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1.5
Oral contraceptives - the Pill - are the result of Gregory
Pincus' extensive studies of the ova and spermatozoa of
animals, including the experimental production of "virgin
birth" and investigation into the chemistry and biological
action of the sex hormones. From this arose his study, with M
C Chang, of the inhibition of ovulation by orally active
progesterone-like substances, and thence, the development,
with John Rock, of oral contraception. We may have many
pills, but 30 years later "The Pill" still refers to this class of
drug. Oral contraceptives have been modified several times
to try to reduce side effects which sometimes occur, but all of
them continue to make use of the same physiological
principles which Pincus and his colleagues first elucidated.
His invention marked the start of a new era in birth control.
Pincus made many other contributions to biological science,
particularly through his initiative in organising the
Laurentian Hormone Conference and the Worcester
Foundation for Experimental Biology, both of which have
played a large part in the development of endocrinology and
reproductive biology. But it is the Pill which has been Pincus'
most far-reaching achievement, the one which has
contributed the most to the peace of mind of humankind
@
2.3
The Pill was invented by man for woman.  But some
sociologists believe that in the long run, man may find
himself like the sorcerer's apprentice, who could not control
the spirits he invoked.

This weekend, chemist shops all over Britain will have sold
more Pills than any other single drug.  A million married
women are taking it regularly.

Under its sweet coating, the birth pill contains as little as
1/20,000th of an ounce of chemical. But experts claim it will
have a bigger impact on all our lives than the invention of
the motor car or the domestic use of electricity. They say it
will change the face of society within the next 25 years,
halting the population explosion-the "birthquake," and
eradicating those two social evils-abortion and illegitimacy.

But it will also have the most profound effect on morality as
we know it?

To millions of men and women the Pill has given true
meaning to the catchphrase married bliss. For many unions
which were in danger of breaking up because of frigidity on
the one part and frustration on the other, it has had the
effect of cementing the marriage.

However, few women are aware of a new and alarming
charge being levelled against the Pill by doctors, sociologists
and psychiatrists.    Some of them believe that it caused
radical, and in some cases, frightening changes in the sex life
of married women - "a sort of bedroom revolution."

The first rumblings of the bedroom revolution were heard in
doctors' consulting rooms by 1963, when a little over
100,000 British wives were on the Pill. Women who used to
complain that their husbands "demanded too much of them"
suddenly became the more demanding partners. Wives who
for years treated lovemaking almost as just another
household chore were suddenly aroused and fascinated by
sex, one doctor reported.

A cynic once described marriage as "the maximum of
opportunity with the minimum of temptation," but the Pill
soon changed this. A woman doctor in Harley Street reported:
"Many women patients now ask even beg me to teach them
the most effective ways of 'seducing' their own husbands.
"It's emancipation all over again."

However, on the debit side the Pill has had a disquieting
effect on some husbands. As the wives became more
passionate, more abandoned, the men became indifferent-
sometimes even frigid.

In fact, it was seen that in some cases male ardour decreased
in proportion to the wives' increasing sex drive. Some
husbands became hypochondriacs, developing imaginary
illnesses.  A number even became impotent.  Hostile attitudes
developed.

Dr Sydney Sharman, a well known psychiatrist with many
years' experience as a consultant in Harley Street, disclosed:
"I have interviewed a large number of general practitioners
in Britain who have prescribed the Pill for a long time.
"Women patients have told these doctors that the Pill created
in them strange and unexpected new sexual urges, needs and
desires. The Pill seems to have released the brakes which
held strong female sexual impulses in check. Women now
want to tempt."

In a nation-wide research project, the Marplan Institute in
West Germany discovered that four women out of every 10
women believe the Pill incites over-indulgence in sex and
tempts wives to be unfaithful. Some psychologists see the Pill
as a tiny time-bomb set to destroy the whole accepted
pattern of love, courtship and marriage. They claim a "silent
sex revolution" has already started and that it will lead to an
entirely new morality.

Love-making, a "male monologue" throughout the ages, has
now become a duologue, between two equal partners. In the
past, women were forced to be more careful than men
because love-making had graver consequences for them.

The fear of an unwanted pregnancy acted as a brake to
desire, and countless wives never experienced the joys of
physical love to the full.  Now the Pill allows them to do so -
or to form sexual attachments as carefree and easily as men
do, should they so desire.

Doctors in Britain have been mainly preoccupied with the
physical side-effects of the Pill.  In other countries, experts
have investigated its psychological effects. The U.S. Family
World Planning Association questioned a representative cross
section of the six million women who are on the Pill. One-
third of them said they were now more aware of sex, enjoyed
it more and had become more demanding towards their
partner. They want to make love more often and enjoyed it
more profoundly when they did.

However, some women had taken steps to curb their new
drive. They asked their doctors for tablets or injections to
slow down desire when its intensity became frightening or
when their husbands wilted under the strain. American
psychologists paint a picture of a future in which the men
will lose first their role as the "leaders" in the interplay of
the sexes and than their "masculine identity."

They have already coined the word "demasculinisation" to
pigeon-hole the process.

How serious is this threat ?  Could we be moving towards a
society in which aggressive women dominate frigid men? We
put the question to Dr Alex Comfort, one of our leading
experts and the author of the study "Sex and Society." Fifteen
years ago, he predicted that the invention of a new, simple,
completely reliable contraceptive would revolutionise sexual
ethics. The Pill proved him right.

But Dr Comfort is confident that while "demasculinisation"
may occur in the "Mom-ridden" American society, where
women already dominate many families, it will not happen in
Britain. "We're too sensible," he says.

"The Pill will emancipate women from sex, but not from the
love and security which she needs. It heightens her sex
awareness and will make her demand her rights.  It will give
her a freedom of choice which she did not possess in
previous cultures. She will become man's equal.  But this
does not mean that she will abuse her new freedom.

"The Pill will do away with false-modesty and fig-leaf
morality.  Sex, detached from guilt, will take its place as a
single, if important, part of the general pattern of human
behaviour. I believe that greater freedom will make woman
more responsible, not less."

Dr Comfort's counterparts abroad are more pessimistic. The
chief of Europe's leading Institute of Sexual Research, Dr Hans
Giese, told us in Hamburg: "Woman is still a closed book to us.
We try to judge her by masculine standards. Men laid down
the 'rule' that man is essentially polygamous, while woman is
by nature monogamous. We have regarded it as a law of
nature that man should ask and woman consent."
@
2.4
LIKE it or not, folks, today we have to wish the Permissive
Society a happy birthday.  We've had 25 swinging, ding-a-
ling years of it.  And the way things are going, it looks as
though it won't run out of steam for many years to come.

Sociologists say that the father of the Permissive Era was a
mild-mannered, middle-aged researcher - and what a lusty
babe Dr Alfred Kinsey produced back in January, 1948.

HE was the man who threw back the curtains of the world's
bedrooms and aired just what went on between the sheets.

HE was the man who changed the love-making habits of
millions.

HE was the man who set in motion the no-holds barred,
anything-goes attitude that rosily colours the intimate lives
of subsequent generations.

What a change he brought about with his incredible report,
Sexual Behaviour of the Human Female.

Until its publication, sex was hush-hush.  But he certainly
opened the flood gates of frankness.

Just consider the post Kinsey years and how things that
raised eyebrows not so very long ago are now taken for
granted or even seem laughable.

1949  Curvaceous Yvonne Goodman, aged 24, defied park
regulations and went for a dip in a pond on Hampstead
Heath, London...the first woman to swim publicly in Britain in
a bikini. "I feel it's a crime to wear clothes in the sun," she
said.  I hope one day people will realise how unnecessary
they really are." Today, few give a second look to girls in
topless swimsuits.

1950  Ingrid Bergman had a baby BEFORE she married
Roberto Rossellini and the film world was horrified.  She
stopped working in Hollywood for six years. Today, there are
many stars who talk candidly of their out-of-wedlock
children and say they have no intention of marrying.

1952  The Teddy Boy came in with a flourish.  Thousands of
teen-aged boys ganged up in velvet-collared drape suits,
frilly shirts, string ties and drainpipe trousers. The older
generations shuddered at this first revolt by youth, little
knowing that the cult would lead to others, progressively
more revolting-the Mods, the Rockers, the Skinheads, the
Greasers, and eventually the worst of all, the Hell's Angels
with their group rapes and sickening violence.

1956  The year romanticism went out of songs.  It was Elvis
Presley who pioneered the "animal approach," getting fans to
heed his hips as well as his voice.  "Elvis the Pelvis" brought
blood to the boil as he flaunted sex as he sang. Before Kinsey,
it was Frank Sinatra who had the bobbysoxers swooning.  But
he had a "mother me" appeal.  Elvis was the first to urge:
"Smother me with sex."  The trend grew, right through the
throbbing Beatles and Rolling Stones years.

1957  The Wolfenden committee reported on prostitution
and homosexuality.  As a result, street girls were driven
indoors, and a discreet ring of call-girls grew. Today, they
openly advertise in cheap shop window cases.  And there are
few prosecutions. In the same year, there were record
queues at every cinema showing And God Created Woman.
Brigitte Bardot appeared nude in it, artistically and
discreetly.  But she caused an uproar. She became the world's
Number One pin up.  Her dainty breasts spurred girls all over
the world to increase their cleavage. Today, screen nudity is
commonplace.  Some of the films made for club showing are
thoroughly sexplicit.  And now we have Marlon Brando's Last
Tango in Paris with noisy copulation prevalent most of the
time.

1960  That most famous of the four-letter words got a vast
public airing for the first time.  It came during an Old Bailey
trial at which a jury had to decide if D.H. Lawrence's novel,
Lady Chatterley's Lover, was obscene. Lady Chatterley's
Lover was cleared - and promptly went on hot-cake sale at
black market prices. Today, four-letter words and even more
detailed sex dialogue and doings are spattered through many
books.  And you can get them all at the public libraries.  And,
as for the paper-backs....

1962  The Pill was launched - on prescription - in Britain.
Only 25,000 women went on it at first.  But a nation-wide
scream went up that here was a licence for promiscuity.
Mothers feared that their blossoming daughters would start
on a career of bed-hopping.  Husbands feared that their
wives would quickly go astray. Today it is estimated that
well over a million British women are on The Pill.  And the
main worries about it centres on its medical side-effects.
Few people still think of it, rightly or wrongly, as a licence for
love-making.

The same year heard a Divorce Court Judge say he found
evidence that two married couples had indulged in wife-
swapping as "positively shocking." Today, there are many
magazines with open advertisements asking for swap-
partners, though it still shocks public opinion.

1964  The topless swimsuit was launched by designer Rudy
Gernreich.  It attracted photographic notoriety, but very few
women showed an inclination to get things off their chests.
Today many pubs and clubs and restaurants have topless
waitresses and dancers.  Blase patrons simply concentrate on
the food and drinks. An enterprising vendor introduced slot
machines into London pubs and cafes, the same year, which
dispensed male contraceptives.  But duress was stronger.
Public opinion made him withdraw. They're back
today...despite bitter attack by some.

1967  Homosexuality between consenting adults in private
was held to be no longer illegal.  And the Abortion Act
received the Royal Assent.  Both subjects, at last, were talked
about.

1968  The rock musical, Hair, complete with starkers cast,
was the first to take advantage of the end of the Lord
Chamberlain's censorship of plays.  It got the accolade when
members of the Royal Family saw it.  But they declined to
respond to the open invitation to dance onstage with the cast.

Simultaneously, Yves St Laurent launched the see-through
blouse.  The mini skirt was rising even higher.  The prophets
of doom warned that girls were inviting rape.  The
introduction of tights brought gloom to men who mourned
the passing of the stocking-top....

1969  The Permissive Era came of age.  Fashion designer
Mary Quant celebrated by revealing that her husband had
once cut her pubic hair into a heart shape.  She also said she
believed it would become fashionable for women to wear
clothes that would reveal such an adornment. It hasn't yet!

Flat-sharing between young men and women became the
answer to a shortage of accommodation.  Nine out of ten
reported: "No monkey business goes on."

1971  Still easier divorce was made possible.  Marriages
could now be dissolved only because of "irretrievable
breakdown".  No longer would there be "guilty" or "innocent"
parties. Glenda Jackson played a scene in The Music Lovers,
filmed by Ken Russell - with an extra-ordinary close-up
revealing scene.

1972  And what a massively controversial year it was, to
herald the Permissive Era's silver jubilee.  Particularly in
films.  Shocks over sex had worn off.  Violence took over.
Two films in particular - Straw Dogs and The Clockwork
Orange - provoked the biggest rows, to censor - or not to
censor.

Two very basic four-letter words were included in the Oxford
Dictionary.

1973  With only a few days gone, the Andy Warhol film
almost shown on TV, started a furore.

That's a quarter of a century gone. What on earth will it be
like in another 25 years time?
@
2.5
With his strong reaffirmation today of past papal
condemnations of every form of artificial birth control, the
Pope has finally removed any doubt that his over-riding
concern is the preservation at all costs of the Roman Church's
claims to authenticity and authority in moral teaching. His
encyclical was introduced at the Vatican today as "an act of
courage" and could be accepted simply as such except by
those within and outside Roman Catholic ranks who feel that
courage in present circumstances is, like patriotism, not
enough.

The encyclical, which takes its name from its opening words
in Latin "Humanae vitae", is comparatively brief and free of
ambiguities.  In many ways it is the most revealing
document of his reign and, because of its subject matter and
the long wait for the papal decision, will evoke the widest
reaction of any of his utterances.

The Pope must have been uncomfortably aware that the
problem of birth control is the issue on which public opinion
will judge the papacy's readiness to bring its teachings closer
to the needs of contemporary life and modern understanding.
For this reason his own explanation of why he has
deliberately rejected the more palatable alternatives offered
him is as interesting as the decision itself.

The costs are obvious enough.  The many Catholics who have
adopted methods of birth control, sometimes with the moral
support of their priests, during the long debate on whether
change could officially be contemplated, are now faced with
the clear-cut alternative of going back to traditional teaching
or transgressing a papal declaration of great solemnity, even
if it should not be regarded as an infallible statement.  The
Vatican's theoretical position in international social questions
remains handicapped by a refusal to permit modern means
of birth control.

The cause of ecumenism is more difficult than ever.  Those
concerned with it at the Vatican make no secret of the fact
that the crucial difficulty regarding mixed marriages is less
the technicality of how a Catholic and a non Catholic should
be married than the difference between the two in the sexual
behaviour permitted them throughout the years of married
life.

Non-Catholics will find discussion of the encyclical hampered
by the Pope's deliberate avoidance of any of the scriptural
texts on which Roman teaching on birth control is based.  He
apparently avoided these on the ground that their
interpretation is still open to more than one view.  Catholic
renewal, in many minds, will be thought severely lacking if
the other aspects of it must remain unaccompanied by a
change on birth control.

The Pope makes clear his awareness of some of these
problems in the opening pages of his encyclical though not of
the connexion between renewal and birth control which is
fundamental in large sections of public opinion.  He notes the
fear that the population of the world is growing more rapidly
than the available resources, with growing distress to many
families and developing countries: working and living
conditions as well as increased requirements in the economic
field and in education, he points out, often make the proper
education of a large number of children difficult.

He refers to changing views on woman's place in society, on
the value to be attributed to conjugal love in marriage and on
the appreciation to be made of the meaning of conjugal acts
in relation to that love.  Finally he draws attention to the
"stupendous progress" made by man in the domination and
rational organization of the forces of nature so that this
domination tends to be extended to man's own total being.

He recounts how he confirmed and enlarged the special
commission studying birth control which was established in
March 1963 by his predecessor, Pope John. The Pope's own
reaffirmation of Catholic doctrine in his encyclical is made in
the following terms: "... We must once again declare that the
direct interruption of the generative process already begun,
and above all, directly willed and procured abortion, even if
for therapeutic reasons, are to be absolutely excluded as licit
means of regulating birth.

"Equally be to excluded, as the teaching authority of the
Church has frequently declared, is direct sterilization,
whether perpetual or temporary, whether of the man or the
woman.  Similarly excluded is every action which, either in
anticipation of the conjugal act, or in its accomplishment, or
in the development of its natural consequences, proposes,
whether as an end or as a means to render procreation
impossible.

"To justify conjugal acts made intentionally infecund one
cannot invoke as valid reasons the lesser evil, or the fact that
such acts would constitute a whole together with the fecund
acts already performed or to follow later and hence would
share in one and the same moral goodness."

No specific mention is made of the contraceptive pill, but it is
clearly excluded for use by Roman Catholics, who remain
ecclesiastically free to follow only the rhythm method
sanctioned by Pius XII.  Pius XII, indeed, who is usually
looked on, unfairly, as an arch-conservative, is the only
modern Pope to have offered any authoritative relief to the
exclusive connexion in Catholic teaching between intercourse
and procreation.

The question of authority is of great importance, but the
Pope places much weight on the Church's role as the great
guardian of private and public morality in a permissive age.
He reflects on what might occur if the Church gave its
sanction to artificial methods of birth control.  A "wide and
easy" road would be opened to conjugal infidelity and the
general lowering of morality.

"Not much experience is needed to know human weakness
and to understand that men - especially the young, who are
so vulnerable on this point - have need of encouragement to
be faithful to the moral law, so that they must not be offered
some easy means of eluding its observance.

"It is also to be feared that the man, growing used to the
employment of anti-conceptive practices, may finally lose
respect for the woman and, no longer caring for her physical
and psychological equilibrium, may come to the point of
considering her as a mere instrument of selfish enjoyment
and no longer as his respected and beloved companion."

The document is essentially a reiteration of the Roman
Church's claim to be the one true interpreter of the moral
law.  It seems as if the old fortress mentality of the Vatican
has come back, this time as the staunch, beleaguered citadel
against modern promiscuity.

The Pope states that the Church's teachings on birth control
may seem to many people difficult or even impossible to
carry out.  Like "all great beneficent realities, it demands
serious engagement and much effort...."  It would not be
practicable without God's help.  "Yet, to anyone who reflects
well, it cannot but be clear that such efforts ennoble man and
are beneficial to the human community."  He speaks as if he
really had no alternative.

It was a typical stroke on the part of the Vatican that the
theologian chosen to illustrate the document, Mgr.
Lambruschini, was a member of the majority in favour of
change in the Pope's special commission.  Obedience is a
prime requirement once the highest authority has spoken,
though it will be interesting to see to what extent the
obligation is observed in the Catholic world at large.
@
2.6
Two reports published today establish more firmly a link
between oral contraceptives and abnormal blood clotting in
women serious enough to necessitate hospital treatment.
They confirm that there is a risk of death from pulmonary
embolism or cerebral thrombosis, Our Medical Staff writes.

But Dr. Denis Cahal, medical assessor to the Dunlop Committee
on the Safety of Drugs, said last night that after studying the
reports the committee did not recommend the withdrawal of
the preparations from the market, since they had therapeutic
and social value and were available on prescription only.

"The pill should remain on the market, provided it is on
prescription only.  The choice whether to take it rests with
the patient and her husband, advised by the doctor", he said.

"The decision must be taken in the full knowledge we have
so far of the risk involved.  We still do not know the whole
story.  It needs longer study, and this is going on, but it will
take some five years before results are known."

It is estimated that the number of women in Britain who
take the pill in a year has risen from about 400,000 in 1965
to about a million.

The two reports, published today in the British Medical
Journal, are by Dr. Richard Doll and Dr. M.P. Vessey, of the
Medical Research Council's statistical research unit, and
Dr.W.H. Inman, senior medical officer of the Dunlop
committee.  They will undoubtedly cause renewed
controversy about the use of the pill.

Assessment of the risk is made more difficult because the pill
is not a drug given for treatment of a disease, where
necessity may be the spur, but is given to healthy women.
The Dunlop committee, taking into account all the factors, see
the present known risk as acceptable.

The reports show that risk of death from pulmonary
embolism or cerebral thrombosis is 1.3 per 100,000 users
aged 20 to 34, and 3.4 per 100,000 aged 35 to 44.  About one
in every 2,000 women on the pill risks admission to hospital
each year with blood clotting disorders, compared with only
about one in every 20,000 women not using it.

To preserve a balance it should be remembered that the
annual death rates per 100,000 in the two age groups of
women in motor accidents is 4.9 and 3.9, and from all risks of
pregnancy, including abortions, it is 22.9 and 57.6.

The reports found no conclusive evidence of a link between
coronary thrombosis and the pill Dr. Cahal said that the
figures did not attain significance "although they do not come
far off".

In earlier investigations it was estimated that the risk of
some form of blood clotting disorder as a result of taking the
pill was about five in every 1,000 women taking it each year.
But many of these disorders were slight and trivial.

In their latest report Dr. Doll and Dr. Vessey conclude that
the risk of a disorder serious enough to need hospital
treatment is about nine times greater in women taking the
pill than for those who do not.  Dr. Cahal pointed out that, on
the credit side, oral contraceptives, if used correctly, were
virtually 100 per cent effective.  There was no evidence of
the stability or variation over the years of the risk-which for
pulmonary or cerebral embolism was about 60,000 to one for
the 20-34 age group and 20,000 to one for the 35-44 group.

The study by the Statistical Research Unit was on married
women,aged 16-40, admitted with various types of
thromboembolic disease to 19 general hospitals in the north-
west regional hospital board's area during 1964-66.

The conclusion was definite: the results were not thought to
have been produced by bias or by any common factor
responsible both for the use of oral contraceptives and the
production of thromboembolism, and therefore the pill was a
cause of the disease.

It was calculated that the yearly risk of hospital admission in
previously healthy women for deep vein thrombosis (blood
clotting in the leg veins) or for pulmonary embolism
(impaction of blood clots in the lung arteries) was nine to 10
times greater for women using the pill.

Of 58 affected patients, 26 had been using the pill during the
month preceding the onset of their illness, while only 10 of
the corresponding 116 "controls" had been doing so.

No relationship was found in this study between heart
attacks and the pill but there was some evidence that, very
occasionally, taking the pill might lead to a stroke.  Five of
nine patients who survived an attack of cerebral thrombosis
had been using the pill during the month preceding their
illness.  But the risk here was much lower than in the blood
clotting diseases.

In the study of 58 affected patients, for each patient two
control patients were selected who matched the affected
patient in regard to hospital date of admission, age (within
four years), and parity in number of children.

Two minor but interesting points were thrown up by the
investigation.  A suggestion made in 1967 that the pill
produced phlebitis only when the woman had varicose veins
was contradicted.  It was found also that the affected
patients were on average,heavier smokers than the control
patients.

Contraceptive preparations last in use before the onset of the
disease were known for 23 of the affected patients and for
eight of the controls.  No indication was found that any one
preparation was more likely than the others to be
responsible for thromboembolic disease though, the report
points out, only a marked effect would have been detectable
with so little data.

Comparison of the duration of use of the pills was also
handicapped by the small amount of data.  But 11 out of 26
of the women who developed thromboembolic disease had
been using the pill for less than six months, and the
corresponding proportion for the control patients was almost
identical.

The second study, also published in the current British
Medical Journal, was under the auspices of the Committee on
Safety of Drugs.  Inquiries were made about the use of the
pill by 385 married women, aged 20-44, who died in 1966
from thromboembolic diseases.

The report states: "On balance it seems reasonable to
conclude that the risk of death from pulmonary embolism
during one year's treatment with oral contraceptives is of the
same order as the comparable risk of bearing one child."

In assessing the risks it was important to remember that
women in the United Kingdom gave birth, on average, to only
two or three children in their lifetime, that other methods of
contraception were reasonably effective and that birth
control may be practised during most of a woman's child-
bearing years.
@
2.7
It is 40 years since Dr Gregory Pincus, an American biologist,
was invited to devise the ideal contraceptive.  His sponsors,
the Planned Parenthood Movement, stipulated that the new
method should be "harmless, entirely reliable, simple,
practical, universally applicable and aesthetically satisfactory
to both husband and wife".

Within a few years Dr Pincus was able to report that he had
achieved his objective, and in 1960 the first commercially
produced oral contraceptive, Enavid 10, was launched in the
United States.  Thirty years ago this week it began tests in
Britain, using 500 volunteers recruited from family planning
clinics in Birmingham.  The British version, Conovid, was
officially launched the following year, in October 1961.

The Pill was welcomed not only as the ideal contraceptive,
but as a force for the liberation of women.  For the first time
women were free to explore their sexuality, without the fear
of unwanted pregnancy.

Dr Clifford Kay, of the Royal College of General Practitioners,
remembers how soon doubts set in.  "At first everyone said
the Pill was wonderful and had no side effects, and of course
that turned out to be nonsense.  When we started to evaluate
it, one nasty thing after another seemed to turn up.  But at
the same time we discovered dozens of beneficial effects
which were totally overshadowed."

In 1968 Dr Kay set up a study involving 46,000 married
women, of whom half were on the contraceptive Pill.  Their
medical histories have been followed ever since, and regular
reports on their progress are published.  His own results, and
those of others, have led him to believe that in the future the
Pill could be promoted not only as the most effective means
of birth control, but as an important way of preventing
disease.

"The latest research suggests that taking the modern, low-
dose Pill actually reduces mortality in non-smokers.  For the
very first time, we are able to say that on balance the Pill is
good for you," he says.  "If, as a doctor, you can combine the
Pill with a determined effort to get women to stop smoking,
or indeed never to start, we can offer them the most
effective method of contraception there is and say it will
actually benefit their health."

Dr Carlos Huezo of the International Planned Parenthood
Federation agrees: "The Pill has saved a lot of lives, and there
is some evidence that women who take it are generally
healthier than those who do not.  This is a message which
family planners need to put across."

Latober America's cautious Food and Drug Administration
changed its Pill recommendations to state: "The benefits of
oral contraceptive use by healthy, non-smoking women over
40 years of age may outweigh the possible risks.  However
all women, especially older women, are cautioned to use the
lowest-dose Pill that is effective."

In Britain, the Family Planning Association recommends that
the Pill is safe for non-smokers up to the age of 45, although
some individual doctors prescribe oral contraception for
older women.

Yet despite all this optimism, concern about the Pill rumbles
on, fuelled at regular intervals by the publication of alarming
research reports.  These concern not only the women who are
on the Pill now, but the millions who have used it in the past
and wonder about lingering after-effects.

Martin Vessey, professor of community medicine at Oxford
University and a world authority on the Pill, has drawn on a
vast amount of published data to establish a balance sheet of
risks and benefits.

He estimates the increased risk of heart attack, thrombosis or
stroke among women using the low-dose Pill as between
one-and-a-half and two times the normal risk.  However,
these increased risks mainly affect smokers, do not seem to
be influenced by the length of the time the Pill is taken, and
do not linger after the Pill is discontinued.  In 1988, out of a
total of 138,000 women who died of circulatory diseases in
England and Wales, only 857 were under the age of 45, and
most of them would probably have been advised against the
Pill.

Vessey says that taking the Pill for more than eight years
may quadruple the effects of liver tumours and the risk
probably persists after the Pill is stopped.  However, only
about 200 women a year die of liver tumours in England and
Wales, and very few of them are of childbearing age.

The effects of the Pill on cervical cancer are disputed.  Taking
it for more than six years may increase the risk by 50 per
cent, and that risk may persist after the Pill is stopped.
However, abnormal cells in the cervix can be identified and
removed before they have a chance to become malignant,
provided women have regular cervical smears every three
years at least.

The greatest controversy surrounds the effects of the Pill on
breast cancer.

On the credit side, the Pill offers protection against cancers of
the endometrium and ovaries and appears to be protective
even after it is no longer taken.

So how do all the risks of Pill-taking measure up against all
the benefits?  Professor Vessey's balance sheet assumes that
a million women use the Pill from the age of 16 to the age of
35, when they or their partners are sterilized, while another
million 16-year-olds rely on condoms until the age of 35,
when they or their partners are also sterilized.  He then
estimates the mortality risks in each group up to the age of
50.

According to his calculations, the protective effects of the Pill
against ovarian and endometrial cancers will save 1,497
lives.  He adds another 131 lives saved by avoiding the
hazards of unwanted pregnancy.  On the debit side, Professor
Vessey subtracts 202 lives lost as a result of Pill-induced
liver cancer, and 186 lives lost as a result of heart attacks,
strokes and thrombosis.  This latter figure assumes that
modern Pills carry a lower risk than their predecessors of
cardiovascular disease an assumption justified by the latest
research, and the fact that high-risk women are now much
less likely to be given the Pill.

The result is that 1,240 more people would be alive in the
Pill-using group at the age of 50 than in the condom group.

However, this optimistic picture assumes that the extra
breast cancer which some researchers have found in young
female Pill-takers simply represents an earlier manifestation
of a disease which would have occurred anyway.  It also
assumes that the higher risk of cervical cancer among Pill
users is caused by differences in their lifestyle rather than
by the Pill itself.

To cover these objections, Professor Vessey has produced a
second calculation in which he assumes that the Pill really
does produce a 50 per cent increase in cervical cancer among
women who use it for more than six years, and that it really
does produce an extra risk of breast cancer in young women.
This would involve an extra 1,075 lost lives, virtually
cancelling out the savings made by the Pill against ovarian
and endometrial cancers and unplanned pregnancy.

However, there is one last scenario which must be considered
the risk that the carcinogenic effects of the Pill on breast
tissue will continue as the woman ages.  This would lead to a
loss of 4,157 lives by the age of 50, leaving the Pill balance
sheet with a debit of well over 3,000 lost lives.  The evidence
collected so far, though, does not support this worst-case
scenario.

So where does all this leave the individual?  We need to
remember that the Pill is still the most effective method of
contraception, virtually foolproof if taken every day.
Although Pill users do need regular medical check-ups, it
does not need to be fitted, unlike an intra-uterine device.  It
does not require accessories, such as spermicides, as the
diaphragm does.  And unlike sterilization, it is a reversible
method which leaves the woman free to have children in
future.

In an age where people worry (or should worry) about
sexually transmitted diseases and HIV infection, the condom
would seem to be the ideal method.  But according to
Rosemary Kirkman of the National Association of Family
Planning Doctors, a survey of 200 condom users revealed
that nearly half of them had experienced a condom bursting
or slipping off in the previous three months.  "You may
understand our reservations about relying on condoms for
contraception where there is a need for high efficacy," she
told a conference at the Royal Society of Medicine last year.

The dangers of the Pill should also be compared with life's
other hazards.  Several years ago a chart was drawn up
comparing the chances of death as a result of Pill-taking with
death as a result of other human activities.  It was based on
data collected from the higher-dose Pills, but even on these it
was found that a female non-smoker under 35 has a two
times greater risk of dying in the home, a four times greater
risk of being run over, and an eight times greater risk of
dying in childbirth than she has of being killed by the Pill.

If she is a smoker under 35 her risks from the Pill are three
times higher than dying in the home, but still less than the
risks of driving a car.  Most women, of course, do have a
choice about contraception, whereas they may feel they
cannot avoid the risks of motoring, crossing the road, or
giving birth.  Whether they are prepared to take the
additional risk involved in using oral contraceptives is an
individual decision.

All this analysis can seem cold-blooded to the Pill user.  The
suspicion creeps in that millions of women have been part of
a vast medical experiment and that men rather than women
have ultimately benefitted.  They, after all, have had the
sexual freedom without the fear of side effects.