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Doctors, women and circulation of knowledge on oral contraceptives in Spain: 1960s-1970s

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Chapter 6
Doctors, Women and the Circulation of
Knowledge of Oral Contraceptives in Spain,
(1960s–1970s)
Agata Ignaciuk, Teresa Ortiz-Gómez, Esteban Rodríguez-Ocaña
Doctor attacked for not prescribing contraceptives. Cardedeu (Barcelona). Local
medicalofcer,DoctorJosédePelegríBarberán,wasattackedbyawomanafter
he refused to give her a prescription for the contraceptive pill. The victim is
suffering from a fractured rib, head injuries and general contusions, caused by a
stone. The doctor asked the patient to leave his surgery, but she continued to hit
Mr. Pelegrí Barberán until he lost consciousness. A passing policeman arrested
the woman. Doctor Pelegrí was transferred to the nearby Granollers hospital,
where he explained that the woman had been his patient for about ten years,
but he had never believed she had symptoms [of illness] that required the use
ofanovulatorydrugs.Healsosaidhewouldleaclaim[againstthewoman]in
court. (Abc Seville 1975, 70)
This short story was published in Abc, one of the leading Spanish daily newspapers,
in 1975, during the last months of the almost four decades of Franco’s dictatorship.
In November of that year, the leader’s death triggered the beginning of the transition
to democracy in Spain. The anonymous woman who violently confronted her
doctor because he had refused her a prescription for oral contraception can hardly
be considered representative of Spanish women of the time. However, the story
raises several issues we will discuss in this chapter: namely women’s demand
for the pill and the reluctance of most medical professionals to prescribe it for
contraceptive purposes prior to the mid 1970s, when it was still illegal to advertise
or publicly display any contraceptive methods. A law prohibiting both abortion
and contraception had been established in 1941 and remained valid, with only
minor alterations, until 1978 (Ortiz-Gómez and Ignaciuk 2013).
In this chapter we focus on ideas held and practices carried out regarding
the pill by male and female doctors, women users and campaigners, and on the
ways the new drug acted upon and problematised established doctor-patient
relationships. We address these questions through the analysis of medical
publications (medical journals and textbooks), women’s magazines and interviews
with family planning activists. We examine the contexts within which information
on the pill circulated, thereby revealing the roles played by doctors and health
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Gendered Drugs and Medicine
134
activists in these processes, and pay attention, not only to gender models and
hierarchies contained within medical discourses on hormonal drugs, but also to
ideas about femininity, maternity, fertility, women’s health and social expectations
of and for women. With this chapter, we complete our study of the circulation of
knowledgeonhormonaldrugsandoralcontraceptivesinscienticpublications
(Rodríguez-Ocaña, Ignaciuk and Ortiz-Gómez 2012) and in the daily press during
the Francoist regime (Ortiz-Gómez and Ignaciuk 2013).
Doctors and Anovulatory Drugs in Spain (1940s–1970s)
In Spain, as in other European countries, hormonal products became used extensively
following the ‘boom’ in research on sex hormones and sex hormonal drugs that
took place in Europe and the US during the 1920s (Oudshoorn 1994, 82–111;
Gaudillière 2005). Through the 1940s and 1950s, information about new
discoveriesintheeldkeptpacewithdevelopmentsinmajorEuropeancountries,
with local medical journals regularly reprinting articles on hormonal therapies
published in the French, German, Italian, British and American press. Spanish
authors also contributed to this knowledge with their own published research.
Most authors were well aware of the contraceptive potential of the new synthetic
hormonal drugs for women. However, as we have already suggested, given the
legal and social Spanish context of the time, this crucial action was downplayed in
favour of their therapeutic effect on some endocrinal and gynaecological diseases
(Rodríguez-Ocaña, Ignaciuk and Ortiz-Gómez 2012).
The circulation of knowledge about newly introduced anovulatory drugs
among Spanish medical professionals in the 1960s followed a similar pattern.
When Schering launched Anovial 21 onto the Spanish market in 1964, medical
journals, especially those specialising in gynaecology and obstetrics, regularly
published commercial advertisements for this and similar drugs, and the Spanish
medical community began to debate whether these new pharmaceuticals should
be called and considered anovulatories or contraceptives. ‘Anovulatories’ or
‘anti-ovulatories’ were the names commonly given to these drugs in medical
publications, especially in the 1960s and early 1970s. At the end of the 1960s,
there was still no consensus on whether ‘anovulatory drug’ was an exact synonym
for‘contraceptivepill’,mainlyduetothestronginuenceoftheCatholicChurch
anditsoppositiontocontraception,anoppositionechoedbytheSpanishscientic
community. Towards the mid 1970s, however, and for some years before and after
Franco’sdeath,publicpositionswithinthemedicalcommunitydiversied:many
began to see contraception as a basic human and women’s right.
Spanish Gynaecologists, Femininity and the Pill
Research in women’s history has demonstrated how, in industrial societies,
women’sbodieshavebeenconguredassitesofpoliticalinterestandintervention.
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Doctors, Women and the Circulation of Knowledge of Oral Contraceptives 135
National states under both democratic and non-democratic regimes have considered
women responsible for physically and symbolically reproducing productive
citizens and the nation itself. Legal methods of regulating reproduction, abortion
and contraception have therefore been implemented (Mayer 1999; Usborne 1992;
Bock and Thane 1996). Doctors and medical systems have contributed to these
policies and ideas, not only by supporting or complying with them, but by
developing new discourses and knowledge about women’s health. Although these
discourses have changed over the nineteenth and twentieth centuries, they have
essentially congregated along two lines: the tendency of the (middle class) female
body to be sick, and motherhood as the female biological identity (Jagoe, Blanco
and de Salamanca 1998; Ortiz-Gómez 1993; Sánchez 2002; Mitchell 2004).
During the twentieth century, Spanish gynaecologists, like their counterparts
in other countries, came to be considered the most authoritative experts for
deningtheconceptof‘woman’, notonlyinmedicalterms,butalsoinrelation
to their social roles or position within the family (de Miguel and Domínguez-
Alcón 1979, 9; Ortiz-Gómez 1993; Sánchez 1999). After 1939, in compliance
with the ideological and political atmosphere of the time, many gynaecologists,
denedwomanin termsofherpotentialmaternity,apotentialunderstoodto be
her vital mission (Dexeus Font 1970, 121 quoted in de Miguel and Domínguez-
Alcón 1979; Botella Llusiá 1966a and other works). As well as academic
publications, a number of noteworthy Spanish gynaecologists also published
texts targeted at the general public, in which they preached about women and
their roles in marriage, family and society. These included discussions about
contraception, and always followed the ofcial guidelines of the Catholic
Church (Clavero Núñez, several editions since the 1940s, 14th edition: 1968;
Botella Llusiá 1966b; 1970; 1973; 1975a; 1975b; 1977). Professor José Botella
Llusiá, one of the most prolic of these authors and an avowed Catholic,
warned of the devastating effect that women’s participation in paid employment
could have on the family, perhaps even on the entire human species (Botella
Llusiá1966b,22;1970,16–17).Armbelieverinthetraditionaldivisionofroles,
he anticipated serious psychological problems for any woman who rejected the
established gender order and wished to participate, like men, in the world beyond
the household (Botella Llusiá 1975a, 26–8; 1970, 42–5). Regarding the education
of women, he declared that:
[she should receive] education the aim of which is not to make her a good
citizen, but rather, a good wife and mother of a family, and in case she stays
single, a person useful to others. (Botella Llusiá 1970, 30)
Sexuality was considered to be so closely related to procreation that Botella
believed a childless woman could suffer from ‘reproductive anxiety’, the internal
conict being the inevitable result of denying her biological destiny (Botella
Llusiá 1970, 45; 1975b, 102–18). He was very careful, however, not to discuss
these theories explicitly in his work targeted at the medical community where,
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Gendered Drugs and Medicine
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inanattemptofscienticobjectivity,BotellaLlusiáinsistedanovulatorydrugs
were safe and their side effects transitory (Rodríguez-Ocaña, Ignaciuk and Ortiz-
Gómez 2012).
These texts were being produced at a time when oral contraceptives were
already available on the Spanish market. In Spain, as worldwide, the introduction
of hormonal drugs presented doctors with both a challenge and an opportunity.
In the broader context of the increasing medicalisation of female reproductive
health, these medicaments provided gynaecologists with a subtle, effective and
relatively harmless tool, with which they could ‘normalise’ women’s physiology
(Marks 2001, 133). Anovulatory drugs could be used to treat infertility and
other gynaecological problems and to prevent conception, enabling doctors to
reinforce their status and increase the social and moral control they could exert
over women and their families. Some doctors advocated that oral contraceptives
should only be prescribed to married women (Silies 2010, 89). Others employed
anovulatory drugs only as therapeutic pharmaceuticals, particularly for a variety of
menstruation-related ‘problems’ such as irregular or painful menstruation or pre-
menstrualdiscomfort.Thisusewasjustiedbythehistoricalmedicalperceptionof
the female body (especially that of a middle-class woman), whether menstruating
or at other stages of the menstrual cycle, as something pathological which requires
regulation and normalising. In absence of such ‘symptoms of illness’ they would
refuse to prescribe the pill, as in our story from the daily Abc. Even when prescribed
for a therapeutic purpose, gynaecologists did not necessarily inform their patients
about the contraceptive ‘side-effect’. In the 1960s, as in the US and the UK, most
medical professionals found it difcult to accept the purely contraceptive use
of these pharmaceuticals, as contraception was not generally considered a part
of medical competence. At the beginning of the 1960s, many Spanish doctors
rejected the use of any contraceptive method. A small poll conducted in Barcelona
in 1963 revealed that 24.9 per cent of doctors interviewed were not willing to
accept birth control in any case, 64 per cent considered it unnecessary to provide
patients with more information on contraceptive methods, and 81.1 per cent
declaredthattheirreligiousbeliefsinuencedtheirmedicalpracticeconsiderably
(del Campo 1968, 231–8). In medical journals published in Spain between 1965
and 1979, contraception in general was not an issue of great interest, appearing
mainly in the context of a technical and moral discussion about the pill (Rodríguez
Ocaña, Ignaciuk and Ortiz-Gómez 2012).
Towards the late 1960s, the pill as a prescription-only birth control method
used under constant medical supervision, had helped to convince most British,
American and German doctors that family planning was a legitimate medical
activity (Marks 2001, 116–17; Watkins 1998, 34; Brockmann 2009, 104).
However, Spanish doctors’ acceptance of the contraceptive use of anovulatory
drugs, and of birth control in general, took far longer. Open opposition was a
regular feature of medical journals in the late 1960s, at a time when the General
Council of the Spanish Medical Association pronounced itself against any measure
of birth control (Abc Madrid 1967). The arguments put forward against using
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Doctors, Women and the Circulation of Knowledge of Oral Contraceptives 137
anovulatory drugs to control fertility in these professional medical journals, were
similar to those expressed by doctors and moralists who opposed the pill in other
countries: these drugs were unnatural, and harmful both to the female body, and
the sexual act (de Soroa Pineda 1967; Nasio 1967). Some authors emphasised the
negative‘physiological’inuenceofthesedrugsonthefemalebody(Nasio1967)
while others employed ‘psychological’ arguments about ‘defeminisation’,
ovulation being considered the basis of female identity (Horno Liria 1972; Polaino
Lorente 1972). As a solution to these problems, those authors who accepted the
practice of some kind of birth control recommended ‘natural’ contraceptive
methods based on observation of the menstrual cycle (Horno Liria 1972; Polaino
Lorente 1972).
In all countries, the introduction of anovulatory drugs obliged Catholic doctors
to take a clear moral or ideological stand (Watkins 1998, 46). However, it must
be remembered that the Catholic hierarchy and community, especially prior to
the 1968 publication of the Encyclical Humanae Vitae, was not unanimous on
the subject of contraceptive use (Felitti 2007). Before the publication of the
Encyclical, which considered the pill and all contraceptive methods except
those based on cycle observation illegitimate for Catholic married couples, a
number of Spanish doctors took part in a moral discussion about possible cases
in which the use of these drugs was appropriate (Abad Martínez 1964). They
made a sharp distinction between acceptable ‘indirect sterilisation’ caused by
the drug when the main purpose was not contraception, and unacceptable ‘direct
sterilisation’, when contraception was the objective. Some cases, however, such
as requests to guarantee adequate, ‘natural’ spacing between births, remained
contentious. A number of authors, including both avowed Catholics (de Soroa
Pineda 1967; Jiménez Vargas and López García 1973) and those who did not
declare their ideological standpoint (Marqués Girault 1962) were opposed to any
use of anovulatory drugs for contraceptive purposes. Others, wishing to appeal
tointernationalmoralists,haddifcultiesinoptingclearlyfororagainstthepill
(Abad Martínez 1964). At the same time, liberal gynaecologists, such as José
María Dexeus, questioned the necessity for doctors to state their religious positions
in publications on the medical aspects of anovulatories (Dr. Doctor. Información
Profesional y Administrativa 1967, 55). After 1968, some doctors and moralists
publically opposed the Encyclical Humanae Vitae (mentioned by Sánchez
Carazo 1998, 478) and the idea of doctors imposing their own religious beliefs
on patients (Carrera 1970; Cónill Serra 1974). However, extremely conservative
positions identifying all contraceptive methods with abortion remained visible,
particularly among doctors from the Catholic Opus Dei University of Navarra.
For the female paediatrician and Opus Dei member, Ana María Álvarez Silván, the
Encyclical Humanae Vitae was a valid reference, enabling both the interpretation
of the concept of ‘responsible parenthood’ within the spirit of Catholicism, and the
formulation of ethical arguments against the pill (Álvarez Silván 1971).
Doctor Álvarez Silván’s discourse is a rare example of a female doctor’s
opinion on oral contraceptives and birth control, at a time when most Spanish
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Gendered Drugs and Medicine
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doctors and gynaecologists were male. In 1960, female doctors constituted
only1.5per centofallSpanishdoctors,agure thathadrisento10.1per cent
by 1975 (Ortiz-Gómez et. al. 2001, 128). A number of these belonged to the
Spanish Medical Women’s Association, which edited the journal Actividades de
la Asociación Española de Mujeres Médicos (henceforth Actividades AEMM)
from 1965 to 1971 (Ortiz-Gómez 2005, 89). Even though the association only
managed to attract a small number of women doctors, most of whom were well
established practitioners, its journal is a valuable source of medical women’s
opinions on the pill in the late 1960s and early 1970s, absent as they were from
mainstream Spanish medical journals.1
In 1968, Actividades AEMM published extracts of conference papers presented
by two Spanish representatives at the XI Congress of Medical Women’s International
Association, held in Vienna. Paediatrician, Lola Vilar, the association’s founder
and president, tackled the topic of the pill in relation to the leading congress issue:
world famine. She acknowledged the great potential of the pill, which could be
‘a redemption to the sexual slavery of women’ (Vilar 1968, 53) and enable women
to enjoy the same rights and opportunities as men. However, turning to Botella
Llusiá’s concept of ‘reproductive anxiety’, Vilar supported the claim that women
undertaking professional careers and using contraception would result in disaster.
Attherstandonlynationalcongressoftheassociationin1971,contraception
and family planning was a key topic. Participants spoke openly about contraceptive
methods,despitethepresenceofpoliticalauthorities,suchastheheadofcerof
the National Public Health department (Director General de Sanidad, J. García
Orcoyen, professor of gynaecology at the University of Madrid) and the president
of the Women’s Section of the National Movement (Sección Femenina de
Falange, Pilar Primo de Rivera). A speech on the contraceptive pill given by
Professor Botella Llusiá was later summarised and commented on in professional
medical newspapers (Tribuna Médica and Gaceta Médica Española) and the
women’s magazine, Ama. Discussions took place about issues featured in medical
journals and the daily press, such as the side effects of oral contraceptives
(Álvarez Simó 1971; Álvarez Silván 1971; Gomis 1971), providing new, or at
least uncommon, insights to the topic of the pill from women’s perspectives.
Although often referring to the Catholic Church’s doctrine on family planning,
these texts also echoed the arguments against the pill formulated by the feminist
health movement in other countries. They criticised the commercial benets
pharmaceutical companies received from the pill (Álvarez Silván 1971, 33–4) and
the coercive family planning programmes initiated in many developing countries
1 Through our search in the Índice Médico Español database (which contains articles
published in Spanish medical journals after 1964) the only article authored by a woman
between 1964 and 1979 was by Christine Imle (1970), ‘Motivaciones contra el Uso de los
Anovulatorios’, Folia Clínica Internacional 20, 251–71 and 318–32, publication derived
from her PhD thesis, in which she discusses contraceptive preferences of female patients at
the University Gynaecological Clinic in Wurzburg with special focus on the pill.
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Doctors, Women and the Circulation of Knowledge of Oral Contraceptives 139
(Meiggs 1971, 23). They also warned pill users against becoming mere sexual
objects for their husbands (Álvarez Silván 1971, 33).
Prescribing the Pill: Ideal Women End Users
As with other medical drugs, prescription of the pill was at the doctor’s discretion.
To justify prescription, doctors could take both medical and social indications into
consideration. In the 1960s and early 1970s there was a debate within medical
literature on ‘legitimate’ indications for the prescription of anovulatory drugs.
Opinions within this debate were heavily dependent on whether the author believed
products such as Anovial 21 should be used as ‘anovulatory’ or ‘contraceptive’
drugs (Rodríguez-Ocaña, Ignaciuk and Ortiz-Gómez 2012). Having reviewed
medical articles and books published in Spain between 1965 and 1979, we have
found that indications felt to justify the prescription of these drugs fell into three
categories: those relating to the female reproductive system; those relating to
general health; and those taking social or personal motivations into account.
Most doctors approved the use of anovulatory drugs to treat irregularities
of the menstrual cycle and other problems relating to the female reproductive
system, such as ‘menstrual alterations, endometriosis, [or] dysmenorrhea’
(Caballero Gordo 1970, 341). The general health indicator implied a recognition
of the contraceptive effect, as the drugs were often employed to prevent
pregnancy ‘after delivery, during breastfeeding or periodic irregularities when
there is a high risk of pregnancy’ (Novo 1969, 49) in women for whom a pre-
existing illness or condition, such as varicose veins or heart disease (Morales
Rodriguez and Trujillo Ramirez 1979) could be aggravated by a new pregnancy.
Thesetwoindicatorgroups,therstinparticular,couldbeacceptedbydoctors
who, following the ofcial position of the Catholic Church hierarchy on oral
contraceptives, only approved of their employment if the main goal was not to
impede conception or, in other words, if they produced ‘indirect sterilisation’
(Abad Martínez 1964). As for ‘general health’, in some gynaecological circles
it was a wide enough concept to always justify prescription of hormonal
contraceptives,suchasattheoutpatientfamilyplanningclinicscreatedintherst
half of the 1970s in some public hospitals, in cities such as Bilbao (Usandizaga
and López Valverde 1978), Barcelona (Cónill Serra 1974; González Merlo 1979),
Madrid (Fernández Penela 2010), Santa Cruz de Tenerife (Morales Rodriguez
and Trujillo Ramirez 1979), Granada (Salvatierra, et. al. 1978; Jiménez 2010)
or Seville (de los Reyes 2009). As the gynaecologists at these clinics would
admit after the legalisation of contraception, they included the third indication,
the social and personal situation of the patient, within the general health label
and therefore prescribed the pill to any healthy woman who requested it. These
practices appear to have been at least partially clandestine before 1975, as so
far we have only found one article openly recommending oral contraceptives
for social reasons. This article, published in 1974 in a medical journal based in
Seville, was by Enrique Solano Berral, a public health paediatrician who defended
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pill prescription to young women, single women and those with many children
and little spacing between them, and to those facing economic difculties or
whose husbands had abandoned them (Solano Berral 1974, 741).
Gynaecologists were well aware of women’s interest in the pill, with patients
openly requesting information on oral contraceptives. In a 1958–1959 academic
course inaugural speech before the members of the Spanish Gynecological Society,
Professor Botella Llusiá ofcially introduced the ovulation-inhibiting potential
of gestagens to Spanish scholars. Using a metaphor of a ‘contraceptive bomb’,
Botella claimed the pill potentially as dangerous to the human race as the atomic
bomb, but also referred to the its therapeutic properties, especially in treating
infertility. He concluded the speech by recommending doctors inform themselves
well about anovulatory drugs, as they would no doubt be facing ‘female patients’
questions’ on the matter (Botella Llusiá 1959, 11; Rodríguez-Ocaña, Ignaciuk and
Ortiz-Gómez 2012). This argument, extended to contraception in general, was
also used by Professor Vicente Salvatierra in the 1973 edition of his textbook for
medical students in Granada. In a chapter dedicated to ‘Sexual problems and birth
control,’ he claimed that:
Knowledge about [contraceptive methods] is useful, because in this course
[gynaecology] we study the facts. The fact is that part of the population uses
different methods, although there is a law which prohibits talking about them.
So it is absurd for a doctor not to know them, and what to do in case of having
to deal with their side effects. (Salvatierra 1973, 307)
Many doctors, regardless of their ethical stance, reported being asked by their
patients about the pill. Gynaecologist, José Carrera, in a chapter on contraception
in the 1970 gynaecology textbook edited by Santiago Dexeus Font, declared that
doctors were obliged to provide information about contraception whenever there
was demand, regardless of their personal opinion on the issue. The same idea had
been expressed by Doctor A. Novo the previous year:
The therapeutic aspect [on ovulation inhibitors] is beyond any doubt; however,
the harsh problem still remains: which is its contraceptive use. We would like
to escape from it, but we cannot avoid the fact that women ask for our advice,
understanding, indulgence or complicity. Moral problems are individual, but we
needtohavesomegeneral,butexiblenormsthatcanbeadoptedineverycase.
(Novo 1969, 49)
On the other hand, the religious or conservative argument was that such demands
should be resisted and rejected by physicians, as in advice given to Opus Dei (an
ultra-conservative catholic organisation founded in Spain in 1928) gynaecologists
and GPs:
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Doctors, Women and the Circulation of Knowledge of Oral Contraceptives 141
For some years now, all doctors face the problem of contraceptives daily. They
[women] blatantly ask for prescriptions as if it was something they had the right
to claim. At times, they ask indirectly, with some kind of excuse or pretence.
He [the doctor] has to know how to say no. (Jiménez Vargas and López García
1973, 503)
Ratherthanmerelyrhetoricaljusticationfordoctorstolegitimiseandprovide
contraceptive drugs, the fact that doctors from all ideological points of view
reported patients’ demand for oral contraceptives can be considered proof this
demand existed. It also indicates a shift in the doctor-female patient relationship.
The fact that women were explicitly requesting a particular drug from their doctors
is unusual in the history of the patient-doctor relationship (Watkins 1998, 39, 50;
Marks 2001, 123). As Elizabeth Watkins has pointed out, the pill not only empowered
doctors, it also empowered women as patients (Watkins 1998, 52). In Spain, during
the 1960s and early 1970s, circulation of the pill helped reinforce the doctor’s
technical and gender power position, within an openly asymmetrical doctor-
women relationship. Women, as users of the pill and other contraceptive methods,
began to challenge this relationship from the mid 1970s onwards. During the
Spanish transition to democracy, social and political changes initiated new spaces
and new working styles, including family planning clinics run by gynaecologists
within the state health system and private feminist family planning centres. At the
same time as these new situations eased encounters between doctors and women
seeking oral contraceptives, other contraceptive methods were starting to become
part of gynaecological and general practice.
Women and the Pill
Access to Oral Contraceptives and Their Users
Inspiteof legal and ideologicaldifculties,the pill was availableandused by
Spanish women almost 15 years before its decriminalisation. Although use of
the pill in Spain was considerably lower than in other European countries such
as Britain, Germany or France, between 1964 and 1978 there was a steady rise
in the sale of oral contraceptives (Ortiz-Gómez and Ignaciuk 2013). As in other
European countries, the main channel through which the pill circulated among
Spanish women was likely to have been medical prescriptions by gynaecologists
and GPs (Marks 2001, 122; Silies 2010, 197). As we have discussed, prescription
of oral contraception was legal where there were therapeutic indications. There
probably also existed a degree of illegal circulation, and some women, especially
unmarried ones, would certainly obtain the pill from friends who had travelled
abroad (de Miguel and Domínguez-Alcón 1979, 143; Hernández 2010). Eva-
Marie Silies has conrmed illegal circulation of oral contraceptives in West
Germany, despite a lack of legal obstacles to the prescription or sale of these drugs.
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This was instead the result of the relatively high price of the pill and, during its early
days,difculties someunmarriedwomenfoundwhen attemptingtogainaccess
to prescriptions (Silies 2010, 89–90). As already discussed, after the mid 1970s
in Spain, women could obtain contraceptives through the family planning clinics
run by feminist activists and political parties. These received occasional support
from the International Planned Parenthood Federation (Europe Region) and other
foreign family planning groups, who provided sample boxes of oral contraceptives
and other birth control methods, such as diaphragms, spermicides, condoms,
cervical caps and IUDs (Jones 2010).
There is no data available for the period under study on exactly who pill users
in Spain were. We suspect that, as in the West German case (Silies 2010, 113)
young, urban, educated and probably also married women had easier access to
oralcontraceptives,havingmoreopportunitiestondadoctorwillingtoprescribe
them (Jones and Toss 1987, 40). According to the sociologist, Amando de Miguel,
these women could not only access prescriptions more easily, but also arrange an
abortion abroad in cases of contraceptive failure. By contrast, lower class women
were forced to use ‘more primitive’ and less secure methods (de Miguel 1973, 43).
Literacy was also a key issue: information on the pill was circulated in the daily
press and women’s magazines but, in the 1960s especially, many rural women
were illiterate and had no access to printed information. However, according
to interviews we have conducted with feminist family activists and women
doctorsinvolvedintherstfamilyplanningclinics,womenfromworking-class
neighbourhoods of large Spanish cities began to seek information on contraceptive
methods and family planning services more actively during the second half of
the 1970s (Jaime 2009; Galindo 2010).
Discourses on the Pill in Women’s and Feminist Publications
Despitethedifcultiesdiscussedabove,wecanassumethat,ingeneral,women
were aware of the existence of the pill. In Germany, where contraception was legal
without restriction in 1965, four years after the introduction of Anovlar, 80 per
cent of women knew of its existence. By the following year, almost all German
women and men had some knowledge about oral contraceptives (Silies 2010, 94).
In Spain, opinion polls conducted in the years 1970 and 1972 found the pill to be
the best known contraceptive method among Spanish women and young people
(Díez Nicolás 1973; Sánchez Carazo 1998, 251). In spite of its legal prohibition,
and the apparent reluctance of many gynaecologists to share their knowledge
with patients, there was a denite circulation of information about the pill
among Spanish women, which potentially constituted the site of a clash between
state-proposed models of femininity and women’s individual interests in
controlling their own fertility.
As has been suggested for other countries, Spanish women learnt about the pill
from friends and trusted doctors, as well as from the mass media, (Sieg 1996, 139;
Silies 2010, 99; Watkins 1998, 50). In the 1970s especially, there was considerable
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Doctors, Women and the Circulation of Knowledge of Oral Contraceptives 143
coverage in daily newspapers such as Abc and La Vanguardia, focusing mainly on
the side effects of the drugs (Ortiz-Gómez and Ignaciuk 2013). Nevertheless, the
information published was rather scattered and inconclusive, and Spanish doctors,
like their German counterparts (Silies 2010, 208), often complained in professional
journals about the low quality of information published in the daily press, and
the fact that many news articles were overly sensational and unbalanced. During
the 1960s and up until the mid 1970s, the last period of dictatorship, women’s
magazines played an important role in promoting the regime-supported ideal of
femininity to Spanish women. The 1960s are considered a decade of successful
development for these kinds of magazine, such as Ama or the Opus Dei-managed
Telva (Sánchez Hernández 2009, 221). Following Franco’s death in 1975, a
new kind of women’s magazine began to be published, such as Dunia which,
although being a mainstream magazine, included frequent feminist approaches
and proposals. The rst exclusively feminist magazines were also founded at
this time, the longest-published being Vindicación Feminista, established by the
feminist activist and lawyer, Lidia Falcón, and printed in Barcelona between 1976
and 1979 (Larumbe 2009).
On the pages of the regime-oriented magazine Ama, the subtitle of which
was ‘a magazine for Spanish housewives’, the pill became an explicit issue
around 1968, with expectations and comments about the publication of the
Encyclical Humanae Vitae (Ama. Revista de las Amas de Casa Españolas
[henceforth Ama]1968,24–6).Therstopinionsaboutoralcontraceptiveshad
been published two years earlier, in the regular agony column, with answers and
comments by a member of Ama’s editorial board, Carmen del Cid. Both the letters’
authors and the journalist responsible for replying were opposed to the pill and
all other forms of contraception, which were presented as immoral tools used to
preventthelargefamiliesgloriedbyAma (del Cid 1966a, 159; del Cid 1966b, 163;
del Cid 1966c, 163). Even though the few publications on oral contraceptives
published in this magazine before 1970 were highly critical of any contraceptive
method, the presence of the pill in the section of readers’ letters indicates social
awareness of the existence of the drug and its contraceptive properties.
In 1970, Ama asked its young male and female readers to send the editors
their opinions on various issues, such as love, friendship, freedom, divorce,
homosexuality, God, and the role of priests. One of these issues was ‘contraceptive
procedures’. Opinions were published in several later issues of the magazine,
and over half of those quoted were, surprisingly, in favour of contraceptives,
with comments such as ‘the best method to avoid [having] children, not a crime’
(Ama 1970a, 38–9), or ‘necessary’ (Ama 1970b, 86–7) and something that ‘should
be authorised as they help to solve many poor families’ problems’ (Ama 1970c, 93).
In the second half of the 1970s, during the democratic transition, Ama became more
explicitly involved in the social debate around the legalisation of contraceptives.
In 1977 it published the opinion of the president of the Spanish Women Lawyers’
Association (Asociación Española de Mujeres Juristas), María Telo, on abortion
and contraception. Telo considered the legalisation of contraception and the
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provision of family planning services by the state necessary to reduce the number
of insecure clandestine abortions performed in Spain (Telo Núñez 1977). The
magazine stated clearly that this was a personal opinion not shared by the editorial
board. However, the fact that it was printed culminated this transition of the
discourse on contraception and the pill in Ama. In 1978, the magazine reported the
imminent legalisation of contraception (Calderón 1978) and printed an article on
contraception in which a doctor endorsed the pill as a safe contraceptive method if
used under medical supervision (Monedero 1978).
During the democratic transition, women’s magazines such as Dunia and the
feminist newspaper Vindicación Feminista discussed the pill to varying degrees.
However, contrary to medical journals, where the pill was clearly the protagonist,
in these magazines the oral contraceptive issue was raised within a broader context
oftheongoingghtforwomen’srights,thelegalisationofabortionanddiscussions
surrounding new models of female sexuality.
Launched in 1976, shortly after Franco’s death, Dunia was subtitled ‘an
intelligentmagazineforawoman’.Beforetheirofcialdecriminalisation,Dunia
published several articles and reports on contraceptive methods and the history,
use and effects of the pill (Dunia. Revista Inteligente para la Mujer [henceforth
Dunia] 1978a; 1978b; 1978c; 1978d; 1978e; 1978f). All of the mentioned articles
plus others published in 1979, assigned sections of the magazine to medicine and
health, in which oral contraceptives were discussed in a pragmatic way, with the
side effects mentioned but not exaggerated. Doctors, especially gynaecologists,
were quoted and portrayed as the main experts on the subject. The pill was
depicted as a well-known and well-used drug, and the publications aimed to
correct mistaken beliefs and stereotypes related to it, instead of advocating for the
legalisation and increased availability of oral contraceptives. It could be assumed
that the use of contraceptive drugs was so extensive, that the magazine preferred
to focus on more urgent issues and claim reforms on abortion or family law
(Dunia 1977, 76–7) rather than debate the legal status of contraceptives.
While in the general press and women’s magazines the role of doctors
remained indisputable, the longest published feminist magazine during the Spanish
democratic transition, Vindicación Feminista, provided during three intense years
(1976–1979) an alternative source of information produced by women and for
women (Larumbe 2009).
Vindicación Feminista dedicated little space to oral contraceptives as an
autonomous topic. As in Dunia, the feminist battle to legalise abortion seems to
have been far more important to editors and contributors than the decriminalisation
of contraceptives. Similarly to Dunia, oral contraceptives were discussed in
Vindicación Feminista, only in the broader context of family planning in Spain.
Journalist, Soledad Balaguer, in a report published in 1977, argued that the pill was
used extensively in Spain despite negative media coverage of its side effects. She
also emphasised that women were more likely to obtain prescriptions for the pill in
private surgeries, where doctors were less opposed to the idea than those employed
in the state health service (Balaguer 1977, 41). Women, especially unmarried
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ones, would visit pill-prescribing doctors whose names they had obtained through
informal networks (Hernández, 2010). These doctors’ motivations to prescribe the
pill probably combined a commercial orientation with a practice less subject to
external control and personal convictions in favour of women’s and couples’ right
to family planning.
The idea that contraceptives, including the pill, could enable women to take
control of their reproduction was described in the same issue of Vindicación
Feminista, a concept championed by Spanish family planning activists
(Jaime 2009), and raised in other countries, such as Germany (Sichtermann 1996;
about pill rejection in Germany see Ulrike Thoms in this volume). The magazine
also pointed out that women’s choice of contraception was limited to the pill, due
to the unavailability of other contraceptives in Spain, even if counter indications or
side effects meant it was not the most suitable method (Oranich 1977, 45).
Other Vindicación Feminista articles published in 1977 focused on class and
geographical inequalities in access to contraception in general, and for the pill in
particular, with rural working class women reportedly being under the greatest
inuence of the Catholic Church, further complicating their access (Fagoaga,
Vigil and Saavedra 1977, 36; Begoña 1977, 66). While in Spain the main axes
that differentiated women’s access to prescription of the pill were class and
urban or rural residence, in West German feminist discourse on the issue of class
inequalities in access to oral contraceptives, the focus was the high price of the
pill and the benets this generated for Schering AG and other pharmaceutical
companies (Silies 2010, 385–9). In Spain during the second half of the 1970s,
however, pharmaceutical companies often collaborated with young doctors in the
early family planning clinics, sponsoring their participation in family planning
meetings and conferences (Jiménez 2010; Villatoro 2010; Jaime 2009) and even
providing oral contraceptive samples. While their goal was indisputably to increase
the sales and circulation of their products, pharmaceutical companies played an
important role in the proliferation of oral contraceptive knowledge throughout
Spain (Sánchez Carazo 1998, 479–80).
In 1978, Leonor Taboada, an Argentinean feminist health activist who had
resided in Spain since the mid 1970s, published a self-help health manual for women
(Taboada 1978a), ideologically close to the American Our Bodies, Ourselves
and the West German Hexengeüster. In this book, and an article in Vindicación
Feminista, Taboada echoed the feminist critiques of the pill that originated in
the women’s health movements of other countries. Both US feminists such as
Barbara Seaman and German groups such as Brot und Rosen focused on the pill’s
side effects and criticised doctors for not providing enough information on
the potential risks and counter indications for women taking these drugs
(Seaman 1995 [1969]; Silies 2010, 385–9). In Vindicación Feminista, Leonor
Taboada condemned the fact that ‘women are made to swallow contraceptives
with dangerous side effects’, citing this as one of numerous demonstrations of the
excessive medicalisation of the female body (Taboada 1978b, 38).
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During the second half of the 1970s there was a considerable increase in the
number of female students entering medicine and gynaecology in Spain. Some
ofthese wouldlater becomeinvolved inthe neweld offamily planningand
collaborate in the already mentioned outpatient clinics in some hospitals (de los
Reyes 2009; Villatoro 2010; Jiménez 2010), or in the feminist family planning
movement. The feminist family planning clinics were sites where doctors
collaborated with health activists, formulating new ideas about the doctor-patient
relationship which echoed those of the international women’s health movement.
They called for better communication between doctors and patients in a dynamic
based on equality, in which women were considered not sick and passive patients
but active participants, executing their newly recognised right to information
about contraception and sexuality (Arnedo 1978; Ortiz-Gómez, et. al. 2011).
(Arnedo 1978; Ortiz-Gómez, et al. 2011). They also provided comprehensive
information and advice on a variety of contraceptive methods, including the pill.
This attitude became a model for medical practice in all Spanish family planning
clinics developed in the 1980s, as well as the new primary health care model that
was beginning to be implemented (Fajardo 2007).
Conclusions
During the 1960s and 1970s, Spanish doctors and their female patients shared a
substantial interest in oral contraceptives. Their motivations, however, were quite
different. While doctors focused on technical aspects of the pill, such as physiological
mechanisms, therapeutic indications and side effects, women approached it as the
most readily available method of avoiding an unwanted pregnancy.
The prohibition of the sale, advertisement and public exposition of contraceptive
methods in Spain that lasted until 1978, accompanied by pro-natalist policies and
the strong support of the Catholic Church, did not entirely prevent the circulation
of knowledge about the pill among experts and the public. Discussions in the
pagesof medical journals reect a broad range of positions regarding the pill,
from complete opposition, through limited acceptance, to total approval. Although
legal, social, political and religious factors contributed to the privileged position of
conservative discourses, the political change triggered by the democratic transition
following Franco’s death in 1975, together with the increased presence of women
within medicine and gynaecology, and the establishment and expansion of family
planning clinics, all contributed to making favourable opinions of the pill visible.
The introduction and prescription of anovulatory and contraceptive drugs was
probably a source of internal conict for many Spanish practitioners who, in
order to decide whether and to whom to prescribe the pill, had to balance their
religious beliefs and personal convictions, and the legal prohibition of providing
oral contraceptives, against increasing patient demand.
Before the mid 1970s, women’s access to the pill in Spain was considerably
moredifcultthaninmanyothercountries,butnotimpossible.Whilefewwomen
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would be as determined to obtain a prescription as the patient of doctor Pelegrí
Barberán described at the beginning of this chapter, their demand for the drug was
an example of their increasing empowerment within society, and a doctor-patient
relationship which was beginning to be challenged.
Access to the pill and to information about it initially varied considerably
between urban and rural women. Married, urban, young and educated women
certainly had much easier access to the pill in the late 1960s, but in the following
decade, especially after Franco’s death, knowledge of contraceptives in general,
and the pill in particular, circulated freely among rural and working class women.
As well as receiving information directly from sympathetic doctors, women could
learn about the pill from the popular press and, in the 1970s, from family planning
services. While knowledge of the pill circulated in a similar way as it did in the
US and in other European countries, a particularity of the Spanish situation was
the lack of a strong feminist opposition to the pill and the pharmaceutical industry.
Despite feminists criticising doctors’ control of access to oral contraceptives,
they did not elaborate as harsh a critique of the medical profession as their
late 1960s American and German counterparts. This lack of explicit criticism
of pharmaceutical companies, which was viewed as crucial by US and German
feminists, only appeared in the discourse of Catholic women doctors, to a limited
extent, in the early 1970s.
Funding and Acknowledgements
This work is a result of two research projects: La constitución de la planicación
familiar en España durante los últimos años de franquismo y en la transición
democratica (Spanish Ministry of Science, ref. HAR2008-05809-HIST) and
ASYS (Spanish Ministry of Economy, HAR2012-39644-C02-00). We are grateful
to the participants in the workshop Gendered Drug Standards, held in Granada in
November 2011, for their comments and suggestions and to Dennis Hubbard for
copyediting early versions of this paper. (1971)
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Gendered Drugs book.indb 152 3/28/2014 10:07:25 AM
... En Espagne, la spécialité de gynécologie existe, mais elle regroupe l'obstétrique, la chirurgie, et les aspects médicaux et hormonaux. Plusieurs travaux suggèrent que cette spécialité a joué un rôle important dans la diffusion des connaissances en contraception, notamment sur les oestro-progestatifs, entre les années 1960à 1980, malgré l'interdiction de cette méthode par le régime franquiste (Rodríguez-Ocaña et al., 2012;Ignaciuk et al., 2014;Ignaciuk, 2015). Toutefois, cette spécialité, ainsi que la profession médicale dans son ensemble, restent pendant longtemps particulièrement peu féminisées Ignaciuk, 2014). ...
Thesis
La pilule contraceptive est aujourd'hui centrale dans les pratiques comme dans les représentations en France, au point que son recours élevé et que le moindre usage des autres méthodes fassent figure d'évidence. La thèse retrace la genèse de cette évidence, en montrant de quelle manière le recours à la pilule comme méthode principale de contraception est devenu, entre 1960 et 2000, une norme sociale et médicale. Elle s'appuie pour cela sur un large corpus d'archives, sur des entretiens avec des expert·e·s en contraception, et sur les données d'enquêtes nationales sur les pratiques contraceptives et prescriptives. Cette recherche montre que la norme contraceptive française – faisant de la pilule la méthode principale d'espacement des naissances, et du dispositif intra-utérin la principale contraception d'arrêt, lorsque les femmes ne souhaitent plus avoir d'enfant – se généralise au cours des années 1980. En parallèle de cette évolution dans les pratiques, la pilule devient centrale dans les représentations médicales et médiatiques à la fin des années 1960, jusqu'à se confondre avec la contraception dans son ensemble. Ce « pilulocentrisme » médical et médiatique s'accompagne de l'éviction des autres méthodes contraceptives. Ce travail de thèse a permis d'éclairer le rôle des expert·es en contraception dans la définition et la diffusion de cette norme. D'une vision de la contraception comme une panoplie de méthodes, ces expert·es évoluent progressivement vers l'idée que la pilule est la seule méthode efficace et sans risque, dans les limites de ses contre-indications. Les industries pharmaceutiques ont également un rôle déterminant dans la définition des catégories mobilisées par les expert·es, et dans la focalisation progressive de l'offre contraceptive sur les contraceptifs oraux. Si des tentatives de contestation de la norme contraceptive ont émergé, notamment dans le champ médical, à la fin des années 1960 et au début des années 1980, elles n'ont finalement eu que peu d'impact. Les militantes féministes des années 1970 se sont révélées être des alliées plutôt que des opposantes à cette norme, et ont érigé la pilule comme symbole des luttes pour les droits reproductifs.
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