Controlling, timing, or avoiding pregnancy is a concern for anyone involved in sexual activity with the potential for sperm-egg contact. The history of contraception is important because controlling birth, either to guard against or to promote pregnancy, has been a concern throughout recorded human history.1 Learning such history sheds light on the scientists, manufacturers, government officials, distributors, salespersons, and activists who paved the way for the variety of contraceptive technologies used today. Additionally, this book provides readers historical context for their own reproductive lives, contraceptive use, and decision-making processes.
More broadly, this book also frames the history of contraception in a wider context of population control, eugenics (including involuntary sterilization), racist and classist restrictions on birth control access, and the extent to which people do or do not accept technological methods into their sexual and reproductive lives. Various technological methods can be embraced or rejected for a variety of reasons, including mental health (loss of libido or desire), physical health (increased bleeding or spotting), and allergies (such as to latex). Additionally, those with strict religious or moral beliefs, such as those who adhere to Roman Catholicism’s prohibition of technological contraceptives and those who avoid hormonal or technological modifications to the body, both favor timing methods, which can also include withdrawal. Some of these individuals, however, may accept the use of external technologies, such as a thermometer or fertility computer, in order to avoid more invasive or morally objectionable internal technologies. Others may use technologies such as sex toys or dolls, with or without the presence of a partner, in order to avoid sperm-egg contact completely. Studying the reasoning behind the use or nonuse of contraceptive methods thus illuminates broader themes in the history of human-technological interaction.
This book raises broader questions not only about the relationship of individuals to technologies but also about the ways that contraceptives play a role in local, national, and international politics. Laws and policies from the US’s Comstock Act to Ireland’s Criminal Law Amendment Act affected and continue to affect people’s personal lives, livelihoods, and decision making. Laws and regulations govern the intellectual property of contraceptives (such as the chemical composition of spermicides); manufacturing standards; testing on animal and human subjects; legal requirements concerning advertising, sales, and distribution; and the parameters under which sales are allowed, such as age restrictions or prescription requirements. National or state policies can force people into involuntary sterilization, unwanted intrauterine devices, or hormonal implants in the service of “population control,” as happened during the 1975 to 1977 Emergency in India. The presence or absence of legal contraceptives in a state or nation serves as a symbol of its commitment to women’s and human rights—in other words, its commitment to reproductive justice.
This book is a history of contraceptive technologies from the opening of the first birth control clinic in Amsterdam, the Netherlands, in 1882 to the present. It traces the research, development, manufacturing, distribution, and use of contraceptive methods that were and are marketed and sold to the public. Those methods were and are available with or without a prescription, for people of all genders. The history of contraception involves the synthesizing of diverse histories, including the history of technology, women’s and gender history, the history of sex and reproduction, population control studies, legal history, and political history. It requires a broad understanding of individual behavior and identity formation; nonprofit advocacy groups and independently wealthy individual advocates; religious organizations; governmental policies at various levels and the execution thereof; and technological development, manufacturing, and distribution, among other factors. Geographically, the primary emphases in this book are on the United States and Western Europe, with secondary emphases on the Caribbean, Peru, Eastern Europe, sub-Saharan Africa, India, and Japan. This book draws on existing scholarship in four areas: first, chronologically and temporally restricted histories of contraception; second, histories of sexuality and sexology; third, histories of fertility and infertility; and fourth, histories and theories of feminist health and reproductive justice. It is organized both chronologically and according to the type of technology under development.
This book identifies the opening of Aletta Jacobs’s birth control clinic as the beginning of a modern contraceptive era. Of course, condoms, behavioral methods (abstinence and withdrawal), and herbal preparations existed long before 1882. The founding of her clinic, however, marks the beginning of organized, internationalized, and systemic approaches to contraception based on the idea that professional medicine had to address women’s need for contraception—and that rubber, chemical, and pharmaceutical industries should, too. The clinical provision of contraception marked a moment when a physician started to take seriously the prevention of pregnancy as a medical concern, and a moment when a doctor prescribed the use of a technology for a patient who was not ill. When word spread about Jacobs’s clinic, it sparked thinking about how, when, and why pregnancies could be spaced or prevented—and by whom. In short, “control over the timing, means (‘artificial’ or ‘natural’), and frequency of conception, and especially its prevention, was at the heart of the modernist reproductive project.”2
Starting with the establishment of Jacobs’s clinic in Amsterdam makes sense for more specific reasons as well: (1) the clinic made the Mensinga diaphragm available to women without the approval or knowledge of their husbands; (2) her clinic established a medical service model that American and British birth control clinics would follow; and (3) Margaret Sanger highlighted her attempted contact with Jacobs (and her successful contacts with Dutch male physicians) publicly as a signifier of her own determination and expertise. Thus, the opening of the Jacobs clinic, while providing contraceptives to a relatively small number of women until 1894, carries ongoing symbolic weight in the narrative of contraceptive history that advocates (particularly Sanger and the English advocate Marie C. Stopes) told. The year 1882 also marks a clear moment in the history of both technology and medicine: the Mensinga diaphragm was a woman-controlled method that was fitted and distributed by a female physician. It was a technology marked openly as one that women could prescribe, control, and use without male interference.
This book examines the history of contraceptives from the perspectives of reproductive justice and feminist technological studies. It argues that tracing access to, research and development of, and use of contraceptive technologies is an outward measure of how a society values human selfhood and autonomy. A reproductive justice approach encourages examination of contraceptives on a three-pronged sociopolitical level: does it permit anyone capable of pregnancy to have children, not to have children, and to raise children in a safe and healthy environment?3 At the same time, a feminist technology studies approach points toward the study of contraceptives as material artifacts on an individual level: in evaluating a technology from a feminist perspective, does it facilitate or constrain equitable gender relations?4 Contraceptive knowledges, materials, and practices that meet people’s changing needs over time both support and strengthen efforts for both reproductive justice and feminist technology.
This history of contraception addresses four themes that resonate across the last 140 years of contraceptive modernity under examination here. The first theme is power relationships: who in a sexual relationship, however short- or long-term, wants and can use contraception; who has legal access to what kind of technology; what the quality of the technology is; how affordable it is; how to use it properly; and when, where, and how often it is available. Gendered power inequalities in a relationship often determine contraceptive use and efficacy, as do the legal structures and the social milieu in which those relationships operate. Social and legal inequalities across countries and cultures permitted men historically to have sex with their wives with or without the latter’s consent and for the husband to throw out contraception or to be violent against her if the wife tried to use it without his knowledge or consent. Furthermore, men have opposed contraception in order to demonstrate virility by impregnating as many women in or outside of marriage as they could (ideally producing more sons), whether or not further pregnancies would harm the woman and whether or not they could afford to feed, clothe, and house the resulting children.5 More equality in marital and sexual relationships, especially after the second wave of feminism in the last third of the twentieth century, along with changes in laws and social mores, greatly affected women’s ability to exercise their right to choose and to use contraception within and outside marital relationships.
The second theme is the persistence of certain contraceptive methods over time. Some methods appear at one point in the historical record and then reappear in different forms or are later repackaged to attract a new generation of users. While understandings of how methods work may change as science advances, with or without that precise understanding, some of them have remarkable staying power. The persistence of methods may speak to their efficacy, ease of use, adaptability to different situations and cultures, and complementarities in the motives of users, manufactures, and promoters. For example, methods that depend on the timing of sex according to a woman’s menstrual cycle (and to some extent sexual positioning and the length of a sexual encounter) have been a longtime part of the contraceptive repertoire of many cultures. However, in February 2017, a mobile app based on fertility timing called Natural Cycles was approved in Europe, and in August 2018, the United States Food and Drug Administration (FDA) approved the technology as well. An ongoing interest in nonhormonal methods for contraception—based on religious beliefs, a desire to avoid the pill, and an overall lifestyle favoring “natural” approaches to living—were all impetuses for the FDA to approve the app with its accompanying thermometer (chapter 4).6 The science behind Natural Cycles is not new, but the mobile apparatus that supports it is.
Third, technology that works for one acceptable purpose may also be used for contraception, though the contraceptive purpose may be legally or unofficially prohibited. For example, homemade and commercial vaginal douches could serve a contraceptive purpose, but in places where contraceptives were illegal in the early twentieth century, they were most often marketed and sold as cleansers and deodorizers. Women could read in between the lines of the advertisements, experiment, or get advice from friends or family to find out that douches could work (albeit with limited effectiveness) as contraceptives. Contraception is often a “camouflage technology”: its real purpose hidden in plain sight.7
Fourth, it is clear that contraception is never a neutral technology. Contraception can be used for any number of reasons. It can be temporary or permanent, involuntary or voluntary, freely chosen or enforced by a government or an intimate partner, enhance sexual pleasure or take away from it. For example, governments may force certain populations to undergo sterilization, particularly for eugenic purposes, if they deem those populations to be somehow “unfit” to continue reproducing. Those targeted can include poor people, mentally or physically disabled people, and people who have committed sex crimes or other offenses, among others. On the other hand, wealthy, light-skinned, and high-status women whose reproduction was deemed socially valuable have often had difficulties getting sterilized voluntarily until they had produced a certain number of children. Manufacturing of, access to, distribution of, and use of contraception varied and continue to vary widely in availability, purpose, and intent. Having multiple options for one’s choice of contraceptive method across a reproductive lifetime—options that are affordable, steadily accessible, unproblematic to use, effective, and safe—is rare indeed.
This book is organized chronologically, beginning in the 1880s when the diaphragm was first obtainable in Jacobs’s Amsterdam clinic. Chapter 2 outlines contraceptives that were available between the 1880s and 1960, when the US FDA legalized the pill for contraceptive use. These include timing and behavioral methods, such as withdrawal and periodic abstinence; chemical and herbal methods, such as commercial douches and spermicidal jellies; and barrier methods, such as the diaphragm and condom. It uses excerpts from literature, oral histories, and memoirs to shed intimate light on the role played by these methods and devices in people’s everyday lives. Some of these methods are unsafe and ineffective by contemporary standards and have fallen into disuse, while the material technology undergirding others has improved and remains sound in the present.
Chapter 3 looks at how the pill and its chemical descendants were developed and then spread across the world—sometimes in the name of providing women with agency over their reproductive lives and sometimes with the intention of population control. It traces the original testing, research, and development of the first hormonal methods in Mexico, the continental United States, and Puerto Rico. As more pharmaceutical companies within and beyond the US began quickly to manufacture the pill, it altered the state of sexual and marital relations according to existing laws, gender ideals, and moral standards. After the chemistry behind the pill was widely understood, pharmaceutical companies began to experiment with other forms of delivery and adapted hormone formulations originally created for other purposes to contraceptive ones. One of the most controversial hormonal methods, Depo-Provera, played two distinct roles in contraceptive history. First, in the US context, its parent company Upjohn fought a decades-long battle against feminist health organizations and the FDA to get it approved for contraceptive use in 1992.8 Second, in the context of the developing world, countries interested in population control—and sometimes with eugenic intentions—made it available (often for free) to poor, racial and ethnic minority, and disabled individuals in the 1980s without providing them full information on the shot’s side effects. Research and development into the “male pill” closes the chapter.
Chapter 4 addresses technological changes in the nonhormonal contraceptive methods first described in chapter 2—how materials, chemicals, and forms of delivery changed along with the ways that decades-old technologies reemerged to provide users with new options. For example, it reviews how the cervical cap, a method little-used outside Germany and England, reemerged in the 1970s US as an alternative to the pill, thanks to the feminist women’s health movement. Also, it investigates how the Roman Catholic Church’s 1968 authorization of a timing method alone as the only non-sinful method of contraception was a critical moment in the technology’s history: it reinvigorated interest in timing methods, caused some to leave their faith, and pushed others to embrace the pill nonetheless.
Chapter 5 introduces the concept of reproductive justice, a simple yet robust theory that structures worldwide reproductive activism in the twenty-first century. Reproductive justice consists of the three basic principles mentioned above—the right to have a child, the right not to have a child, and the right to parent children safely and healthily. Reproductive justice, based as it is in human rights principles, provides a foundation for activism at local, national, and international levels. It likewise provides the groundwork for analyzing reproductive injustices in the past and a vision for the future in which everyone can decide to become a parent or not in environments that support the human flourishing of all. Access to safe contraception is thus one element of a reproductively just world.
Chapter 6 is divided into three parts: first, its focus is on the ways that existing contraceptives must adapt in order that all people, including overweight or obese individuals and trans individuals, can use them safely and effectively. The second section covers present-day contraceptive technologies and new forms of distributing them, such as brothels with robot-only sex workers, where people can have sex with inanimate, humanlike machines that cannot become pregnant or transmit sexually transmitted infections. It ends with an examination of the current world situation regarding contraception and the efforts of international health organizations and pharmaceutical companies to support contraceptive access, especially to the approximately 225 million women who are deprived of it.9 There is a long way to go to ensure that contraceptive information and methods are accessible to everyone. As long as humans have reproductive sex, people will continue to innovate new ways to manage conception and contraception alike.