It was supposed to make every child a wanted child, give women control over their bodies and grant couples worry-free sex.
Such were the aspirations of health professionals worldwide when the medication now known simply as "the pill" arrived on the market 50 years ago. It was the first birth-control method that did not require use in the heat of the moment, the first that could be used by a woman without her partner's knowledge or cooperation.
An estimated 12 million American women take the pill today and about 80% of women will use it at some time during their reproductive years. Its uses have moved far beyond the original intentions of its makers: Today it is given to cut the risk of uterine and ovarian cancer in high-risk women; to alleviate abnormally heavy or painful periods; to fight anemia; to stabilize mood; even to clear up acne.
As a tool for women's career advancement in the latter half of the 20th century, the pill's impact was monumental, said Elaine Tyler May, a historian at the University of Minnesota and author of "America + The Pill: A History of Promise, Peril and Liberation."
But despite the freedom in career and family planning it extended to so many women and couples, the pill has not fulfilled one big hope. Fifty years on, about half of all pregnancies in the U.S. are unintended and 22% of pregnancies end in abortion.
"It's not going to be the answer to unintended pregnancy — we can be sure of that," said James Trussell, director of Princeton University's Office of Population Research and a leading authority on contraception.
Trussell thinks that the pill's time is passing — and that the future lies instead with fool-proof contraceptives that require almost no thought or action.
Before the Food and Drug Administration voted in May 1960 to approve the first oral contraceptive, beyond abstinence the only forms of birth control available (and these mostly to married couples) were sterilization, the diaphragm, condoms and natural family planning (the "rhythm method").
The thought of out-of-wedlock pregnancy struck terror in women in midcentury America, said Claudia Goldin, a professor of economics at Harvard University who has studied the pill's effect on professional women. The proper course of courtship was to go steady, become lavaliered, pinned, then engaged.
"They were a set of steps that led almost irrevocably to marriage, and they were set down at an early age," she said. "The pill allowed us to get rid of all of those steps."
That first pill, Enovid, contained a mixture of the hormones estrogen and progestin that worked to prevent ovulation. Women took one active pill a day for 21 days, then a placebo pill for seven days to allow for menstruation, which the pill's inventors thought was necessary and would assure women they weren't pregnant.
In the post-pill era, the average age of first marriage began to creep up as women and couples no longer felt they needed to wait to become sexually active. The rate of women in professional schools rose from 18.4% of professionals in 1960 to 36.4% by 1998.
The pill also has been credited — or blamed — for overturning sexual mores, but there is less evidence that it caused or evenly greatly contributed to the sexual revolution, May said. The nation, she noted, experienced sharp changes in sexual behavior in the 1920s, during World War II, and during the 1960s and '70s.
Other predictions swirling around at the time of its debut did not come true, May said. The pill did not curb worldwide population growth, create happier sex lives for married couples or reduce rates of divorce.
As a drug, it did not deliver as expected either. It was not as safe as its creators had hoped. Within a year of Enovid's introduction, reports trickled in that its high hormone content raised the risk of blood clots, heart attacks and strokes, and that women who smoked had an even higher risk of side effects. This led to reformulations to lower the hormone dosages and warnings for smokers to avoid the pill.
Today's birth-control pills contain about 25 to 35 micrograms of estrogen compared with the 150 micrograms Enovid contained, said Dr. Daniel R. Mishell Jr., a professor of obstetrics and gynecology at USC. Progestin content went from 10 milligrams in the original to about 1 milligram.
"It has remained effective but with increased safety," Mishell said.
Though today's oral contraceptives are far safer than the first iterations, they still have some risks. And the new pills continue to invoke controversy. Last year, the FDA reprimanded Bayer HealthCare, makers of Yaz, for marketing the pill to treat PMS and acne, and for failing to cite the drug's risks. More than 1,000 lawsuits have been filed against Bayer charging that the kind of progestin in Yaz and Yasmin, another pill it markets, raises risks of blood clots and strokes.