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Paper presented at the Conference of Muslim Jurists held at Lucknow Uttar Pradesh 15-17 May 2007 by Professor Dr Omar Hasan Kasule, Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine at the Institute of Medicine Universiti Brunei Darussalam WEB: http://omarkasule.tripod.com.
ABSTRACT
Using the oral contraceptive pill as an example, this paper argues that medical technology has an impact on social structure and social behavior. Physicians are already powerful role models in society who can influence social thoughts and practices. This influence is enhanced by the way they use the increasingly powerful medical technology. Technology can be applied by physicians to produce negative or positive social change. The paper concludes that Muslim jurists must be up to date regarding the social implications of new medical technology.
Key words: medical education, social engineering, medical technology, oral contraceptive pill, sexual behavior, sex revolution
1.0INTRODUCTION
The oral contraceptive pill was cited as the most important technological innovation of the 20th century[1]. On its introduction in 1960 it soon replaced sexual repression and other less effective methods[2] to become a mass phenomenon in fertility control. Its impact has been compared to major discoveries such as discovery of fire, discovery of electricity, and discovery of atomic energy[3]. The present paper will explore the impact of the pill on social change and use it as an example to illustrate the argument that physicians have a potentially big impact on social change depending on the way they use medical technology which in turn is determined by the values imbued in their medical school curricula.
2.0 DEVELOPMENT AND IMPACT OF THE PILL
2.1 Development of the pill
There is some indicative evidence that the development of the pill was not an accident but had a background agenda. There was a strong desire among family planning agencies and the feminist movement to get an effective contraceptive that would let the woman control her sexuality. Margaret Sanger of Planned Parenthood spearheaded the campaign to produce a safe and effective contraceptive. With funding provided by Katharine Dexter McCormick, Planned Parenthood invited Dr Gregory Pincus (a biologist) to develop a safe pill, a task achieved in 1950.
Dr Gregory Pincus called the father of the pill had already generated controversy by the time he developed the pill. He had achieved in vitro fertilization in rabbits a discovery that generated so much controversy that he lost his position at Harvard University and he moved to Clark University where set up the Worcester Foundation for Experimental Biology in 1944[4]. It is noteworthy that his pioneering research set the stage for 2 sexual revolutions that will be discussed below.
2.2 The first sexual revolution: 1960s and 1970s
The US Federal Drug Administration (FDA) approved the oral contraceptive pill on 23rd June 1960. The oral contraceptive pill (OC) was the first effective contraceptive that gave women a reliable and private control of fertility[5] that could be used without any worries about pregnancy since its failure rate was low being less than 1 percent[6]. The launch of the pill triggered a sexual revolution[7] that started in earnest in the early 1960s and laid the foundation for the second sexual revolution of the 1990s that is still evolving[8]. The first sexual revolution was a drastic change in sexual behavior of the masses involving all social classes and eventually all countries of the world. This revolution has had far-reaching effects on the fabric of society, the family, disease patterns, gender roles etc.
The major change brought by the pill was to not only to allow sexual intercourse at any time, in any condition, and without any prior preparation but also to separate sexual enjoyment from reproduction[9]. The purpose of sex could become recreation only without the possibility of procreation[10]. For the first time in human history sexual enjoyment was decoupled from the social responsibility of fatherhood and motherhood among potentially fertile couples. What started as birth control among married women soon extended to unmarried leading to promiscuity. It is now extending to teenagers and sex education programs are becoming mandatory in many schools with the message being clear that children can have sex but that it has to be safe sex using a contraceptive[11]. The mass media have been very active players in the sexual revolution by encouraging sexuality among youths while at the same time condemning teenage birth or abortion[12] which leaves effective contraception as the only option.
Studies within the first 10 years of the use of the pill explored its impact on sexual behavior[13] [14]. The evidence linking the pill to the sexual revolution is circumstantial but is very convincing. It is unlikely that the sex revolution following on the heels of the introduction of the pill could have an alternative explanation. It may be true that the sex revolution was already on the way but the pill accelerated it by providing a more effective contraceptive which removed the inhibitory fear of pregnancy.
The sexual revolution based on liberation of fear of pregnancy started with the pill and was completed by two major later developments. The morning after pill and legal abortion on demand (following the US Supreme Court ruling in Roe vs Wade) ensured that even if contraception failed there were remedies. This removed any lingering fear of unwanted pregnancy that had remained even with the use of the pill.
2.2 The second sexual revolution: 1980s and 1990s
The mass use of the pill and the major changes in sexual mores soon led to a second sexual revolution that is also referred to as the neo-sexual revolution[15]. Whereas the first sexual revolution saw the separation of sexual enjoyment from reproduction, the second sexual revolution saw the separation of sex from reproduction altogether. Using technologies of assisted reproduction such as in vivo insemination and in vitro fertilization with surrogate mothers or fathers, it became possible to produce children without coitus. Such children could identify either a surrogate father or mother so some element of parenthood existed. This remaining sense of parenthood could soon be eroded by cloning. Reproductive cloning is a further development that may usher in reproduction without involvement of any gametes and will negate the traditional concept of descent from a parent. It is conceivable that the brave new world of medical technology will soon breach the reproductive barrier between humans and animals with unimaginable consequences.
2.3 The social impact of the pill
The impact of the pill was not limited to sexual freedom. Sex without reproduction soon gave way to sex outside marriage. Devaluation of the family, divorce, teenage pregnancy, fatherless families, and teenage problems such as teenage suicides[16] and drug addiction. Alongside the changes due to medical technology, the second sexual revolution has seen the elevation of homosexuality from a closet secret to social respectability with several jurisdictions legislating for same-sex marriages. The gay or lesbian couples have also had the audacity to claim parental rights by adopting children or trying to produce children using artificial means. Kindergartners in New York City were taught that gay and lesbian families are the same as heterosexual families[17]
2.4 Conclusion: Medical Technology leading to social change
This paper presents the thesis that the oral contraceptive pill is a prime example of a technology that leads to major social change and has with time led to an ideological change by affecting the way people think about marriage, reproduction, and family. I do not agree with the views of the developers of the oral contraceptive pill, Gregory Pincus and John Rock who argued that technology does not determine behavior[18]. They could have said this to avoid the guilt of having introduced a technology that in essence could be good but was applied in a wrong way with profound negative effects on society.
[1] Contents of the paper presented previously at the Paper presented at the 8th Annual Conference of the Islamic Medical Association of Malaysia held at Kota Baru on July 1-3
[3] www.fda.gov/fdac/departs/2000/400_word.html accessed June 24th 2006
[4] Segal SJ. Segal SJ. Gregory Pincus, father of the pill. Popul Today. 2000 Jul;285:3.
[5] Fraser IS. Forty years of combined oral contraception: the evolution of a revolution. Med J Aust. 2000 Nov 20;17310:541-4.
[6] www.science-spirit.org/new_detail.php?news_id=545 – accessed June 30, 2006
[7] www.science-spirit.org/new_detail.php?news_id=545– accessed June 30, 2006
[8] www.science-spirit.org/new_detail.php?news_id=545– accessed June 30, 2006
[9] www.en.wikipedia.org/wiki/Oral_contraceptive#Social_and_cultural_impact– accessed June 30, 2006
[10] www.archives.tcm.ie/thekingdom/2003/01/29/story8124.asp– accessed June 30, 2006
[11] Besharov DJ, Gardiner KN. Trends in teen sexual behavior. Child Youth Serv Rev. 1997;195-6:341-67..
[12] Money J. Sexual revolution and counter-revolution. Horm Res. 1994;41 Suppl 2:44-8.
[13] Black S, Sykes M. Promiscuity and oral contraception: the relationship examined. Soc Sci Med. 1971 Dec;56:637-43.
[15] Sigusch V. The neosexual revolution. Arch Sex Behav. 1998 Aug;274:331-59.
[17] Brown J. Contraception and abortion: the deadly connection. Family Found. 1993 Sep-Oct;202:9.