It’s an infuriatingly complicated blend of social, economic, political, and even religious factors that hark back to the 1960s when the Pill first became available for reproductive purposes.
Today, affordable and easy-to-use pregnancy tests are a quick hop and a skip away at your local CVS store. This means a pregnancy scare can be quelled (or confirmed) within an hour of noticing a late period. There are also ultrasounds that can date a pregnancy to the week it was conceived. That was not the case 50 years ago. The break (and later, the placebo pills) were designed to trigger a withdrawal bleed and reassure the user that she was not pregnant in the absence of instant pregnancy tests and ultrasounds.
"There was a practical reason for designing the pill three weeks on, one week off but there really wasn’t a biological necessity for it from the perspective of birth control pill,” said Wysocki, who is also a former member of the American Sexual Health Association Board of Directors.
“The myth is that you must have bleeding when you’re taking oral contraception when in fact that was just engineered into the pill for these other reasons.”
It was also decided by the makers of the Pill that the addition of the withdrawal bleed would help woman accept their product as a form of contraception by making it feel more “natural”. They felt that women wanted to have periods, and would be uncomfortable with a birth control method that stopped them. Clearly, there weren’t very many women in the room.
“Studies have consistently shown that when women are told there are no harmful effects from not having a period while on the Pill, especially with regards to fertility, they choose to have less frequent periods or eliminate them entirely,” Nitu Bajeka, ObGyn and co-founder of Women for Women's Health UK, wrote in an article for HuffPost.
But it was not just the women who needed convincing that the Pill was natural. One of the creators of the Pill, John Rock, was a devout Catholic.
Rock himself had made a living teaching women how to manage their fertility cycle depending on whether or not they wanted to have children, performing hysterectomies and talking openly to his patients about sex, even the unmarried women – all of which was surprisingly progressive for the period. At the same time, he was aware of the deep-rooted social conservatism within the Catholic Church. As anyone who knows even the tiniest bit about Catholic dogma will tell you, contraception is considered a sin.
There was, however, a loophole. That is that a married couple would not be sinning if there was a natural reason keeping them from falling pregnant. (Hence the rhythm method.) Rock thought that if the Pill – which was, after all, just a top-up of hormones already produced in the body – could be marketed as “natural”, it might just win the approval of the Catholic Church. Historical spoilers: it didn’t, but it was still another reason for introducing a seven-day break and withdrawal bleed.