THE VFA PIONEER HISTORIES PROJECT
Dr. Sharon Camp
“The reproductive health community, when they work together with their funders, can accomplish really big things.”
Interviewed by Judith Waxman, June 2021
JW: We need your full name and where and when you were born.
SC: I’m Dr. Sharon Camp and I was born in Easton, Pennsylvania on November 7th of 1943, which makes me seventy-seven years old.
JW: Briefly, tell me about what your life was like before you got involved in women’s issues and include your ethnic background, sibling background, that kind of thing.
SC: I grew up in the middle of the Mojave Desert. My dad was a rocket scientist and I had two younger siblings, both girls, and my mother was legally blind. I grew up fairly fast because at a young age, I was my mother’s eyes. She didn’t drive and she couldn’t see to read. She did Braille and taught Braille. She was a very inspirational figure, but I also was very close to her given the role that I played for her.
I went to college in Southern California at Pomona College. On graduation I had three choices: I had been accepted by Columbia and Johns Hopkins for their international studies programs and by the Peace corps to go to Senegal. My parents were pretty horrified at the idea of my going off to Africa. Meanwhile, they’d moved back to Maryland. So they said, we will pay for graduate school if you will not go in the Peace Corps and go to Johns Hopkins instead of Columbia.
That’s what I did. I went to the Washington campus, SAIS, for the first two years and then moved up to the Homewood campus in Baltimore for the PhD because I thought I wanted to teach and do research. That was about the time I got involved in some political campaigns locally and decided that academia was way too dull. From that time on, I knew I really wanted to be involved in public policy.
JW: What campaigns did you work on?
SC: I worked first for a congressional candidate named Hart who actually borrowed Gary Hart’s campaign stuff, but he lost to Hogan, the father of the current Maryland governor. I was subsequently involved in other campaigns and then in 1972 I got elected to the Democratic State Central Committee for Charles County, where I served for eight years. That was deeper into politics, local at that point. While I was working on my dissertation, I worked for one of our local newspapers, the St. Mary’s Beacon, as the coeditor.
I got my first real job as a lobbyist working on domestic hunger issues. I worked for a group called the Children’s Foundation that worked on the WIC program and school lunch, school breakfast and also was under contract to something called the Native American Technical Assistance Corporation. That gave me about thirty-five major native American tribes to work with as a consultant and to help them take over the USFDA food and nutrition programs rather than receive those programs through the states. The bigger tribes like the Navajo and Arapaho and Papago and Yakima and Seminole were all in a position to take over these programs and run them for themselves. That’s what I helped them do.
After about four years an opportunity came around to work in international development which is where I really wanted to be given my degree. That job was as a lobbyist for what was then called the Population Crisis Committee. These were the years of Norman Borlaug and No Hunger and zero population growth. It turned out I worked for that organization for 18 years. At the end I became co-president in charge of the government liaison, media liaison, publications, policy research, most of the programmatic aspects of what we did. I got a pretty high profile in the last eight or nine, ten years that I was there. I did a lot of television interviews, a lot of public speaking.
On our twenty-fifth anniversary I got the board to change our name to Population Action International. The new message being we don’t have a crisis; we have some challenges. What we need to focus on is voluntary family planning. The tenor of what we did changed quite a bit and we spent a lot of time trying to link population issues back to a whole range of development issues. This includes women’s development, the environment, national security, and democracy. That gave me a chance to work on a lot of things outside the population field that were of real interest to me.
JW: During those years when there was concern about too many people, did you get pushback from women? Were women involved in any of the decisions? Obviously this country did not initiate any rules but I’m old enough to remember a lot of the rhetoric and media and hype to have fewer children.
SC: There was pushback from feminist health groups, a lot of pushback around contraceptive safety, which was unfortunate. Some of the internecine fights between feminist organizations and family planning groups were around the safety of contraceptives like Norplant, Depo Provera, the IUDs. There were problems over the course of contraceptive history with IUDs, for the most part they were pretty good, safe and effective. I actually used depo Provera for 13 years before it was approved by the FDA. That’s how much I believed in its safety. But I was at odds with some of the feminist groups around Depo and I think Depo and Norplant both got a bad reputation with feminists because they were misused by people who wanted to control women’s sexuality.
JW: Did that have a racial component?
SC: It probably did, yeah. Given what went on with sterilization in the South, I would guess that it probably did. Although that wasn’t the fight at the time, the fight was among white women basically. When Depo was under development and seeking FDA approval, its proponents actually argued that it would be great for institutionalized women who couldn’t manage their own sexuality, they’d be protected this way. That right away gave it a bad name.
JW: Red flag there.
SC: Exactly. Early on after its introduction judges were giving low income women who had just delivered a cocaine addicted child, for example, the choice of getting Norplant or going to jail. These were good contraceptives, not perfect, but safe and effective. They got an unfortunately terrible reputation because they became associated with coercion. When I entered the field, none of the major U.S population, family planning, reproductive health organizations, were headed by women. Men headed most of the family planning programs around what we then referred to as the Third World. I don’t think they trusted women to make good public health decisions.
Most of us in the field who were women understood that if you gave women real choices, beyond contraceptives, but giving them control over decision making about childbearing, you didn’t need to coerce them to have fewer children. The more data we’ve accumulated over the years demonstrates really strongly that low income women without good access to family planning services have on average, at least one more child than they wanted. Whereas women in the upper quintiles of the income scale had the number of children they wanted.
It took us a while to learn that lesson, but I think we did at the Cairo conference. By the time of the Cairo conference, I had left what was then Population Action International for about a year and was taken on by Nafis Sadik, the head of the UN Population Fund, to anonymously write the Cairo Plan of Action. My salary was paid by the Rockefeller Foundation, I lived in a hotel in New York. I met with Nafis and a few of her staff secretly, but most of her staff didn’t know I was writing this. It took me 16 days.
At The Pew Foundation Susan Sechler knew what was going on and provided support to the Population Reference Bureau to gather for me all of the reports out of the regional and technical working groups leading up to the Cairo conference and organize them under an outline that I gave them. I was able to write this very quickly pulling on all of the resolutions and findings from all of these expert and regional meetings.
JW: Would you mind giving a couple of highlights of what came out of your outline?
SC: It was the conversion of the family planning field from one that was focused on demography to one that was focused on women and their families. It was a very different tone and what was interesting was prior to the Cairo conference, feminist health groups were lined up to oppose whatever the UN produced – they were ready to attack. They were so pleased with the document that they got behind it for the most part, which probably helped clear the way for the conferees from 180 countries to reach consensus. It wasn’t everything that I wanted, I put into it everything I wanted, but some of the things got taken out including a clear statement about the need to face an epidemic of unsafe abortion and the right of adolescents to have the information and services they needed to protect their health. In both those sections the language got kind of mauled and it didn’t actually make much sense.
JW: What year was this again?
SC: 1994. It was the Cairo conference; the last UN conference on population and development. There were follow up conferences on a smaller scale, but there wasn’t another.
JW: At some point you went to a pharmaceutical company?
SC: Yes, I went to Wyeth. My fairy godmother Robin Chandler Duke was on the board of American Home Products and got me an interview and I was hired as director of women’s health policy. Wyeth had brought out Norplant, they had a big women’s health franchise. I thought by standing up for Norplant that they had done a courageous thing so I thought maybe I could help them. I was there two weeks before I resigned.
JW: That was because?
SC: For somebody who had worked all of her life in the nonprofit world, it was a lethal atmosphere. I sat at a different table at lunch and talked to people all across the company. There were very few people who really were happy in their work or really proud of what they were doing. I met too many people who were biding their time until retirement. There was a lot of infighting because people were highly competitive and backstabbing. I knew I wouldn’t survive in that atmosphere. Then a couple of years later, Wyeth had almost entirely abandoned its women’s health franchise. They pulled Norplant off the market; they’d sold their pill franchise.
I wouldn’t have stayed there anyway. I walked out not knowing where my next mortgage payment was coming from and was fortunately hired by a man named Steve Sinding at the Rockefeller Foundation to work with Nafis on the Cairo conference. I had already gotten involved in the issues of medication abortion and emergency contraception. I was the founding chair of the Reproductive Health Technologies Project (RHTP) before I left Population Action, and that was put together initially to build a very broad-based coalition around an effort to get what was called RU486, mifepristone, licensed in the United States.
We brought together people from the population community and also people from the women’s health community, as well as feminists like Ellie Smeal. It was a technology we could all agree on. We could all agree that women needed this additional choice. In 1994 the French company Roussel-Uclaf, licensed the Population Council to take the product through the FDA and bring it on to the market in the US. I was still working at PAI at that time, and the members of RHTP looked around for some other reproductive healt technology that we could build a broad coalition around. We ended up focusing on emergency contraception and microbicides (to provent STIs).
The microbicides never went anywhere but we did begin to build through the Reproductive Health Technologies Project and internationally through the International Planned Parenthood Federation, a movement to make emergency contraception a standard of care in women’s health. At one of the global health conferences a bunch of us from the field were chatting about the effort and Francine Coeytaux, who was co-head of the Pacific Women’s Health Institute, told us PWHI had started a study with Kaiser Permanente to test the acceptability of a homemade packet of emergency contraceptives and measure any impact on unintended pregnancy.
I said we should be running those kinds of research projects all around the world and see if we can plant some evidence. Out of that discussion the International Consortium on Emergency Contraception was born. I was its facilitator for three years, which meant I raised all the money and organized all the meetings and kept everybody in touch with each other.
JW: You were just starting to coordinate the international coalition on Plan B?
SC: That was one of the two origins of Plan B. The other was a large domestic US coalition that was housed in the Reproductive Health Technologies Project. I was the founding chair of that, so I was very much involved in both the domestic and international effort. Both on the domestic and the international side, we set out to make emergency contraception a standard of care in women’s health care. At the time, very few people or women actually knew that you could use a high dose of oral contraceptives within a few days of unprotected sex and prevent pregnancy.
It was something that had been known about in the medical community for decades, but no one had ever bothered to tell women about it. It was rarely used outside of rape crisis centers. On the domestic side we developed radio, print, a hotline called 188NOTOOLATE. We urged the FDA to try and get the industry interested in it, and were helped by activists within the FDA like Phil Corfman. On the international side the ICEC developed medical guidelines, training materials for clinicians, model consumer information, pamphlets, checklists, all kinds of things in multiple languages and distributed those around the world.
JW: I can remember if you knew where to go online, there would be information about how many of the brand of pills you were taking would work. Was that part of the project?
SC: That was part of the effort. The website was housed at Princeton University, developed by James Trussell who is very much a part of this movement, and it also was also called Not Too Late. The international Planned Parenthood Federation also developed some online information that was accessible in many countries and in various languages and eventually became a directory of what oral contraceptive could be used in the different counties to make up an EC regimen and much later information about dedicated products and their availability. But in the early years, all we were doing was teaching clinicians or women to cut up packages of oral contraceptives. That was clearly not the way to mainstream a EC. We really needed a dedicated product that was packaged and labeled for this specific use.
But it was hard to get the pharmaceutical industry engaged. Both on the domestic side and the international side activists lobbied the major companies, in the United States and Europe, trying to find a company that would bring out a dedicated product. The only major company that was interested was Schering AG in Germany but they declined to bring out a product in Latin America or Africa because so many drugs ended up de facto over the counter and they wanted that clinician between them and the product liability. That was a nonstarter since the consortium was focused broadly on developing countries.
Meanwhile at the World Health Organization there was a large clinical study in 14 countries, 22 study centers underway with a Levonorgestrel pill that had been developed by Gedeon Richter and marketed in Eastern Europe for a number of years for ongoing postcoital contraception. It was mainly for use by adolescents whose sexual activity would be infrequent. The WHO hypothesis was that without the estrogen in it, the Levonorgestrel tablet would cause less nausea and vomiting. This was a real problem with the old regimen of combined oral contraceptives where 50 percent of women got nauseous and some 20 percent threw up. It really wasn’t a very good method.
The worry, hoever, was that without the estrogen, it would be less effective. It turned out when we unblinded the data that Levonorgestrel by itself was actually more effective, not something anyone anticipated. The Consortium of which WHO/HRP was a member, decided to leapfrog over the old method and come out with a product based on the Gedeon Richter tablet. Gedeon Richter agreed that they would supply the new product, which would be packaged and labeled for this specific indication, to the public sector family planning programs of developing countries for 20 cents a packet. This was totally affordable which also tells you how little it really costs to make and package the drug.
This is the product and now sells for $45 to $50 in drug stores in the U.S. But we formed this public private partnership and as the Consortium began introductory trials of the product in the four countries Mexico, Indonesia, Sri Lanka and Kenya, we realized that it might appear that we were promoting third class medicine for Third World women. That this was a product for the developing world and wasn’t going to be marketed in Europe or the United States. We therefore, needed to get it through a major Western regulatory agency, and we picked the FDA first because it was considered to be one of the toughest so any product that was approved in the US was going to be well validated.
JW: Have a lot of credibility.
SC: Yes, a lot of credibility. And also, because USAID was supplying about a third of the contraceptives for public sector family planning programs across much of the developing world. We assumed that if it had FDA approval and there was a sponsor in the US for the product, that USAID could buy it. It took years before that happened, but it eventually did. But Gedeon Richter, while prepared to supply the product anonymously, was unwilling to take it to the FDA or launch it onto the US market out of fear of the anti-abortion lobby. So we were forced to launch a new pharmaceutical company.
JW: That you started on your own?
JW: Because you couldn’t find one in the U.S.?
SC: There wasn’t one in the U.S. or Europe that would be willing to bring the product to the United States, they were all afraid. I like to say that decisions in the pharmaceutical world industry are a balance between fear and greed. If something is really scary because it’s deemed to be controversial, then it would have to be highly profitable for them to get involved in its development. Emergency contraception was viewed by the industry as something used only or needed only by adolescents and poor women who didn’t have any money to pay for it so there wouldn’t be any profit in it.
We launched a little company in January of 1997, and it took us quite a while to develop an agreement with Gedeon Richter because midway through the process they got scared someone would find out they were the source of it and they would have people knocking down their doors in Budapest. We were finally able to convince them to sign an agreement and in January of 1999, a year later, we sent the FDA a 50 volume new drug application, just like a real company. Because it was deemed an important public health initiative by a very friendly FDA, they put it on an accelerated clock of just six months and waved millions of dollars in fees that we otherwise would have had to pay. They approved it after six months in July of 1999.
JW: That was still in the Clinton administration. Is that right?
SC: Yes. Right. We unfortunately only got 18-month expiration dating from the FDA, so we launched Plan B with product that was going to expire in about five months because it had been manufactured earlier. We sent it out to Planned Parenthoods across the country knowing they were early adopters of new contraceptive technology. Planned Parenthood and other public sector family planning institutions and family planning offices in states were the major consumers of customers for Plan B initially. It was some time before drug wholesalers took on the product, before it was widely available in pharmacies. As long as it was a prescription product, Wal-Mart and many independent pharmacies would not carry it at all.
JW: They would not carry it if it was prescription?
SC: No, even as a prescription drug, right. Interestingly enough, when it went over the counter, Walmart stocked it. By then the brand was well known and less controversial.
JW: Why would you take it as a prescription, do you know? No.
SC: No. I think it was the politics of Sam Walton and his family, which are pretty conservative. We submitted the supplementary drug application to take it over the counter in April of 2003, but it didn’t switch until 2006 and it was June of 2013 before it was free and clear of an age restriction. Because the initial age restriction meant that it was behind the counter for so long, it’s still behind the counter in a lot of pharmacies, and every year the American Society for Emergency Contraception runs a survey with volunteers like myself participating. We go around to all of our neighborhood pharmacies to see how they’re handling Plan B. In my local Walgreens, the first year I went, it was locked in the manager’s office.
JW: And this is after the age restriction was gone?
SC: Yes. There is a movement, I was originally part of it, but I’m not involved in the leadership anymore, to take oral contraceptives over the counter. And there is a little French company called HRA Pharma that’s been putting together an application to the FDA, but the FDA asked for huge amounts, an unreasonable amount of data on very young adolescents. Only about one percent of adolescents under 15 have ever had sex so to recruit a whole bunch of them for an over the counter study where they have to initiate their request for emergency contraception is just a nonstarter. Anyway, the effort is moving along and hopefully with the new political climate that will come about.
JW: Because they’re protecting themselves from the claim to that “young, it shouldn’t be over the counter”.
SC: Well one would hope that it would then come out without an age restriction, but I think that’s probably too much to ask. Even though this is going to be a progestin only product, won’t have any estrogen in it, so it’ll be very safe for everybody.
JW: But after this amazing operation, people were in charge of you went to the Guttmacher Institute?
SC: I went to the Guttmacher Institute in November of 2003. The handwriting was on the wall: big Pharma was sniffing around because the product was finally profitable. It had a good margin, it was well established, the sky had not fallen in when we brought it to market. A number of companies were interested in it and I knew that a handoff was in the offing. At one point in my life I would have said DEETE you couldn’t pay me enough to take a job in New York. But then Guttmacher came along.
The presidency of Guttmacher has to be the very best job in the field. I ended up commuting once a week to New York, spent four days and nights in New York, one in the Washington office here and weekends at home on the family farm in Maryland when I wasn’t traveling. I stayed at Guttmacher for almost 10 years retiring just short of 70. Mainly I retired a little bit earlier than I wanted to, a few months earlier, because I got really sick. It took me a while to get back on my feet once I retired and moved home and I hated retirement for about six months, but now I’m happily retired.
JW: Good! But I want to go back to one of the things you focused on at Guttmacher which was branding.
SC: When I walked in the door you could assemble on a table all of the various publications and products that the institute produced. They looked like they came from ten different organizations. There was no pallet, there was no common typeface, there was no “Guttmacher Voice.” I hired the executive volunteer service corps to provide us with a retired PR executive, a really great man. He took us through a rebranding exercise the first goal of which was to get rid of the acronym. If we wanted to raise the profile of the organization, which I did because I knew it could have more impact, we’d never establish any level of name recognition with an acronym.
JW: Which was AGI.
SC: Right. We changed the name from Alan Guttmacher Institute to Guttmacher Institute and referred to ourselves as Guttmacher. Alan Guttmacher was at one time the head of Planned Parenthood, he was an OBGYN practicing in Baltimore and New York. He was the person who recognized the need for operations research in the family planning field and established the predecessor organization to Guttmacher within Planned Parenthood. For a number of years and for several years after I arrived, Guttmacher was still a special affiliate of Planned Parenthood.
One of the things we did during the rebranding was to change that relationship. We still worked very closely with Planned Parenthood, but we didn’t want to be viewed by the media as the research arm of Planned Parenthood. It then made it much too easy for our opponents to label us as a biased mouthpiece for Planned Parenthood. We did substantially raise our profile: we were all over the media, our data and analysis were considered by reporters like Nicholas Kristof, as the ‘gold standard’. As a result of that we had a lot more impact on policy both in the United States and around the world than we otherwise would have. That felt like a really good accomplishment.
The other thing that I was fairly proud of was the effort to meld together our research, communications, and public policy work. When I got to Guttmacher the organization was very Balkanized. The research people did the research they were interested in and then fought with the communications team over how to interpret the data in the press coverage. The policy staff sat down here in Washington by themselves talking to each other and had very little impact on the research agenda. What I was able to accomplish was first of all to marry the communications and research teams in a way that they both came to respect each other. They still fought over things but at least they were collaborating pretty effectively.
I think the communications that came out were evidence based, they treated the data properly, but there were findings that were also accessible to the broader public. The research agenda that Guttmacher developed going forward was and still is based on a policy agenda so that going into a research project, people understood what questions they were trying to answer and what impact the answers might have on policy. And they weren’t always the answers we wanted.
JW: They were reliable, and you say the press was interested, but I know the rest of the reproductive health community relies still very heavily on the research.
SC: Research and data analysis. I can remember people telling me that they were, especially graduate students, on the Guttmacher website all day.
JW: Yes, I taught a graduating class in health policy and I tell the students right out, here’s where you go. Well, that’s super. So, you are retired, but I know you haven’t stopped your activities in this field.
SC: I’ve slowed down considerably.
JW: Yes, but I know about your continuing local Planned Parenthood work.
SC: Yes. I’m a board member on my Planned Parenthood of Maryland. Interestingly enough it was one of six Planned Parenthood investors in plan B. It wasn’t a big investment, but they made one hundred and seventy eight percent back on their investment. Next time somebody comes to Planned Parenthood affiliates and says help us develop this product, there will be a whole lot more people lining up to participate. I’m on that board, I’m also on the Maryland Council for the Planned Parenthood Advocates of Maryland, Northern Virginia and D.C. And I understand you’re on the on the PPNW board so I will probably see you at a meeting at some point.
I’m also still on the board of what was Population Action International, now just PAI. I will be rotating off after seven years, I stayed an extra year to see PAI through a leadership transition. Now we have a very strong CEO and I feel I can rotate off. I believe people shouldn’t stay on boards more than six years. Until last June I was on the board of Melwood, which is a big organization outside my field. But it was very interesting.
JW: Sharon you’ve made an incredible contribution to the world of women’s health and reproductive care. Is there’s anything you want to add before we close?
SC: I hope that if people take away something from the Plan B story, it will be that the reproductive health community, when they work together with their funders, can accomplish really big things.