The History and Evolution of Birth Control in America

When you think about the history of birth control — as one does, what with so little else going on in the world these days — your mind probably goes straight to the invention of the iconic little Pill back in the ’50s. But the story of birth control actually begins millennia earlier.

“The very concept of birth control is not modern,” explains Linda Gordon, a history professor at NYU who penned the definitive history of birth control in America, 1976’s Woman's Body, Woman's Right: A Social History of Birth Control in America (updated and republished in 2004 as The Moral Property of Women: A History of Birth Control Politics in America). In fact, “The desire to prevent conception is probably as old as sex itself,” according to Andrea Tone, a professor of history at McGill University and the author of Devices and Desires: A History of Contraceptives in America.

Yep, we humans have been figuring out ways to get it on without getting pregnant since, more or less, the beginning of time. “You can go back to the most ancient societies and the most ‘primitive’ societies that anthropologists have discovered, and in every one of them, people are attempting to control their fertility,” Gordon says. (That includes not just contraception but abortion, too, Gordon points out, which was traditionally performed illegally by the same people who have helped deliver babies for centuries: midwives.)

The Wacky (and Wise) Birth Control Methods of Yore

Like most premodern medicine, a lot of the early forms of birth control were based not on science but on myth and magical thinking. The mammalian fertilization process involving the sperm and egg wasn’t even observed until the late 19th century, so our understanding of reproduction was pretty limited for most of human history. “Many [forms of birth control] didn't work, were unsafe, and lacked an aesthetic appeal,” says Tone.

They were also pretty bizarre — there is seemingly no end to the number of, erm, resourceful ways we’ve tried to keep our ovens bun-free over the centuries: unpleasant-sounding ointments, tinctures, and elixirs made of herbs and decidedly less edible stuff, like lead and leeches (in ancient China). Rituals in ancient India that had women fumigating their vaginas with neemwood smoke or inserting oil-dipped rock salt into them (come to think of it, these practices do sound very Goop-esque). The donning of amulets fashioned from dismembered dead animals, like weasel testicles (in the Middle Ages) and mule uteri (in ancient Greece). And a particularly primitive practice seen throughout the ages called coitus interruptus, aka the withdrawal method, or “pulling out.” (Can you even imagine?)

But beyond the nasty concoctions and Hannibal-like rites, our ancestors also came up with some surprisingly ingenious methods. In fact, Tone says, “Many of the contraceptive technologies available today are modifications of methods that have been used since ancient times.” There is even evidence of primitive intrauterine devices (IUDs) being used over the centuries, she says, though we shudder to imagine what those looked and felt like. These nonhormonal early versions probably worked by interfering with ovulation, fertilization, or implantation by causing mild inflammation of the endometrium.

Perhaps the most tried-and-true form of birth control is the barrier method in all its permutations. Over the centuries, women have used organic matter to construct devices called pessaries — small, round vaginal inserts, kind of like primitive diaphragms or cervical caps, meant to block ejaculate from entering the cervix — "in a range of shapes and sizes using stones, metal, glass, and other substances,” Tone says. If shoving a shard of glass up your vagina sounds uncomfortable, then consider the ingredients of choice in ancient Egypt: a mixture of crocodile dung, ant paste, and honey.

One of the simplest and cleverest barrier methods survived the centuries to become fodder for an iconic Seinfeld scene. “In really ancient societies, people that lived near the sea — where natural sponge grows — would insert these sponges in the vagina to block the sperm from reaching the uterus [and] prevent conception,” Gordon explains. They also experimented with natural spermicides that imparted a lovely citrusy scent but probably stung like hell. “Generally speaking, any acetic fluid, like orange juice or lemon juice, is going to kill sperm. So women would sometimes soak the sponge in lemon juice or wash themselves out with [it].”

Women had most of the fun to themselves, but not all. There are records of Japanese men sheathing their penises with primitive condoms made of stuff like leather (erotic) and tortoiseshell (no thanks). They were more sophisticated in 16th-century Italy, Tone says, where men wore linen sheaths soaked in herbal tonics to prevent the spread of STIs like syphilis. By the early 19th century, American men were sporting condoms fashioned from animal intestines. Sexy stuff.

Along Came the Rubber

Finally, after centuries of crafty, nature-based DIY methods, the first real technological revolution in contraceptives arrived in colonial America with the invention of vulcanized rubber in 1839. The latex-like material was used to manufacture condoms of a much higher quality, as well as, in time, the vaginal diaphragm: a shallow cap-shaped device that grips the vaginal walls and blocks the cervix so sperm can’t enter. Unlike pessaries and sponges, the rubber diaphragm had a flexible outer ring that made it easier for women to insert themselves, Gordon says. “And for a very, very long time — really until 1960 — that was the only form of reliable contraception available [to women].”

The Crusade Against Birth Control Begins

This is also about the time when the U.S. government hopped on the anti-birth-control bandwagon that most of the monotheistic religions had been riding since the start of the modern period, Gordon says. “Between the 1840s and the 1890s, for the first time, most of the states…had either banned contraception or radically limited it,” effectively making it illegal throughout the U.S. And in 1873, the Comstock Act outlawed the distribution of all “obscene materials,” making it illegal to distribute not just stuff like pornography, but anything having to do with artificial contraception.

But women weren’t about to hand over their right to control their own reproduction just because Uncle Sam said it was illegal. They just did it on the D.L. Low-tech methods like pessaries and douches were still common. Well-to-do women bought birth control overseas in Europe, Gordon says, where they were “much more relaxed about contraception, even in Catholic countries, like France.” And smugglers brought it back to the U.S. to be sold on black markets.

The Beginnings of a Movement

With a hearty women’s suffrage movement already long under way at the start of the 20th century, a number of powerful socioeconomic and political forces coalesced into a growing demand for birth control — rolling out another battleground in the fight for women’s rights. Among them, Gordon says, were state laws that made childhood education compulsory, in turn removing children from the workforce (and transforming those little breadwinners into little money pits), as well as legislation raising the marriage age. And when American men went off to fight in World War I, women filled many of those jobs. As Gordon puts it, “There were a lot of things about modern life that just made it really impractical if not impossible for women to simply have one childbirth after another after another.”

World War I actually played another unexpected role in setting the stage for a birth control revolution. Bustling prostitution industries sprang up around army bases and seaports, and soon the U.S. Navy was facing a full-on epidemic of venereal disease, Gordon explains. Facing a massive loss of days of active duty, the desperate secretary of the Navy put aside his evangelical beliefs and made condoms standard issue for sailors. And when the men came home, they weren’t about to give up the handy access to safe sex they’d become accustomed to. Condoms started being sold in drug stores (purportedly solely for the prevention of venereal disease, per the package label, Gordon says).

This condom boon did not sit well with women. “It really stimulated the birth control movement because it created an unfair double standard,” Gordon says. “Men could go to any drug store and get a condom, and there was nothing like that that women could get legally.” What’s more, “a lot of women did not want to trust men to be the [the one to provide contraception]. They wanted to have that power in their own hands.”

Margaret Sanger and the Birth Control Leagues

The organized fight for contraception started taking shape, and the face of this movement was a charismatic and ambitious woman named Margaret Sanger, regarded today as “the person most responsible for transforming birth control from a widespread private practice into a political, public movement,” as Tone puts it. While working as a visiting nurse in New York, Gordon says, Sanger was “appalled” by the poor health of lower-class women giving birth to children they couldn’t afford — or resorting to dangerous back-alley abortions. That experience galvanized her extraordinary life’s work for decades to come. During a visit to Europe in 1915, she connected with like minds and learned about diaphragms. “She came back to the United States just determined to do something about this, and she was brave enough to be willing to be arrested,” Gordon says — which she was, the first time, after illegally opening the country’s first birth control clinic in New York the next year. In 1921, she founded the organization that would later become Planned Parenthood.

Grassroots campaigns taking their cue from Sanger were thriving in virtually every major city by the 1920s. Organizations called birth control leagues spread the word and ran illegal clinics. “There emerged for the first time a real, powerful social movement for birth control,” says Gordon, and “that’s when you begin to see this real change in public opinion.” They even began gradually overturning the laws against contraception, state by state. (Though the Comstock Law was still in effect, it stopped being used to prosecute discussion about birth control, Gordon explains.) Many of these laws remained in place, however.

Finally, the Pill

It took a few decades for science to rise to the challenge issued by birth control activists. (Meanwhile, condoms and diaphragms continued to reign supreme.) In 1950, Sanger kicked off the search for the Pill, securing funding from her wealthy husband and close friend Katharine McCormick (a brilliant biologist, women’s rights crusader, and heir to a massive fortune) and facilitating research done by two scientists, Gregory Goodwin Pincus and John Rock.

Pincus and a leading fertility doctor named John Rock more or less stumbled upon the idea behind the Pill while searching for an infertility treatment. He thought giving women doses of the pregnancy hormones estrogen and progesterone might help them conceive, but it only tricked the body into thinking it was pregnant by artificially suppressing ovulation: the basic and brilliant mechanism underlying the Pill. After repurposing the drug, years of experimentation, and clinical trials conducted by Rock in Puerto Rico and Haiti, Sanger had something.

While many women experienced unpleasant side effects and there were concerns about safety and reliability from the start, the drug proved unprecedentedly successful at regulating women’s menstrual cycles and preventing fertilization. “It was the first time that anyone sort of tinkered with a woman’s hormones as a way of preventing conception,” Gordon says. In 1957, the FDA approved the Pill — but only for the treatment of menstrual disorders. (Coincidentally, “an estimated 500,000 women quickly reported having such disorders,” Tone says.) Then in 1960, the FDA OK'd the Pill to prevent pregnancy.

In addition to the backlash from conservative Americans and religious institutions like the Catholic Church (which had officially banned birth control in 1930), there were a couple of not-insignificant obstacles to surmount before the Pill would reach the status it enjoys today. Contraception was still illegal in a number of states, but pills were easy to smuggle across state lines and share among friends, Gordon says. Also, neither drugmakers nor doctors were really prepared for the upheaval. “Many established pharmaceutical companies in the late 1950s passed on the opportunity to bring an oral contraceptive to market,” Tone says, with some fearing boycotts by American Catholics and others doubtful that women would even be interested. And doctors weren’t familiar with the science of hormones that make the drug possible.

But ultimately, American women who had long been waiting for the self-agency that this new drug offered embraced it en masse. “Once that pill was available, you just could not stop women from gaining access to it,” Gordon says. “Women's sudden, surging interest in the Pill is…a reflection of women's desires for a contraceptive that provided what other methods did not: It was female-controlled, discreet, and, when used as prescribed, almost 100 percent effective,” Tone adds.

The Pill was nothing short of a boon for the birth control industry as a whole. “The Pill's popularity and profitability feminized, medicalized, and pharmaceuticalized contraception,” Tone says. “Companies that had previously held back introduced rival oral contraceptives to claim a part of the profitable Pill pie.” With the tides shifting in the medical community, the pharmaceutical industry, and mainstream culture, the Supreme Court finally legalized contraception for married couples in 1965; singles got to join the party in 1972. (One year later, abortion too became legalized in Roe v. Wade.)

There was some serious backlash against the Pill in 1970, based on concerns about safety and serious side effects, like embolisms and heart attacks. “The amount [of hormones] that was in the pill [back then] was about 100 times what’s in the birth control pill today,” Gordon explains. After heated congressional hearings on the matter, the formulation was altered and warnings about the side effects and safety of the Pill was added to the package. It took a while for doctors to figure out just how low of a dose would still be effective. These less potent pills and the progestin-only pill (the “mini pill”) were introduced in the ’80s. “Fast forward to today, we now have over 40 different brands of oral contraceptives,” Tone says.

Beyond the Pill

The Pill isn’t the only kind of birth control to emerge in the last 50 years, of course. Although it had been experimented with earlier, safe and effective tubal ligations (aka getting your tubes tied, or severing the fallopian tubes) and vasectomies (severing the vas deferens) came about in the early ’70s for those looking for a more permanent solution.

But most of the birth control products brought to market since are essentially riffs on the hormonal method the Pill introduced. “After the Pill came some other developments that were technologically interesting but not really revolutionary like the Pill,” Gordon says. The patch, implants, injections, the vaginal ring, hormone-releasing IUDs: These are merely different (and more convenient) vehicles for delivering pregnancy-preventing hormones, either semi-permanently implanted for an ongoing dosage, or taken every few months. It’s important to point out that the tremendous variety of hormonal contraceptives available today have become an integral part of gynecological medicine, having outgrown their function of merely preventing fertilization to be prescribed to treat problems like menstrual irregularity, painful periods, and endometriosis.

Surprisingly, there’s really only one highly reliable and safe nonhormonal contraceptive that has been introduced in the decades since the Pill: the nonhormonal IUD. Though proto-IUDs have been used around the world throughout history, they weren’t well vetted or widely available in the U.S. until the late ’60s, when T-shaped IUDs made of plastic and/or metal hit the market. In the 1970s, serious safety concerns surrounding one particular brand of IUD — reports of pelvic infection, infertility, even death — caused the FDA to ban the device, and soon other IUDs were pulled from the market. They made a comeback in 1988, with the advent of the highly effective copper IUD that we still use today, which can prevent pregnancy for about 10 years. Copper, scientists found out, is really good at stopping sperm from swimming toward the eggs they want to fertilize.

The Birth Control Revolution’s Reach

Looking back today, it can be difficult to grasp just how major the impact of the Pill was on life for American women. “I would argue that effective contraception was probably in the whole of the 20th century the most important change for women,” Gordon says. The ability to be in control of their own fertility and reproduction gave women a profound new autonomy over their own bodies, their health, and their sexuality. The Pill hugely factored into the sexual revolution of the ’60s by decoupling sex and children, transforming the sex lives of both single women who were dating and married couples. Most importantly, the ubiquity of birth control granted women a radical new degree of freedom to shape their futures — whether they wanted kids, how many they wanted, and when they wanted them. This in turn enabled women to pursue higher education and careers over marriage and motherhood.

And that they did. The change happened fast, too: According to one study cited by Planned Parenthood, by 1970, college enrollment was up 20 percent among women who had access to the Pill by the time they turned 18 (compared to women without access). And between 1969 and 1980, the dropout rate among women with access to the pill was 35 percent lower than women without. Empowering women to pursue and excel in higher education and the workforce has had deep and irreversible economic and societal repercussions.

Today, 62 percent of women age 15 to 44 use some kind of birth control, according to the CDC. It is currently covered by insurance courtesy of the Affordable Care Act (though the Trump administration made moves last year to chip away at that coverage under the banner of religious freedom for employers). While still formally unsanctioned by religious institutions like the Catholic Church, it is no longer an issue at the forefront of mainstream conversations about faith and is broadly deemed morally A-oK by Americans across the board: 91 percent of them, according to Gallup’s most recent moral survey. Birth control has become imperceptibly woven into the fabric of society, a prerequisite for modern life — as unremarkable and taken-for-granted as the rest of our most miraculous technological innovations.

But the story here is far from over, as scientists are working toward developing safe and effective forms of male birth control. To which women everywhere say, "About damn time." The past few thousand years have been real, guys, but we’re ready and willing to share this load. If there’s anything the long, fascinating history of birth control has shown us, it’s that the powerful, universal desire to have sex without reproducing elicits an astounding amount of creativity and persistence from humans — and is not going away anytime soon.

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