‘Not Quite Ready’: Scotland and The Pill, 1961-1970

Alexandra Cowie traces the history of contraception and reproductive health in 1960s Scotland.

In 1993, the Economist named the pill as one of its seven wonders of the modern world (Economist 1993, 48). Considered an iconic symbol and defining feature of the so-called “swinging sixties,” the development and distribution of the oral contraceptive pill permanently altered considerations of sex. In the Scottish context in particular, Glasgow family planning doctor Elizabeth Wilson praised the availability of effective oral contraception as “an historical event equivalent to the discovery of the circulation of blood” (Wilson 2004, 79).

First made commercially available in Britain under the name Conovid, the pill was made available at point of access through the NHS in 1961 (Junod and Marks 2002, 134). Far more than its formulation of synthetic progestin and oestrogen, which had been used for the treatment of “menstrual irregularities” under another name for four years, the pill’s “stated” purpose made it most significant for public interest (Tyrer 1999, 11S-16S). Contraception had previously been viewed largely as a behavioural intervention adopted and negotiated by a couple, which medical professionals could consult on where necessary. The pill, on the other hand, required repeated interactions with the medical community in order to obtain a monthly prescription. It thus encouraged medicalised understandings of pregnancy prevention, bringing to the fore new questions about sex and morality.

Green packet containing birth control tablets
Birth Control Packet. Credit: Unsplash.

The Letter of the Law

Contrary to popular belief, the pill was always legally available to all women in Britain, irrespective of marital status. When asked in a 1961 parliamentary debate, “Is it left to the doctor to decide whether these pills shall be prescribed for both married and single women?” the Minister for Health responded: “It is always for the individual doctor to decide what are the medical requirements” (HC Deb, 4 December 1961). However, in practice, the involvement of a doctor’s personal morality largely limited prescriptions to married women. The prevailing belief among the Scottish medical community was that unmarried women should have no need (medical or otherwise) for contraception of any kind (McCance and Hall 1972, 698).

While healthcare in Scotland fell under the remit of the NHS, the room left for interpretation in national legislation makes specificity all the more significant to this analysis. The interventions of Scottish legislators meant that Scottish women had a distinct and historically significant experience of accessing oral contraception in the 1960s.

Dual Authority

Prescriptions for the pill were ostensibly available from any qualified doctor. They were obtained from either a general practitioner or more often a specialised family planning clinic. This system of dual authority emerged because while general practitioners were typically responsible for the prescription of medications, the field of family planning and reproductive care was not fully absorbed into the NHS until 1974 (NHS Scotland 2023). The advent of oral contraception complicated this divide significantly because willingness to prescribe the pill varied vastly between practitioners. The law emphasised the doctor’s use of their own discretion, which meant that almost any argument could be made for a circumstance constituting “medical necessity”. Moral concerns about encouraging premarital sex frequently superceded any genuine understanding of an individual’s medical needs.

Indeed, many GPs were incensed by the idea that they should be asked to aid in the prevention of pregnancy. One such doctor, Arthur Hill, wrote to the British Medical Journal, arguing passionately that “our calling is to guard against illness… It is no business of a doctor to interfere with normal physiology. Use of drugs in this way is a debasement of our profession, a misapplication of our knowledge and totally unworthy of a great profession” (Hill 1961, 52). As oral contraception was not curative, but rather solving an issue that had yet to emerge, its impact was difficult to comprehend for those unsympathetic to the risks of pregnancy.

Clinics in Scotland, mostly run by the Family Planning Association (FPA), could more reliably be expected to provide oral contraception. However, this was also contingent on their own moral code. The central body of the FPA did not condone advising unmarried women on contraceptive matters until at least 1964 (The Guardian 1964, 5; see also Wilson 2004, 82). In spite of this, informal and unauthorised channels of access arose to aid unmarried women in search of contraception. Anecdotal evidence points to a “shared wedding ring” that circulated the waiting rooms of a clinic in Fife, as well as falsified wedding invitations presented as evidence of an impending marriage status (Macaulay 2015, 188). The mere existence of such strategies indicates the significant obstacles unmarried women in Scotland faced when attempting to access contraception.

Furthermore, FPA clinics were limited by financial constraints. Working with only charitable donations and grants from local authorities, they found that rural clinics were sparsely attended and difficult to justify sustaining and thus catered disproportionately to larger cities (Davidson and Davis 2012, 131). However, when examining urban areas, population size and density are not accurate indicators of the availability of oral contraception. In fact, the best served city in this regard was not the largest city Glasgow, nor the capital city of Edinburgh, but instead Aberdeen: a city with less than a fifth of Glasgow’s population (HC Population, 24 March 1965).

Aberdonian Exceptionalism

Aberdeen’s seemingly anomalous contraceptive care provisions can be attributed to the presence of an already strong, well-established reproductive healthcare community in the region. Sir Dugald Baird, although not acting alone, came to represent the uniquely high standard of obstetric and gynaecological care in Aberdeen: so much so that the new maternity hospital has been named in his memory. Recognised by his contemporaries as “an extraordinary obstetrician,” Baird introduced and implemented innumerable measures, including meticulous record keeping, and epidemiology into obstetric and gynaecological practices throughout his career (Howie 1987, 378). In doing so, he and his colleagues created an unparalleled understanding and positionality regarding reproductive health and the role of contraception in the Aberdonian medical establishment (Macnaughton 2004).

Through both his direct involvement in opening the first free family planning clinic in Britain, and his broader focus on long term comprehensive reproductive care, Baird introduced and maintained the structures for strong family planning services in Aberdeen. Women, regardless of marital status, could access free contraceptive advice, appliances and services almost a decade before their universal availability outwith the city (Thompson and Aitken-Swan 1973, 138). While a clinic in Edinburgh specifically intended to provide women with the pill was established in 1962, pointing to some similarities between the two cities, it was not until 1968 that another clinic in the capital opened to provide single women with reliable access to oral contraception (Wadsworth et al. 1971, 133). The clinic Baird opened in Aberdeen operated seven hours a day, six days a week, while its closest counterpart in Dundee was open for only four days of each month. Moreover, although Glasgow’s population was more than five times that of Aberdeen, its family planning clinic opened only twice a week (Glasgow Herald 1966).

However, the provision of such services should not be equated with an understanding of their availability among the general public. Even in Aberdeen, 58 percent of sexually inexperienced students were unaware of the availability of contraceptive materials or advice, and only half of their sexually experienced unmarried counterparts believed these services were adequately available (McCance and Hall 1972, 696). Furthermore, although by 1970 half of the patients at Aberdeen Maternity hospital had taken the pill, most had obtained it through their GP rather than a clinic (Thompson and Aitken Swan 1973, 138). Access alone, without a clear understanding of what was available, was not sufficient to ensure Scottish women could obtain oral contraception.

‘Not Quite Ready’

Irrespective of the resources seemingly at their fingertips, Aberdonian women did not see universal, or even remotely reliable access to oral contraception in the 1960s. The variable experiences of women in Scotland attempting to obtain the pill can largely be attributed to the “reluctance of the policy community to engage with reproductive issues” (Davidson and Davis 2012, 148). Scottish Secretary of State William Ross argued that the country was “not quite ready” for single women to be universally permitted access to contraceptive advice and treatment by law, and delayed legislation that had already been passed in England and Wales by three years (Macaulay 2015, 129). Although Ross argued that this was to reflect regional moral character, in practice this system provided policymakers with an opportunity to entirely avoid difficult questions about morality and propriety in Scottish society, and to ignore the clear need for investment in public health structures for supporting reproductive care.

Conclusion

Without governmental support, regional exceptionalism brought about by medical practitioners was insufficient to combat the discrepancies in quantity and quality of contraceptive care in Scotland. The legal basis in place equally facilitated good faith and stringent interpretations from practitioners, and in areas where there was not yet a strong foundation in this field, policymakers “reluctance” far more closely resembled negligence than the preservation of propriety as they prevented women from readily accessing oral contraception. No amount of motivated individuals like Baird could counteract the incredibly confusing national policy. This, among a number of other factors, meant that access to the pill in Scotland during the 1960s was varied and unevenly distributed.

About the author

Alexandra Cowie is a recent graduate of the University of Edinburgh with an honours degree in History. She is primarily interested in applying the principles of social history and microhistory to histories of sexuality and medicine. She looks forward to continuing her research in this field as she applies for postgraduate study. Alexandra can be found on Twitter @alexandra_cowie.

References

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Economist. 1993. “The Age of the Thing.” 25 December 1993: 48.

Glasgow Herald, 21 June 1966.   

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Howie, James. 1987. “Sir Dugald Baird (1899-1986).” British Medical Journal (Clinical Research Edition) 295, no. 6594: 378-379.

Junod, Suzanne White and Lara Marks. 2002. “Women’s Trials: The Approval of the First Oral Contraceptive Pill in the United States and Great Britain.” Journal of the History of Medicine and Allied Sciences 57, no. 2: 117-160.                                             

Macaulay, Kenneth. 2015. “Birth Control Knowledge: Scotland, 1900-1975.” MD thesis, University of Glasgow.

Macnaughton, Malcolm. 2004. “Sir Dugald Baird,” Oxford Dictionary of National Biography. Oxford: Oxford University Press.

McCance, Colin, and D.J. Hall. 1972. “Sexual Behaviour and Contraceptive Practice of Unmarried Female Undergraduates at Aberdeen University.” British Medical Journal 2, no. 5815: 694-700.

NHS Grampian. 2024. “The Baird Family Hospital & The ANCHOR Centre.” Accessed 11 January 2024.                    

NHS Scotland. 2023. “Timeline.” Accessed 24 March 2023.

Our Own Reporter. 1964. “FPA Favours Help for Unmarried.The Guardian, 5 June 1964.

Thompson Barbara and Jean Aitken-Swan. 1973. “Pregnancy Outcome and Fertility Control in Aberdeen.” Journal of Epidemiology & Community Health 27, no. 3: 137-145.

Tyrer, Louise. 1999. “Introduction of the Pill and Its Impact.” Contraception 59, no. 1: 11S-16S.

United Kingdom. 1961. Hansard Parliamentary Debates, vol. 650 cc 922-3.

United Kingdom. 1965. Hansard Population, vol. 709. Debated on Wednesday 24 March 1965.

Wadsworth, Michael, et al. 1971. “Attenders at a Contraceptive Clinic for Single Women.” Journal of Biosocial Science 3, no. 2: 133-144.

Wilson, Elizabeth. 2004. Sex on the Rates: Memoirs of a Family Planning Doctor. Argyll: Argyll Publishing.

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