The enduring quest for effective and accessible women's sexual and reproductive healthcare

My term as The FASEB Journal's Editor-in-Chief (January 2016–January 2023) was a great privilege, among which was writing monthly editorials on a wide range of topics, including women's health.1-3 When Patricia Morris, a leader in both female reproductive biology and related healthcare policies, accepted my invitation to join the editorial board, I proposed that she consider leading a series on women's sexual and reproductive health. She was keen, but we had to wait because she soon was elected President of FASEB and thus stepped down from the Journal's editorial board for that year. But then we rekindled our shared idea and she went forward with her typical wisdom and energy, with only a modest degree of input from me on potential subjects and authors. The series now comes to fruition with the publication of the first article,4 together with Dr. Morris' eloquent introduction.5 I am most grateful for her leadership in creating this series and I believe it is one of the most important things the Journal has ever done. In the contraceptive axis of this field, we think of Gregory Pincus, M. C. Chang and Carl Djerassi—all three geniuses in my opinion. Pincus and Chang discovered the Pill,6 and Djerassi invented a pharmaceutical process for an orally active progestin that eclipsed the G. D. Searle compound Pincus and Chang discovered.7 But all along, there were also key nonphysician/nonscientists who rallied the cause. In remembering and saluting such volunteers, I hold at the pinnacle Mary Woodward Lasker. Although the foundation she and her husband created had rules about their coveted awards, the trustees were allowed to make other awards at their discretion. Coordinating with Planned Parenthood, they launched a Special Award in World Population; Chang and Pincus were the 1954 and 1960 recipients, respectively. (Of historical note, Mary Lasker had a long association with Planned Parenthood; her husband Albert, a public relations master, was credited with coming up with the organization's name, with the view that it would be more acceptable than the “birth control”-bearing name Margaret Sanger had proposed). Some volunteers bring money and an elite circle of supporters, and I suspect Mary Lasker would have supported women's causes whatever her wealth. But there were others too, less well-known. Marion Fennelly Levy (1925–2023), known to all as Penny, started out in public relations at the department store chain Lord & Taylor but then became a champion of women's rights and health. Her many leadership roles in women's reproductive health included serving as Director of Women's Programs and Family Planning at Save the Children, as Chair of the Board of Planned Parenthood of New York City, and as a member of the board of the Alan Guttmacher Institute. Levy died on May 18, 2003. Another heroic volunteer in this theater who has recently passed away is Peg Diem Yorkin (Peggy was her given name, which she hated and never used). Following years of fundraising for charitable organizations in Hollywood, for example, SHARE Inc., which focused on support for disabled children, in 1987 she cofounded the Feminist Majority, whose initial mission was to get more women elected to Congress, an effort which many historians agree succeeded. Three years later, she teamed with Feminist Majority cofounder Eleanor Smeal and others to travel to Paris and lobby the company Roussel Uclaf, which held the patent on mifepristone (a.k.a. RU-486), to seek U.S. Food and Drug Administration (FDA) approval. (A parallel lobbying effort had been made by Etienne Baulieu, based on his preclinical and clinical studies, as well as by Dr. Sheldon Segal of the Rockefeller Foundation's Population Council.) The company agreed to support FDA approval, which was granted in 2000. Levy and Yorkin, like many other advocates, women and men alike, had the dream of women—all women—being able to have full access to sexual and reproductive healthcare. At 98 and 96, respectively, they lived to see this dream come to reality in some respects, and yet they also lived to see the U.S. Supreme Court decision in Dobbs. Only a few weeks after their deaths, the FDA approved, on July 3, a blood test to detect preeclampsia risk and then, on July 17, an evolved version of the Pill for over-the-counter sale, putting control of a contraceptive state into the option of so many women who had not had it before or at least not without prescription impediments. The latter FDA decision descends from decades of research and safety studies. Everything the pioneers of the first Pill knew led them to deploy two hormones, correct strategy at the time. Science marches on, and improvements come, as this new series in the Journal will attest. And yet, the United States still ranks shockingly low on many indices of how women, worldwide, are at risk from inadequate healthcare on all fronts, including their sexual and reproductive health. We must always bear in mind the global dimensions of this problem. This series updates much progress on several fronts, welcome indeed. But there is so much more to be done.