Birth control

Birth Control in America: A Brief History of Contraception

Let’s look at how far women’s reproductive health options have come in the last 100 years.  In an era when women and men have a number of effective options to prevent unwanted pregnancy, it’s easy to forget that this wasn’t always the case. In fact, before the introduction of the birth control pill in 1960, couples accepted the reality that sex could — and did! — regularly lead to parenthood.

Sex and Pregnancy Before the Birth Control Pill

Prior to the pill’s approval, “American women were extremely constrained in their ability to delay, space, or prevent pregnancies,” says Megan L. Kavanaugh, a principal research scientist at the Guttmacher Institute, a research organization in New York.

And as you’ll see below, men didn’t have it so great either.

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Withdrawal and Abstinence Were the Prime Birth Control Methods

With reliable contraception scarce, people often relied on abstinence to keep them childless, according to the nonprofit sexual health organization Our Bodies Ourselves. (1) After all, this is the only method guaranteed to prevent pregnancy.

Withdrawal, or the stopping of intercourse before sperm is ejaculated, was another long-used method, the group says. (1)

Some couples tried to time their sexual activity for times when the woman was less likely to get pregnant. Called natural family planning, or the Billings method, this uses a woman’s resting body temperature (which rises a fraction during ovulation), the least fertile dates of her menstrual cycle, and the consistency of cervical mucus (long and stringy just before ovulation) to predict the time with the lowest odds for pregnancy.

What people could not rely upon was getting accurate information in schools. Sex education as we know it only got started after the 1960s, with widespread implementation in the 1980s and beyond.

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Early Versions of Condoms and Spermicide to Help Prevent Pregnancy

Comfortable condoms may be a recent invention, but couples have used rudimentary versions for thousands of years. Animal intestines, fish bladders, and linen were some of the materials used for sheaths. (Ouch!) Sometimes, the item was soaked with one or more chemicals to provide a spermicide. (1)

Some early versions of condoms were made from animal intestine. This sheath comes from a sheep.
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Vulcanized Rubber Revolutionized Condoms

Condoms took a major leap forward in the mid-1800s, when Charles Goodyear created a process whereby natural rubber could be made more durable, so it didn’t crack as it previously had. This “vulcanized” rubber not only revolutionized tires, sneakers, and athletic gear, it ushered in a new age for birth control. This discovery allowed rubber condoms (as well as the less widely used diaphragms) to become mass produced and wildly popular (despite federal and state anti-birth-control laws), according to a Public Broadcasting System documentary on the topic. (2)

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The Comstock Act of 1873 Made Birth Control Illegal

One of the broadest laws making birth control illegal was the Comstock Act. Passed by the federal government in 1873, it made it a crime to possess, distribute, or provide information about contraception or abortion. Penalties for breaking the law were steep: up to five years in jail and a large fine. (3)

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Women Used Homemade Douches to Help Prevent Pregnancy

With women bearing the brunt of an unwanted pregnancy, and condoms dependent on the cooperation of the man, it’s not surprising that women long tried to concoct their own chemical brews to prevent pregnancy. Unfortunately, for the most part, these were not very effective.

In preindustrial America, for example, homemade herbal douches were mixed and inserted before sex. If an unwanted pregnancy occurred, other strong herbs, like pennyroyal, were ingested in the hope it could terminate the pregnancy. (2)

In the early 20th century, products that could be purchased without a prescription in the drugstore were popular. To stay within the law, they were sold as feminine hygiene rather than contraception. These items, mostly ineffective as birth control, ranged from suppository pills to vaginal jellies to cleansing douches. (2)

Condom quality control took off after 1937, when the FDA introduced testing standards in order to fight venereal disease.
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The Quest for a Pill to Prevent Pregnancy

With medicines becoming available in the 20th century for many medical conditions, people began to yearn for a pill they could pop that would effectively prevent unintended pregnancy.

That hope began to seem like a reality in the late 1930s, when animal experiments demonstrated that high-dose progesterone could stop a woman’s ovulation. A decade later, a chemist was able to make a synthetic version of progesterone, called progestin, and the pill moved one step closer. (4)

The People Behind the Development of the Birth Control Pill

As a history of the pill in the journal Canadian Family Physician explains, the method’s initial clinical investigation was surprisingly driven by two devout Catholics. Margaret Sanger had been a longtime birth control advocate. She opened the first birth control clinic in 1916, earning her a sentence of 30 days in jail. (1) Sanger raised money for research and helped with an early trial in Boston under the ruse of being a fertility study. John Rock, MD, worked with colleagues to conduct key clinical trials. (4)

Early Clinical Research on the Birth Control Pill

These early studies were performed in Puerto Rico, largely because it had no anticontraception laws, had a strong network of birth control clinics, and was not too far from the mainland United States. Although women’s advocates later criticized this research because participants were not told of the risks and had not given informed consent, this was the standard practice at that time. (5)

Effectiveness, and Side Effects, of the Birth Control Pill

These studies proved the effectiveness of the pill, although early versions were not without significant side effects, including nausea, dizziness, headaches, and blood clots. (6)

Finally, in 1960, the first hormonal birth control pill was approved by the Food and Drug Administration (FDA), ushering in a new era of reliable contraception. (6)

Continued improvements in the pill, as well as the other hormonal methods that followed, have had a major impact, not only on childbearing but on society and on women’s lives.

The Birth Control Pill Changed Everything

Immunizations, better treatment for heart disease, and the pill — these are among the top 10 public health achievements of the 20th century, according to the Centers for Disease Control and Prevention.

The impact of hormonal birth control on women’s (and men’s) lives cannot be overstated, says Kavanaugh.

The ability to delay and space childbearing is not only crucial to a woman’s health, it directly affects her social and economic advancement, Kavanaugh says. “Women’s ability to obtain and effectively use contraceptives has a positive impact on their education and workforce participation, as well as on subsequent outcomes related to income, family stability, mental health, and children’s well-being,” she explains.

The Pill Has Greatly Impacted American Women’s Lives

According to Planned Parenthood, fully one-third of the wage gains made by American women since the 1960s can be traced to oral contraceptives. Between 1970 and 1990, hormonal birth control accounted for some 30 percent of the increase in the rate of women entering skilled careers like medicine and law. It has also been the most influential factor enabling women to stay in college. (7)

Couples recognized the benefit this method provided right away. The pill was officially approved by the FDA in 1960. But the FDA had given it the nod three years earlier to “regulate menstruation” — with the package required to warn about its “contraceptive activity.” Some half-million women used the pill during these years. (6)

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Early Oral Contraception Side Effect Risks Were Significant

Enovid was the pill approved in 1960 for contraception. That pill, along with others in those early years, had very high doses of hormones. This led to side effects like dizziness and vomiting, and a rare but risky increase in heart attacks and strokes. (6)

It took more than a decade — and a lot of public prodding from women — for scientists to become concerned enough about these problems to study lower doses of hormones, which proved to be just as effective. These lower doses are what are used in birth control pills today. (6)

Finally, All Women Could Get the Birth Control Pill

It wasn’t until 1965 that the law banning birth control was struck down by the U.S. Supreme Court.

Eventually, concerns over side effects led to low estrogen pills, such as Zorane (1965).
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However, this case, Griswold v. Connecticut, applied only to married couples. Millions of unmarried women were still denied the pill. Finally, in 1972, the Supreme Court case Baird v. Eisenstadt legalized birth control for everyone. (1)

Manufacturers worked hard in the 1980s to improve the pill, offering women new dosages, progestins, and multiphasic pills. (4)

Today, the pill remains a sought-after method of reversible birth control. Some 26 percent of all birth control users are on the pill, amounting to 16 percent of American women of reproductive age. (8)

The First Intrauterine Birth Control Devices Faced a Rocky Road 

With women clamoring for additional birth control choices, the FDA approved the first intrauterine devices (IUDs) in the late 1960s. These early devices did not use hormones, primarily serving to block the egg from implanting.

In 1974, however, one of these IUDs, the Dalkon Shield, was pulled from the market after it was linked to numerous infections and seven deaths. Although only that one brand was implicated, other manufacturers feared expensive lawsuits and also pulled their IUDs from the market, denying couples this contraceptive option for years. (1)

Finally, in the 1990s, a new copper IUD called ParaGard was approved. And in 2000, the Mirena IUD, which additionally releases a progestin, came on the market. (1)

Low-Tech Birth Control Methods Are Still Around, and Still Useful

For women who don’t want to or can’t take hormones, barrier methods like the condom and the diaphragm remain viable birth control methods. Condoms, available in varying materials, textures, and even flavors, are currently used by about 15 percent of contraception users, according to the Guttmacher Institute. (8)

Withdrawal and the rhythm method are also practiced but by a small percentage of couples. (8)

More Hormone Delivery Systems Keep Coming

Over the last few decades, hormonal contraceptives have become available in methods beyond an oral pill. These range from injections and vaginal rings to hormonal patches and insertable rods. (8)

Emergency contraceptive pills, designed to be taken after unprotected sex, first emerged in the late 1990s. But their availability greatly improved in 2013 when Plan B One-Step was given the nod by the FDA to be sold in drugstores without a prescription. (8)

Sterilization Is Still Contraception King

Although great strides have been made in reversible birth control methods, none is ideal. Perhaps this is the reason that the greatest number of reproductive-age couples opt for permanent sterilization.

Some 25 percent of women in this age group and 8 percent of the men have chosen sterilization as their method of birth control. Taken together, this makes sterilization the most widely used contraception method in the United States today. (8)

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