I. Begin at the Beginning
The next time you’re picking up a box of condoms or a prescription for the pill, remember that you are part of a long tradition. According to ‘History of Contraception‘ by Malcolm Potts and Martha Campbell, written records of methods of birth control and abortion stretch as far back as 1550 BCE Egypt. The earliest visual representations of abortion can be found in Cambodia, on temples that were completed in 1150 CE. Some ancient methods were relatively simple, ‘such as the woman holding her breath at the time of ejaculation or the jumping backward seven times after coitus.’ Other methods were more logical, though potentially harmful: douching or wiping out the vagina after intercourse, or inserting a variety of substances (including honey and pepper) prior to intercourse to act as a barrier or rudimentary version of spermicide. ‘The ancient Egyptians made vaginal plugs out of crocodile dung. Aristotle recommended cedar oil and frankincense as spermicides. Casanova prescribed the use of half a lemon as a cervical cap.’¹ The condom’s predecessors date back at least to the mid-1500s. In Cyrene, an ancient Greek city in North Africa, an herb called silphion was used to prevent or possibly expel pregnancies until it was harvested to extinction. Extracts from related species have been shown to prevent implantation in mice.
Everything stayed the same for a long time. A high rate of infant mortality helped keep the population in check. More children meant more labour in poor farming families. Then industrialisation began to take root. People gave up farming, moved to cities. The infant mortality rate began to drop. The population grew faster than ever before. In the late 1800s, women already caring for large families turned in increasing numbers to abortion. One American physician commented in 1873 that ‘it is rare to find a married woman who passes through the childbearing period who has not had one or more!’ Some women turned to advertisements for ‘female pills’, which included warnings not to be taken by pregnant women. (Hint, hint.) Some pills were harmless, others contained poisons. An outbreak of lead poisoning in one England town, which caused a number of miscarriages, led to a fad for diachylon, a plaster containing lead—one chemist sold 500 doses in one year. Abortion was the only reliable form of birth control available to women. It would take a hundred years for contraceptives to catch up to the times.
II. The Birth of Modern Birth Control
In the mid-1800s through the early 1900s, products akin to modern forms of birth control became available, although not especially effective. The latex condom was invented by Fredrick Killian in 1919. Women could obtain cervical caps and diaphragms, though they were often too large (causing infections) or too small—about 24% of women using them still got pregnant. The first IUDs (intrauterine devices) were invented by accident: metal pessaries intended to block the cervix were anchored in the uterus and sometimes broke, leaving the intrauterine portion behind, which proved to be a successful form of contraception on its own. From 1892 to 1920, Dr. Clelia Duel Mosher studied the sex lives of 45 women, 28 of whom used contraception. Jonathan Eig, in The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, details Mosher’s findings: ‘the most popular form of contraception was Lysol, the antiseptic soap, whose formula in those days contained cresol, a phenol compound that often caused inflammation and burning. The second most popular choice was the condom.’ One woman used a ‘woman’s shield.’ Another had an IUD, ‘one of the most painful and medically dangerous’ methods of contraception: ring-shaped and bulky, they often caused infections. The rhythm method wouldn’t be invented until the 1930s, when scientists finally learned how ovulation worked. Before then it had been thought that the middle of a woman’s cycle was the safest time to have sex to avoid pregnancy. Doctors had explained this to women for decades. The middle of the menstrual cycle is in fact the time pregnancy is most likely to occur.
Why weren’t those options developed further and faster into truly safe and effective methods? Enter Andrew Comstock, who petitioned the US government to extend its anti-obscenity laws to everything he deemed obscene, including contraception. The Comstock Act was passed in 1873, making it illegal to distribute contraception across state lines. While Comstock was depriving women access to contraceptives, states across the US were criminalising abortions. In 1857 the American Medical Association began a campaign to outlaw all stages of abortion. By 1910 only one state did not have laws banning abortion.
Poor women had never gained access to the limited forms of contraception available. Abortion was still the only recourse for many of them: ‘Women swallowed lye and gunpowder, placed leeches inside their bodies… hammered their abdomens with brickbats, and swallowed poisons.’¹ They used knitting needles and shoe horns. They threw themselves down flights of stairs. They had large families and no money and husbands who wouldn’t take no for an answer. These were the women Margaret Sanger met as a nurse visiting tenement buildings in New York. She watched many of them die, ‘because their bodies could not hold up against the strain of producing so many babies in such poor conditions, or because they used primitive birth-control devices that caused infection, or because butchers posing as abortionists botched their jobs.’¹ Sanger helped nurse one woman back to health after a self-induced abortion, while the doctor attending scolded her for bringing the problem on herself and recommended her husband sleep on the roof. Three months later Sanger came back to care for the same woman, who ultimately died of complications from a second self-induced abortion.
In 1916 Sanger opened America’s first birth control clinic in Brownsville, Brooklyn. It was shut down after nine days. But her timing was lucky: court decisions were slowly but surely eroding the Comstock Laws. After the Crane Decision in 1917, licensed physicians were able to prescribe contraception (though only to prevent or cure disease). The ban on imported contraceptives was lifted in 1937. The last restrictions on contraceptives for married women were struck down in Griswold v Connecticut in 1965—the case that would be cited in Roe v Wade. In 1972 Baird v Eisenstadt finally assured unmarried women the right to contraceptives. Sanger was also lucky to recruit Katharine McCormick to her cause. McCormick was rich, and she was eager to do as much good as possible with her wealth. She helped Sanger found the first legal birth control clinic—on the pretense that the clinic’s purpose was to study birth control. McCormick was more than a benefactor, though. When the clinic ran out of the birth control they were in fact dispensing, she went on a trip to Europe, supposedly to shop for the newest fashions. She did buy trunks and trunks of clothes—and had a seamstress sew over a thousand diaphragms into the clothes, to smuggle into the US.
It wasn’t enough for Sanger. She wanted a contraceptive women could take without the permission of their husbands. Something safe and reliable. Something that wouldn’t prevent women from having children later in life. She met with countless scientists who told her No, it couldn’t be done, or No, they couldn’t be seen working on something so disreputable. And then, in 1950, at a time when one in four women experienced at least one unwanted pregnancy, she found Gregory Pincus. Pincus said yes. It would take years of research and experimentation for Pincus to come up with the right combination of hormones. It would take a great deal of Katharine McCormick’s money. It would take some bending of the truth about the purpose behind the first clinical trials, and conducting the final clinical trials in Puerto Rico, where contraceptives weren’t illegal, like they were in many parts of the US.
The 1950s were a time when contraception and even education about family planning still faced opposition at every level. Doctors in favour of contraception were too afraid to admit it, and plenty of doctors were still against it. A Planned Parenthood doctor during that time stated: ‘Being a woman means acceptance of her primary role, that of conceiving and bearing a child. Every woman has a basic urge and need to produce a child.’¹ Pressure from the Vatican kept the World Health Organization from helping nations who sought help with family planning. In 1955 Planned Parenthood asked the United Nations ‘to recognize a woman’s right to birth control as a basic human freedom.’¹ They refused. The National Institutes of Health were forbidden from supporting contraceptive research until 1959.
But public perception was changing. During WWII the military provided all US soldiers with condoms. Condom sales… swelled… after the war was over. Population control was a pressing concern in the minds of government leaders and the media. (Unfortunately population concerns were tinged with racism and remnants from the Eugenics movement.) Even the Pope was losing force among Catholic women. In 1957 Catholic women had an average of 20% more children than other women. In 1968, after Pope Paul IV issued an encyclical upholding the church’s ban on all forms of artificial contraception, American Catholics attending mass weekly fell from 71% to 50%. By the 1970s, Catholic women were having children at a rate nearly identical to that of other women.
When the first birth control pill was finally submitted for FDA approval in 1957, the manufacturer (Seale) applied only for permission to market the pill for menstrual disorders. The FDA had no choice but to approve the sale of the drug (Envoid)—it did help regulate menstrual cycles. Of course, one of the side effects was that it prevented ovulation. Seale had to list the ‘side effect’ on every bottle sold, granting them all the free advertising they could hope for. It was still illegal in seventeen states to sell contraception, but there were no laws forbidding the regulation of menstrual cycles. 500,000 women were taking Envoid before it was approved as a method of birth control. When Seale did submit a request to expand the use of the drug to include birth control, a Gallup poll showed nearly 75% of participants believed birth control should be legal. Envoid was approved for use as birth control on 9 May 1960. By 1965, 6.5 million women were taking the pill. There was a certain amount of backlash in the media: teenage sex clubs, housewives gone wild. But one gynecologist said, of his prescribing it for college students: ‘I would rather be asked for the pills than for an abortion.’
The pill had measurable changes on society. Families became smaller, dropping from an average of 3.6 children in 1960 to less than two by 1980. One woman said she kissed Pincus’ picture—for the first year in eight years of marriage, she wasn’t pregnant. Women could not only limit the size of their families but could start families later as well—could choose both a career and a family:
In 1970, women comprised 10 percent of first-year law students and 4 percent of business school students; ten years later, those numbers jumped to 36 percent and 28 percent, respectively. […] Harvard economist Claudia Goldin’s research has shown that the pll had a direct effect. Women were more likely to enroll in graduate school and postpone marriage in states that lowered the age of consent for contraception from twenty-one to eighteen.¹
In another study, Martha J. Bailey at the University of Michigan concluded that the pill led to an increase in hourly wages for women, helping to narrow the gender wage gap.
III. After Pill
The success of the pill, and the way it normalised the idea of a woman seeking contraception from her doctor, helped pave the way for a new generation of IUDs. By 1960 several plastic IUDs had been invented, allowing for much easier insertion than their ring-shaped predecessors, which had required dilation of the cervix. They became popular in developing countries as a form of birth control given to women living in poverty, who were thought incapable of remembering to take a pill every day. By 1974 the US government, International Planned Parenthood, the Population Council, and other organisations had funded IUD insertions for 7.5 million women in developing countries. Despite the connotation the devices had in the eyes of these organisations, women of all economic backgrounds began to embrace the IUD.
Then came the Dalkon Shield. Hugh Davis, one of its creators, openly denied his financial stake in the product and failed to report crucial information in the shoddy clinical trials he conducted. (For part of the study women took another form of birth control in addition to using the Shield.) The device was re-engineered before it went on sale and the new version was never tested. The pronged design increased its chances of perforating the uterine wall. The material and design of the string (necessary since those prongs made the darn thing so hard to remove) allowed a pathway for bacteria to enter the uterus: imagine a bumpy country road between the vagina and uterus paved over with an expressway. The Dalkon Shield was marketed aggressively, potential side-effects understated or omitted, the rate of pregnancy advertised as 1.1%, which the company knew to be untrue. Doctors inserted 2.2 million devices between 1971 and 1974. One physician reported that the insertion was ‘the most traumatic manipulation ever perpetrated upon womanhood.’² It was not uncommon for patients to faint from the pain. Thousands of women suffered infections, miscarriages, and birth defects. Many had to have hysterectomies, and at least eighteen women died. The manufacturer defended itself against lawsuits by insisting that the women bringing them were promiscuous and that was the cause of their medical issues. The Shield wasn’t officially recalled until 1984, after CBS’s 60 Minutes ran a story on the company’s refusal to issue a recall.
Sterilisation has an even more disturbing history. Championed by the Eugenics movement in the first half of the twentieth century for those ‘unfit’ to procreate, it gradually became sought after by middle class women who wanted an alternative to the pill and IUDs. Initially hospitals refused to administer the procedure unless the woman’s life was in danger: hospital policies had often developed in the first half of the century, when Eugenicists also promoted the procreation of women deemed ‘fit.’ White middle class women were supposed to be making babies, not getting sterilised. There was no legislation in place, so women began to sue for the right to the procedure. In 1971, one of the first lawsuits was filed and won against a hospital for refusing the surgery. The legal precedent established by that case and others would legitimise forced sterilisations quietly occurring throughout the country.³
Black women in Mississippi had a name for these surgeries: Mississippi appendectomies. They went in for abdominal surgery and left, unbeknownst to them, without their uteruses. Victims of forced sterilisation varied from region to region. Border states targeted Mexican Americans, while in New York, a rise in the Puerto Rican immigrant population meant those women were targeted. The Indian Health Service helped hospitals sterilise 25% to 42% of Native American women. The belief everywhere was the same: these women couldn’t help but reproduce uncontrollably, and the children to whom they gave birth would grow up to be burdens on the state just as their mothers had been. If these ‘welfare queens’ needed government hand-outs, then they would also have to accept whatever the government saw fit to do to their bodies. Many women were told they would lose their welfare benefits if they did not undergo sterilisations.³
IV. Here and Now
According to the Guttmacher Institute, ‘99% of women aged 15-44 who have ever had sexual intercourse have used at least one contraceptive method.’ The methods of birth control that came to the forefront during the 1960s and 1970s are the same forms we use today. Data collected in 2010 showed that, in all US women ages 15-44, 17% were on the pill, 16.5% had been sterilised, 10% used male condoms, and 6% had partners who had undergone vasectomies. Only 3.5% used IUDs, but that number is increasing. Data collected by the National Center for Health Statistics show an 83% increase in IUD use between the periods 2006-2010 and 2011-2013.
Conducting a poll of myself, I found this data to be valid. I tried the pill. (I think it was called Yaz? It was whichever one there were ads for on TV when I needed birth control. I don’t recommend this method of choosing birth control.) It took awhile before I made the connection that once a month, for a few days, I wavered between burning self-hatred and obliterating despair, and that those days were always the days right before I got my period, and that maybe hormonal birth control wasn’t the right option for me. I don’t think I learned until after I had stopped taking it that studies have shown higher rates of depression in women taking hormonal contraception.
The next time I needed birth control I went with a different method of selection: I did what my friends did. I knew two women who had just gotten IUDs and couldn’t stop talking about how wonderful they were. I did… some research. I saw it was the most effective and least costly (over the long term) form of temporary birth control. What more could a young and (hopefully) fertile woman ask for? If I had looked more closely into possible side effects, it would have been a harder decision to make. Fortunately, I guess, I waited until after the little bugger was securely tucked inside my uterus (a still painful procedure—seriously, ladies, if you get one, take the day off) to start exploring a forum for women with IUDs, chock full of horror stories. (Granted, the majority of women who have no issues probably aren’t posting.) Nothing too terrible happened to me. Nothing unendurable. For about six months after the insertion, I had cramps. EVERY SINGLE DAY. After two and a half years, I still get cramps most days, at least for a minute or two. They are different from the cramps that used to accompany my period. Sharper. Very distinctly, they are a shriek from my uterus that a foreign object is in its space and it wants it gone. It’s the best form of birth control, for me.
I sometimes feel frustrated by the options I have. The pill, sterilisation, and IUDs have all been around, in basically their current forms, for more than 50 years. Yes, new methods of hormonal contraception have been introduced: a patch, an implant, a vaginal ring. But it’s all more of the same. Risk the effects of hormones or an IUD, or choose to give up the option to have children. Maybe we just haven’t waited long enough. Maybe it will take another 50 years. Or maybe this is it. We’ve come a long way from lemons and Lysol. Maybe there is a limit to what we can impose on our bodies. Maybe that’s a good thing. Or at least an inescapable thing. Maybe circumventing the most basic instinct life has requires a small sacrifice.
¹The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution by Jonathan Eig, W. W. Norton & Company, 2014.
²Devices and Desires: A History of Contraceptives in America by Andrea Tone, Farrar, Straus and Giroux, 2001.
³Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950 – 1980 by Rebecca M. Kluchin, Rutgers University Press, 2009.