Birth Control

Human beings have sought to avoid child bearing since ancient times and have used many methods to prevent conception or to kill a developing fetus. Religious and secular authorities usually discouraged the separation of sexual intercourse from procreation because they believed that it violated natural law or deprived the state of human capital. Thus, while individuals pursued their self-interests through such practices as coitus interruptus or inducing abortion, they usually acted in flagrant violation of official standards of sexual conduct.

Falling Birth Rates and the Social Environment

The English economist and cleric Thomas Malthus brought reproductive behavior into public debates over the nature of poverty through his Essay on Population (1798). He argued that rapid population growth forced down the living standards of the working classes, whose only hope for amelioration lay in "moral restraint" or the prudent postponement of marriage. In the early nineteenth century, English labor organizer Francis Place and other champions of the poor advocated family limitation as a tool in the struggle for social justice and sometimes published descriptions of how to prevent conception. These neo-Malthusians found a growing audience during the nineteenth century as birth rates began to decline in many countries that were actively involved in the developing market economy of the Atlantic world. These secular declines in fertility resulted from the private efforts by the sexually active to avoid pregnancy and were routinely denounced by political leaders, who attempted to suppress information on fertility control techniques. The term birth control was coined in the June 1914 issue of The Woman Rebel, a militantly feminist journal published in New York by Margaret Sanger (1879-1966), who became the preeminent champion of reproductive autonomy for women through her campaigns to abolish the legal and social obstacles to contraceptive practice. Eventually the term birth control became a synonym for family planning and population control, but the term family planning was originally adopted by those who wished to disassociate the movement to control fertility from Sanger's feminism, and the phrase population control was largely a post–World War II movement led by social scientists and policy-making elites, who feared that rapid population growth in the non-Western world would undermine capitalist development.

The precise timing and social determinants of the demographic transition in western Europe and North America from a vital economy of high birth rates and high death rates to one of low fertility and low mortality is still much in dispute among demographers, perhaps because of class and geographical differences in motivation and behavior. While French peasants seem to have been pioneers in fertility restraint during the eighteenth century, a broad spectrum of native-born Protestants in the United States led the turn to family limitation during the nineteenth century. In the United States the average native-born white woman bore seven or eight children in the late eighteenth century, but by the middle of the nineteenth century she was the mother of five, by the early twentieth century the mother of three, and by the middle of the Great Depression of the 1930s the mother of two. One of the remarkable aspects of the American demographic transition is that there were no sustained declines in INFANT MORTALITY before 1900. Several generations of American women had fewer children than their mothers despite high infant mortality and vigorous attempts by social leaders to encourage higher fertility.

The fertility decline is best understood as a response to a changing social environment. As the home ceased to be a unit of production, and as the manufacture of clothing and other goods moved to factories, children no longer provided necessary labor in the family economies of the emerging middle and white-collar classes. Rather, they became expensive investments, requiring education, capital, and an abundance of "Christian nurture" from mothers who measured respectability by the ability to stay home and efficiently manage the income won by their husbands in a separate, public sphere of work. Marriage manuals, some containing instructions for contraception, were prominent among the self-help books that became a staple of American culture after 1830. Romantic love became the rationale for marriage and religious leaders gave new prominence to the erotic bonds between husbands and wives. Thus, socially ambitious married couples bore the burden of reconciling sexual passion with a manageable number of children, whose socialization required more expensive and permissive nurture.

Historians now attribute the fertility decline to restrictive practices–contraception, abortion, and abstention from coitus–rather than biological changes or shifts in the percentage of individuals who married or their age at marriage. The efforts by individuals to control their fertility for personal reasons inspired the first self-conscious attempts to suppress birth control. Between 1840 and 1870, leaders of the medical profession organized successful campaigns to criminalize abortion through new state laws. The culmination of the campaigns against abortion in state legislatures coincided with the passage of the Comstock Act (1873) a strengthened national obscenity law in which no distinctions were made between smut, abortifacients, or contraceptives–all were prohibited.

During this period of legislative repression of contraception, Catholic theologians debated the moral implications of claims by experimental physiologists that there might be a naturally occurring sterile period in the female menstrual cycle. Church authorities quietly accepted the legitimacy of limiting coitus to periods of natural sterility, but the effectiveness of this "rhythm method" proved limited, and the Church's ancient prohibition on "artificial" contraception was reaffirmed by Pius XI in the encyclical Casti Connubi (December 1930).

Margaret Sanger

By the second decade of the twentieth century women in both Great Britain and the United States had begun to challenge the taboos on fertility control. Margaret Sanger won her place as the charismatic leader of the birth-control movement in the United States through her ability to develop a compelling rationale for the acceptance of contraception as an alternative to illegal abortion, since an appalling number of women died from septic abortions. Although she was influenced by the anarchist Emma Goldman and by trips to Europe, during which she was impressed by the sexual know-how of ordinary French women and by the birth-control advice stations operated by feminist physicians in the Netherlands, Sanger claimed that the death of one of her nursing clients from a self-induced abortion led her to focus all her energy on the single cause of reproductive autonomy for women. Sanger opened the first birth-control clinic in the United States in October 1916, in the Brownsville section of Brooklyn, New York. A police raid closed the clinic after ten days, but Sanger's trial and brief imprisonment made her a national figure, and in appealing her case she won a 1919 clarification of the New York State obscenity law that established the right of doctors to provide women with contraceptive advice for "the cure and prevention of disease."

Sanger interpreted this decision as a mandate for doctor-staffed birth-control clinics. Spurred by the emergence of an English rival, Marie Stopes, who opened a birth-control clinic in London in 1921, Sanger played down her radical past and found financial angels whose support allowed her to organize the American Birth Control League in 1921 and the Birth Control Clinical Research Bureau in New York City in 1923. The first doctor-staffed birth-control clinic in the United States, it provided case histories that demonstrated the safety and effectiveness of contraceptive practice and served as a model for a nationwide network of over 300 birth-control clinics by the late 1930s. In 1936 Sanger won an important revision in federal law with U.S. v. One Package (1936), which established the right of physicians to receive contraceptive materials. In 1937 the American Medical Association recognized contraception as an ethical medical service.

On the eve of World War II, the limits of the birth-control movement seemed to have been realized. A majority of Americans practiced some form of fertility control, but there was widespread concern about the low birth rate and little support for public subsidy of the services. Many social leaders were disturbed by the more permissive standards of sexual behavior that emerged during the first decades of the twentieth century as young women became increasingly visible as wage earners and as participants in an eroticized consumer culture. Alfred Kinsey and other pioneers in the survey of sexual behavior documented increases in premarital sexual activity that convinced some social conservatives that sexual liberation had gone too far. After World War II, however, influential social scientists such as Frank Notestein of Princeton University's Center for Population Research provided a new rationale for birth control by drawing attention to rapid population growth in the Third World and by arguing that the United States risked losing the Cold War because economic development compatible with capitalism might be impossible if the means were not found to curb birth rates.

Birth Control after World War II

John D. Rockefeller III became the leader of a revived movement to promote population control by founding the Population Council in 1952, after he failed to convince the directors of the Rockefeller Foundation that his interests warranted major new initiatives. The Population Council subsidized the development of academic demographic research in the United States and foreign universities and by the late 1950s was providing technical assistance to India and Pakistan for family planning programs. Concerned over the failure rates of the conventional barrier contraceptives such as condoms and diaphragms, the council invested in the clinical testing, improvement, and statistical evaluation of intrauterine devices (IUDs), that is, objects placed in the uterus to invoke an immune response that inhibits conception. A second major advance in contraceptive technology came with the marketing of an oral contraceptive by J. D. Searle and Company in 1960. "The pill" depended on recent advances in steroid chemistry, which provided orally active, and inexpensive, synthetic hormones. Margaret Sanger ensured that these new drugs would be exploited for birth control by recruiting Gregory Pincus of the Worcester Foundation for Experimental Biology for the work and introducing him to a feminist colleague, Katharine Dexter McCormick, who provided the funds Pincus needed to realize their dream of a female-controlled form of birth control that did not require specific preparation before sexual intercourse and thus made spontaneous sexual activity possible. The pill's rapid acceptance by the medical community and its female clients was enhanced by the growing use of synthetic hormones to treat a wide range of gynecological disorders so that contraception now appeared to be divorced from the "messy gadgets" of the past and was place in the context of modern therapeutics. In 1963 the Roman Catholic gynecologist John Rock, who had led the clinical trials of the first oral contraceptive, proclaimed, in The Time Has Come, that contraception was, thanks to the pill, now compatible with Catholic natural law theology. Rock's optimism proved false when Pope Paul VI's encyclical Humanae Vitae (July 1968) confirmed traditional teachings that prohibited artificial contracerpition, but by then a majority of married Catholics in the United States were practicing birth control.

A series of federal court decisions and new welfare policies reflected the changed status of birth control in public opinion. In 1965 the U.S. Supreme Court, in Griswold v. Connecticut, struck down a statute that prohibited contraceptive practice. The court continued to expand the rights of individuals to defy outdated restrictions in Eisenstadt v. Baird, (1972), which established the right of the unmarried to contraceptives. As President Lyndon Johnson's War on Poverty emerged from Congress, the Social Security Amendments of 1967 specified that at least 6 percent of expanding maternal and child health care funds were to be spent on family planning services. The Foreign Assistance Act of the same year provided aid for international programs, and contraceptives were removed from the list of materials that could not be purchased with Agency for International Development funds.

By the late 1960s feminists and population control advocates were successfully challenging state laws that limited access to abortion. In 1973 the U.S. Supreme Court attempted to forge a new consensus in Roe v. Wade, which recognized the right of abortion on demand during the first trimester of pregnancy. The Court's decision simply added fuel to an escalating firestorm of controversy as Roman Catholic leaders found common cause with Protestant fundamentalists and social conservative critics of the welfare state in a "right-to-life" and "family values" movement. From the left, groups such as the Committee to End Sterilization Abuse (founded in 1974) charged that minority women were being coerced by government maternal health programs that they viewed as genocidal. Revelations that disproportionate numbers of Hispanic and African-American women were sterilized in government programs that lacked adequate ethical guidelines supported complaints by such organizations as the National Women's Health Movement and the International Women's Health Coalition that the American health-care establishment had gone radically wrong in its high-tech, top-down, paternalistic approach to reproductive health issues.

At the 1974 United Nations World Population Conference, held in Bucharest, Rumania, John D. Rockefeller III recognized the criticisms of conventional family planning programs that had been mounted by feminists and the Population Council was reorganized to emphasize holistic approaches to women's health issues. New ethical guidelines were developed for federally sponsored maternal health programs as well, but deep social divisions remained between "pro-choice" and "pro-life" advocates, with the Democratic Party embracing the former and the Republican Party embracing the latter. Despite numerous challenges in state and federal courts and legislatures, Roe v. Wade remained the law of the land. In the late 1990s federal and state expenditures for subsidized family planning, including contraception, sterilization, and therapeutic abortion, exceeded $700 million annually, while the birth rate among the native-born was below the level needed to maintain the population, which continued to grow because of liberal immigration laws and mass immigration to the United States.

The birth rate was even lower in Europe, where in countries such as Spain and Italy reproduction was not at a rate high enough to maintain their populations. In many other parts of the world, including China, India, and the Middle East, previously high birth rates were also in decline.

See also: Conception and Birth; Eugenics; Fertility Rates; Obstetrics and Midwifery; Sexuality.


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