his years as a medical student and resident, Lazorwitz was shocked by his patients’ dramatically variable responses to oral contraceptives and his superiors’ lack of knowledge or interest as to why. “I would ask attendings and experts in the field,” he says. “There was no explanation for it.” We can do better, he thought.
“Acceptance,” he says, has been the status quo of women’s health. Funding hasn’t been plentiful either. Although most oral contraceptive pills have far less estrogen than their predecessors and more advanced formulations of the progestin hormone, the pill and its many side effects have remained quite similar since the 1950s, says Lazorwitz. He performs the surly voice of one of his colleagues. “We don’t need to make things better. Women can take these pills, and they can deal with the side effects. They’re fine.” In other words, if the pill was stopping pregnancy, the pill was working.
In November 2024, Lazorwitz began the Birth Control and Genetics study, which seeks to discern why the same medication causes such a variety in type and intensity of side effects. In a previous study, Lazorwitz identified a gene in contraceptive implant users that affected their metabolism of hormones. The same gene might predict how patients react to oral contraceptives. Future pill formulations, prescription practices, and more personalized care would benefit from this understanding.
“The pill has a very troubled past,” he says. “There are lots of drugs we’ve tested in populations we shouldn’t have.” His goal is to provide the very best options to his patients so that they can choose—not be coerced by lacking information, care, or good options.
“The pill is not not the bad guy. It’s more that we can’t rely on only the pill.” Lazorwitz hates when he hears physicians boast that everyone should be on this pill or that IUD. He believes there are as many right answers to contraception as there are individuals.
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I sit with Wilhelmina McQuarrie ’27, a Yale sophomore studying political science, in the nave of Sterling Library on a beige leather chair. Her story is much like those of Asha, Anabel, and the ten other women with whom I spoke. She suffered difficult side effects, and received conflicting advice from doctors she saw at home, at school, and while traveling. Yet, when she opens her mouth to speak about her experience, she pauses. “Thank God for birth control,” she says. She needs to say this, she feels. Women’s autonomy is endangered by abortion bans and threats from President Trump to enforce the Comstock Act, which was never fully repealed. On April 1, the President’s administration terminated US funding for contraceptive care in developing nations, leaving 50 million women without access to birth control.
Wilhelmina feels caught. How can women hoping to defend their autonomy raise concerns about their health––concerns that might erode support for contraceptives? “It is really uncomfortable to address the fact that this amazing, liberating option might have big consequences for our health,” she says.
Wilhelmina’s ability to engage in this discomfort is a feature of the political climate of the last six decades, according to Professor Licskai. The 1970s initiated a loss of trust in medical authority—and more generally in all forms of institutional authority, as one scholar notes in an article published in the National Library of Medicine. This loss of trust may have also empowered patients. “On the one hand, it’s fantastic that patients are able to say, ‘I’m not going to accept medical authority without question,’” which was not the case for much of the 20th century, she says. “It also means that it’s really hard to know what to trust, whom to trust.”
Social media has exacerbated this fraying of unilateral scientific authority into the pluralistic, experience-driven authority of social media. The discomfort is a trade of one sometimes-corrupt truth, in exchange for many sometimes-false truths—between a doctor saying, the unfit must be sterilized, and a woman posting, the birth control pill must have caused my infertility.
Doubt is also easy for opportunists to commandeer, and patients may fall prey to a new set of political interests. “I’m interested in the place where the far left meets the far right on subjects like vaccination and birth control, this idea of naturalness, where ‘natural’ becomes a stand-in for ‘good,’” Licskai says. Are some of the rampant negative social media posts about birth control pills selling this moralizing concept? Could they be selling products, like natural family planning apps, she wonders?
Dr. Sheth is wary of contraceptive misinformation on social media. “But,” she says, “I can’t shut down the conversation just because a patient says, ‘I saw this on social media,’ because that’s a part of their world.”
After seven months of being on the pill, Asha’s told her doctor that the medication was not working for her. She switched to a different estrogen pill in late September, which restored her upbeat spirit and gracious sense of humor. But, a year after beginning birth control, her periods are similar and sometimes longer than they were before. “Looking back, I wish I had just powered through those five days a month,” she says.
When Anabel left her soccer team before college—and was more comfortable with an invasive procedure and conversations about her body—she opted for an IUD at Yale Health, which was itself a harrowing process, causing the worst pain of her life and persistent issues with placement and bleeding. Increasingly, Anabel has been considering giving up hormonal contraceptives altogether, but for now, she’s decided to keep the IUD. “It’s just this perfect catch-22. There’s no good option.” she says, arms crossed with the resolute composure of a future doctor. “I have so many fish to fry in the world, and it’s like, I gotta pick my battles.”
Dr. McNamara never discusses her own contraceptive care with her patients, but she shares in Anabel’s frustration. She is keenly aware that science has yet to explain everything about her body. “I know that I cannot take a birth control pill,” she admits. “I get horrible brain fog. I feel very weird. It’s a totally bizarre reaction, and I have never found anything in the medical literature that describes it.”
Even as a trained physician, McNamara struggles to resolve the conflict between her own experience and medical information, between her values and those of some other doctors, between her commitment to contraceptive care and the injustice from which her field was born. How could her patients solve the paradox, she wonders?
-Mia Rose Kohn is a sophomore in Grace Hopper College and an Associate Editor of The New Journal
Illustrations by Mia Rose Kohn.
Correction: This article has been updated to clarify that there is no evidence of Griswold directly expressing eugenicist views. The article has also been updated with fuller context on Sanger’s quote about sterilization in Nazi Germany.