Las Borinqueñas: The Science and History Behind the Play

The EST/Sloan Project is committed to “challenge and broaden the public’s understanding of science and technology and their impact on our lives.” In that spirit, we offer this essay on the science and history behind Las Borinqueñas, the 2023/2024 Mainstage Production of the Ensemble Studio Theatre/Alfred P. Sloan Foundation in collaboration with the Latinx Playwrights Circle & Boundless Theatre Company.  Las Borinqueñas began previews at the Ensemble Studio Theatre on April 3 and ran through May 5.

An essay by Rich Kelley

The United States in the 1950s was an unlikely place to develop the first oral contraceptive. The U.S. Federal Government and 30 states banned birth control. The NIH, the National Science Foundation, and the WHO refused to support reproductive research. Pharmaceutical companies considered testing an oral contraceptive too risky: They would need healthy women of childbearing age as test subjects. Why would those women want to take part?

Birth control activists wanted to fund the development of a “simple, foolproof birth control method,” preferably a pill. They approached Dr. Gregory Pincus, whose work studying fertility had earned him a reputation as something of a “mad scientist.” As a researcher at Harvard, Pincus garnered national attention when he developed the first test tube rabbit embryo. Scare headlines about “fatherless babies” followed and Pincus was denied tenure.

Pincus accepted the challenge to develop a birth control pill. He focused his research on progesterone, “nature’s contraceptive.” When an egg is fertilized, progesterone prepares the uterus for implantation and shuts down the ovaries, so no more eggs are produced. Could progesterone be put into a pill, effectively tricking a woman’s body into thinking it was pregnant?

From left: Celson-Ramon Garcia, John Rock, Gregory Pincus (seated) in 1957. Source: Worcester Foundation for Biomedical Research

Pincus began doing animal studies using synthetic progesterone with promising results. For the first human tests, he partnered with Dr. John Rock. Rock had been working on curing infertility by injecting women with progesterone and estrogen to pause ovulation and allow the reproductive system to reset. In one study, after stopping the hormones, 13 of 80 patients became pregnant within four months, an effect gynecologists called the "Rock rebound." At Pincus's suggestion, Rock tried the same experiment with the new oral contraceptive, with similar success.

For their first large-scale clinical trial, Pincus and Rock chose Puerto Rico, where the population had surged by 18% in a decade, a growth which caused concern among American politicians and activists (often, but not always, motivated by xenophobia and racism) as well as some of the Puerto Rican upper classes. Unlike the mainland U.S., birth control was legal in Puerto Rico. Sixty-seven family planning clinics promoted the rhythm method, provided diaphragms, spermicides, or condoms, and also referred patients to hospitals for sterilization. Many physicians and reformers believed sterilization was the solution to population control. Hospitals had policies urging maternal patients to have la operación after delivery; some required it after the third child. One survey in 1953-54 found that 40% of all women who had practiced some form of contraception had had la operación. But Puerto Rican women were often not informed by their doctors that sterilization is permanent. 

Dr. Edris Rice-Wray consulting with low-income women in the 1950s Source: Henrylee Marlo CC4.0

Oral contraceptive trials began in Rio Piedras in 1956, directed by American Dr. Edris Rice-Wray and Puerto Rican social worker Iris Rodriguez. They selected a group of 100 women and a control group of another 125. Participants had to be under 40 and must have already had two children to ensure fertility. The trial targeted economically disadvantaged women in Puerto Rico, who were often marginalized and lacked access to adequate healthcare. Many of these women were not adequately informed about the potential risks and benefits of the pill. Some were not aware that they were participating in a clinical trial and taking an experimental drug. 

Rice-Wray gave each woman a 20-day supply of the pills, known as Enovid. "When the bottle is over and you start menstruating," she told her participants, "you count one, two, three, on your fingers, and when you have counted all your fingers, that is the time to start again" on a new bottle. If birth rates went down among participants taking Enovid compared with those in the control group, the pill could be deemed effective.

Enovid, the first birth control pill from G. D. Searle Source: G.D. Searle & Co.

The pills used in the first trials contained an extremely high dose of hormones: more than 10 times the average dose of the pill today. Many participants experienced extreme, sometimes debilitating, side effects. Rice-Wray recorded her findings: among the first 221 women in the study, about 17% had negative reactions and 25 withdrew because of those reactions. There were complaints of dizziness, nausea, headaches, vomiting, and abdominal pain. Pincus considered most of these psychosomatic. Some women reported severe complications, such as blood clots and strokes. The high incidence of adverse reactions raised concerns about the safety of the pill and the adequacy of monitoring and oversight during the trial. Even more troubling, three women died during the trials, but because there were no autopsies, it was never learned if the pill was a factor in their deaths. After the trial concluded, there was limited follow-up and long-term monitoring of the participants to assess the lasting effects of the contraceptive pill. 

By the end of 1958, more than 800 women had enrolled in tests of the pill, but only 130 had taken it for a year or more. To disguise this shortfall, Pincus presented his data in terms of the number of menstrual cycles instead of the number of women. "In the 1,279 menstrual cycles during which the regime of treatment was meticulously followed,” Pincus wrote, “there was not a single pregnancy.” 1,279 menstrual cycles sounded more impressive than 130 women. 

In 1957, the FDA approved pharmaceutical giant Searle’s application for Enovid as a treatment for menstrual disorders and infertility. The FDA finally approved Enovid as a contraceptive in May 1960. By 1965, more than 6.5 million married women and an untold number of unmarried women in the U.S. were using the pill.

The introduction of the birth control pill marked a revolutionary turning point in women's reproductive rights, societal roles, and economic empowerment. With the ability to control when and if they became pregnant, women gained unprecedented freedom to make decisions about their bodies and futures. This autonomy extended beyond family planning to encompass educational pursuits, career advancement, and personal fulfillment and to challenge traditional gender roles and patriarchal structures. According to data from the U.S. Bureau of Labor Statistics, the labor force participation rate of women aged 25 to 54 in the United States increased from 34.9% in 1950 to 60% in 1999. Data from the U.S. Census Bureau shows that the gender wage gap narrowed from 60% in 1960 to 75% in 2020.

Labor Force Participation of Women in the USA, 1955–2005 Source: Our World in Data

By enabling women to control their fertility and delay childbirth, the pill has reduced maternal and infant mortality in countries with high fertility rates and has empowered women to pursue higher education and increased women’s labor force participation worldwide. Yet, according to the World Health Organization (WHO), an estimated 214 million women of reproductive age in developing regions have an unmet need for modern contraception, highlighting the persistent barriers to access.

Today, about 10 million women in the U.S. use the pill, and 13 million have undergone sterilization. However, in 2016, 40% of Puerto Rican women of childbearing age who used birth control had been sterilized, while less than 10% surveyed used an oral contraceptive. During the Zika outbreak of that year, a temporary CDC assistance program made many forms of birth control available for free and included a broad education campaign to inform women of the opportunity. During that program, there was a surge in women accessing birth control, suggesting that price and information access are both factors that continue to make birth control less accessible to Puerto Rican women today.

Resources:

Briggs, Laura. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. University of California Press, 2002.

Eng, Jonathan. The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution. W. W. Norton & Company, 2014.

Garcia, Ana Maria, La Operación documentary, 40 minutes. Latin American Film Project, 1982.

Lankford, Kathryn. More than a Way Station: Ground-Level Experiences in the Field Trials of Oral Contraceptives and IUDs in Puerto Rico, 1956-1966 (Ph.d dissertation, 2021)

Ramirez de Arellano, Annette, and Conrad Seipp. Colonialism, Catholicism, and Contraception: A History of Birth Control in Puerto Rico. The University of North Carolina Press, 1983.

Speroff, Leon. A Good Man, Gregory Goodwin Pincus: The Man, His Story, the Birth Control Pill.  Arnica Publishing Inc., 2009.

Tone, Andrea. Devices and Desires: A History of Contraceptives in America. Hill & Wang, 2001.

World Health Organization, “Contraception”

“Las Borinqueñas is more than a title” A Personal Statement from Nelson Diaz-Marcano

Las Borinqueñas is more than a title.

More than a play. They are the women who help a whole country not only survive but preserve its identity. They’re the people who raised and cared for me and mine everyday, despite everything trying to tell them we were not worth it. Las Borinqueñas are our mothers, sisters, partners, friends, who take care of their community despite themselves. Las Borinqueñas are heroes who are often forgotten.

Nelson Diaz-Marcano (Photo: Jackie Abbott)

My obsession with this story started years ago when I was living with my then girlfriend who had severe menstrual pains. Her doctor suggested the pill might help and she only found one that helped after years of trying different formulas which often left her paralyzed from deep cramps or so uncomfortable she had to forgo eating that day. This led me to study the birth control pill history and to my shock I found that the trials had not only happened illegally in my homeland, but that I knew someone that had been through them. She  had passed away of natural causes by the time I found the story, so I never got to talk to her. This woman who sacrificed her body to help create the miracle of birth control had been buried and barely anybody knew her name. Yet everyone knows the name of Gregory Pincus, Edris Rice-Wray, John Rock and Margaret Sanger.

That unfairness, that these people who gave everything could be lost to time, while these people that took advantage took all the credit, didn’t sit well with me. It doesn’t sit well with me because it’s another part of the erasure of a culture so beautiful that to conquer it,  you have to make them forget who they are.

But Las Borinqueñas won’t let us forget.

My mother Carmen Yaritza Marcano, who woke up every morning, despite rheumatoid arthritis, to make sure we were fed and educated, wouldn’t let me do that.

My abuela Hilda Suarez, who was one of the most respected teachers and one of the first post office workers in Gurabo Puerto Rico, won’t let me do that.

My other abuela Victoria Rodriguez who raised kids since she was a teenager, would never let me do that.

And my sister Yarinel Diaz is a living reminder of the everyday strength that is required to exist as a Borinqueña. Yet she thrives.

All these women were matriarchs of a proud but embattled culture.

As a child, Hilda was paraded in an American flag dress through the town square so she could receive benefits once her father died and her sister couldn’t work.

Victoria was married to my grandfather when she was 12; she had to raise her own kids, but also the kids from my grandfather’s other wives.

All these women were the women the community relied on.

My mother helped heroin addicts recover, fed people in need and never denied help to anybody, even while she acted like she hated helping.

My abuela Victoria is considered a matriarch not only by my grandfather’s children but by the whole community of the Barrio Jaguas.

My abuela Hilda was an unofficial advisor to local politicians from my town. She also taught English to most of the town in the 60s and 70s.

It continues with my sister, who after taking care of my mother for more than 15 years, created a fitness program  to improve the lives of older people in our hometown.

These are the women who raised me. The woman who would never let me forget. So I won’t let you forget them. This play is for them. Because without them I would be nothing. Without them, Puerto Rico would have been a memory. Thank you Borinqueñas.

Las Borinqueñas is the 2023/2024 Mainstage Production of the Ensemble Studio Theatre/Alfred P. Sloan Foundation in collaboration with the Latinx Playwrights Circle & Boundless Theatre Company. It began previews at the Ensemble Studio Theatre on April 3 and ran through May 5.