Whilst well into its twenties by the time the 1960s had swung around, the NHS was still in a nascent state of development when it came to women’s health.
Maternity wards were yet to become the norm, with mothers still giving birth in the community under the care of midwives. Family planning was outside the remit of the NHS, and advice and access to birth control was provided largely by networks of charitable clinics.
Socially, the nation was yet to liberalise attitudes towards sex and women’s rights, with family planning advice at the onset of the decade still provided solely to married women, and abortion remaining illegal until 1967.
Despite advances in emancipation made during the war years, women were still vastly underrepresented politically and in the workplace, married off young, and economically dependent on men.
The arrival of the oral contraceptive pill in 1961 proved to be a trigger for change, stimulating a new era in British attitudes towards sex.
Prior to its invention, contraception was, in the words of author Margaret Drabble, “remarkably unreliable and fairly repulsive”. Whilst newer forms of latex condoms and plastic intrauterine devices were going some way to ameliorating this, access was outside the NHS and contraception was largely confined to the middle classes and controlled by men.
The first form of oral “birth control” was licensed for use in the UK in December 1961, when Health Minister Enoch Powell announced that it would be made available on the NHS, and that it would be left to “the individual doctor to decide in each case” who should be provided with a prescription.
In practise, however, the pill was only available to married women on “therapeutic grounds”. Unmarried women, minors or women wanting birth control for social reasons were unable to access it with public funding.
The Conservative government of the day had to tread carefully in making the pill available, with the Ministry of Health reluctant to be seen as encouraging promiscuity in any way.
Segments of the voting population still professed strongly held beliefs over the morality of contraception, as emphatically put by one reader of the Sheffield Star who in September 1966 wrote, in protest of a new family planning clinic for unmarried women, that contraceptives were “encouraging a moral delinquency which is already woefully out of hand”.
Catholic Bishops condemned it as “against the law of God” and whilst the Church of England was accepting of contraception by the late 1950s, it sanctioned its use only within marriage. Powell himself represented a mixed picture, with his liberal stance on the introduction of contraception and legalising homosexuality contrasted by strongly held anti-abortion views and the now infamous “rivers of blood” speech made later in the decade.
Pressure from social and religious groups was further compounded by concerns over the cost of the pill – which was subsidised heavily by the NHS to the tune of 15 shillings per monthly prescription, with patients contributing 2 shillings (equivalent to a total of about £18 in today’s currency).
During his announcement in the House of Commons, Powell was questioned by fellow Conservative MP Nicholas Ridley, who warned “the prescribing of these pills could cost a lot of money if not controlled on medical grounds” – an obvious hint that any policy to allow wide-ranging access would be met with resistance.
GPs too proved reluctant to prescribe contraception. Concerns over unknown side effects, a lack of experience in providing sexual health advice and a lingering distaste amongst largely male doctors for discussing birth control, limited the number of early prescriptions issued.
The BMA was traditionally opposed to doctors’ involvement in family planning, reflecting a longstanding view that contraception, not being a “cure” for disease, was a moral issue that should be managed outside of the medical profession. The pill, with its obvious requirement for medical involvement, presented a quandary – it was clear that women taking it would require medical advice and supervision, but this would represent an entirely new level of involvement for the medical profession in family planning that it was not necessarily willing to embrace.
The issue of pricing played a shaping role in changing the medical profession’s attitudes to contraception. In 1966 the BMA successfully lobbied for GPs to be allowed to charge women an additional fee when prescribing the pill for social reasons, and when this payment was abolished in 1975 the BMA secured GPs a yearly payment for every woman receiving contraceptive advice. This bonanza went a long way towards changing doctors’ attitudes towards the provision of contraception and despite the various obstacles to access, the number of women utilising the pill rose from 50,000 in 1962 to nearly a million in 1969.
This enthusiastic uptake was driven by women themselves, with reports of women responding in large numbers to requests for trial volunteers and writing en masse in response to TV and magazine features on the pill to request further information. So highly in demand was the new technology that women were said to be willing to move doctors if unable to obtain a prescription. Single women, still barred from access, sometimes resorted to wearing fake wedding rings, with tales of the same ring being passed around GP waiting rooms.
Kenneth Robinson, Labour Health Minister, played a pivotal role in introducing the NHS (Family Planning) Act of 1967, which extended contraceptive services to all women, for any reason - regardless of age or marital status. These services were still however provided by local health authorities, and it was not until the reorganisation of 1974 that contraception was made available to all women directly through the NHS.
The introduction of the pill is widely viewed as a defining moment in the history of the NHS. Beyond its effects on liberating women from the confines of childrearing and transforming social norms, it was the first time that a medicine was prescribed in large numbers to healthy adults, bringing them into contact with the health service and serving as a catapult for the development of modern screening and preventive services. Its arrival also demonstrated the power of patients (in this case, women) to transform medical practice and challenge the status quo. In today’s NHS, the arrival of a single pill with all the benefits of efficacy, safety, and affordability – all whilst meeting a huge unmet need – may sound like an unachievable fantasy, but the lessons of history show us that innovative technology could prove to be a catalyst for change that immeasurably improves the health of a nation.
Yasmin Sheikh, Account Manager