America and the Pill

When the oral contraceptive arrived on the market, its champions claimed that the tiny pill promised to end human misery and eradicate the causes of war by controlling population. In meetings and conferences across the globe, experts met to address the “population bomb.” At one such meeting, in the summer of 1965, hundreds of medical experts gathered in Bombay (now Mumbai) to discuss the problem of overpopulation. The site of the conference was not accidental. India, one of the most densely populated and impoverished nations in the world, was a telling backdrop, a living showcase of the need for population control. Participants included doctors from all over the world, and Indian physicians comprised the largest group in attendance. Between the Western male doctors wearing suits and the sari-clad female physicians from India, where reproductive medicine was the domain of women, the contrast could not have been more striking.

The most dramatic moment in the conference came when an American doctor made the claim that oral contraceptives would solve India’s overpopulation troubles. With a theatrical flourish, he unfurled a roll of birth control pills like a streamer and tossed it into the packed auditorium. The assembled medical professionals watched as the plastic-wrapped promise of health and prosperity rose into the air and hovered above them for an instant before gently settling across attendees’ laps. The presenter then declared that the pill offered the solution to world hunger and poverty. Even in small villages with little access to medical facilities and low levels of literacy, women could easily learn to take the pill every day and control their fertility. This simple tablet would bring an end to India’s most pressing problems. His extravagant prediction was breathtaking. ² As it turned out, it was also wrong. India, with a population spread across the country in remote villages lacking the medical personnel required to provide prescriptions and exams, was one of the countries most resistant to the pill.³

Nevertheless, many experts and leaders in the United States and around the world believed that overpopulation was a serious problem and that the pill could help resolve it. World population had nearly doubled between 1900 and 1960, from 1.6 billion to 3 billion. It would double again by the end of the century. The population bomb seemed to be exploding, unleashing unforeseen human misery. Many believed that finding a solution would bring peace, prosperity, and the good life to all. Cold warriors in the West saw overpopulation as a political problem: Impoverished people in overcrowded countries might be tempted to turn to communism.

Woven into this prediction was the same ambivalence about scientific progress that had greeted the atomic bomb. Science had discovered the huge destructive power of nuclear energy—now it had to figure out a way to turn it to good use. Similarly, scientific and medical discoveries had improved life expectancy so dramatically that the death rate had declined, but the birthrate had not. Science would now need to find a way to lower the birthrate. The pill promised to be the stealth weapon that would defuse the “population bomb” by limiting the size of “nuclear” families across the globe.

Both at home and abroad, population control generated considerable controversy. Advocates who agreed on the need for access to family planning services did not all agree on goals or methods. Some were motivated by humanitarian concerns, others hoped to achieve cold war political aims, and still others were primarily interested in social engineering and eugenics. In the United States, population controllers included conservatives who considered the children of poor people to be a burden on taxpayers, eugenicists who believed in curbing the fertility of the “unfit,” and environmentalists who saw the nation’s growing population as detrimental to the natural world and a drain on resources.

Some experts believed the pill was the perfect solution because of its effectiveness and simplicity. Others thought the pill wasn’t suitable for use among poor people. They feared that needy, uneducated women would not be able to take it properly and consistently, or that it was too expensive and required too much medical monitoring to be useful in remote areas. Issues of cost and medical care were real concerns, but in clinics where the oral contraceptive was offered free or for a modest fee, poor women requested it and used it with the same success as more affluent women. Women made their own decisions according to the contraceptive options available to them.

WOMEN’S DESIRES FOR EFFECTIVE BIRTH CONTROL converged with population controllers’ efforts at social engineering. These efforts gained tremendous momentum in the mid-twentieth century due to the era’s rapid population growth and the political imperatives of the cold war. But population control has a history that dates back to the nineteenth century. The birth control movement emerged parallel to the population control movement, and although they did not always have the same aims, the two often intersected. Population control was not a concern of the early birth control pioneers. The radical beginnings of the movement were grounded in the quest for women’s rights. Birth control advocates argued that women could never achieve equality unless they were able to control their own reproduction. This was the starting point for Emma Goldman, Katharine McCormick, Margaret Sanger, and other leaders of the movement. At the same time, they saw contraception as vital to alleviating the suffering of poor women burdened by constant childbearing. This impulse brought birth control into the eugenic conversation. Radicals were as likely to advocate policies that dovetailed with eugenics as conservatives, albeit for different reasons. While conservative eugenicists aimed to reduce the population of the “unfit,” women’s rights leaders hoped to improve the health and well-being of mothers and children. As Emma Goldman asserted, “Woman no longer wants to be a party to the production of a race of sickly, feeble, decrepit, wretched human beings. Instead she desires fewer and better children.”⁴

Over time, the birth control movement, especially under Margaret Sanger’s leadership, became more fully aligned with the population control effort. By the 1950s, when the birth control movement shifted to an emphasis on family planning, these currents converged. The two terms—family planning and population control—were often used interchangeably, but they did not mean the same thing. Family planning emphasized individual choice, whereas population control focused on large-scale reduction of fertility rates.⁵

These movements merged into a coherent public policy agenda that was first articulated during World War II. Initially, family planning was geared toward domestic needs, reflecting the rational, scientific approach to family life. By the time the United States entered the war, birth control clinics had proliferated around the country.⁶ In 1942, when the Birth Control Federation of America changed its name to the Planned Parenthood Federation of America, it marked a change in the organization’s direction fully in keeping with this new national focus. According to Abraham Stone, medical director of the Margaret Sanger Research Bureau, “Planned parenthood” signaled “the need for individual couples to plan their families and for nations to plan their populations.” Sanger vigorously opposed the name change. She believed that “planning” weakened the woman-empowering message of “birth control.” Nonetheless, she was overruled.⁷

Wartime brought new attention to rational preparations. Family planning experts urged contraception as a scientific approach to personal happiness as well as national security. One poster declared, “MODERN LIFE IS BASED ON CONTROL AND SCIENCE. We control the speed of our automobile. We control machines. We endeavor to control disease and death. Let us control the size of our family to ensure health and happiness.” PPFA proclaimed, “A nation’s strength does not depend upon armaments and manpower alone; it depends upon the contentment . . . of its people. To the extent that birth control contributes to the health and morale of our people, it makes them less receptive to subversive propaganda, more ready to defend our national system. . . . Victory cannot be won without planning.” With rational family planning, “more healthy children will be born to maintain the kind of peace for which we fight.” Margaret Sanger herself called for “national security through birth control.”⁸

At the same time, the war gave rise to the first direct connections between the American birth control movement and population control abroad. Looking toward the postwar era, the PPFA became more concerned with the international implications of contraception, not only for poverty and political unrest, but in relation to healthy markets abroad. After the war, concern shifted to the dangers of overpopulation in developing countries, where the population was growing twice as fast as in the industrialized world.

Population control seemed a panacea for the world’s ills. The movement included government officials and professionals from around the globe, but most of the leadership and funding came from the United States. Years before the pill became available, population control advocates saw contraception as the key to development, prosperity, and the success of democracy and capitalism in developing countries—and the best means to avoid war, famine, and the spread of communism. To that end, new organizations took shape. Margaret Sanger founded the International Planned Parenthood Federation (IPPF) in 1952. That same year, John D. Rockefeller III established the Population Council. He promoted progressive, noncoercive principles geared toward alleviating human suffering rather than reducing the population: “Our concern is for the quality of human life, not the quantity of human life.”⁹

Observers and commentators had a wide range of perspectives on the dramatic rise in world population, but all seemed to agree that it was reaching crisis proportions. Humanitarians voiced concerns about increasing poverty and the plight of the poor, who would likely face starvation and disease. Less charitable were the cold warriors who worried that overpopulated poor countries would be drawn to communism and align with the Soviet Union, or that the large families in the developing world would be unable to afford American-made consumer goods, undermining the potential for vast foreign markets.

Not everyone shared these concerns. The Catholic Church remained staunchly opposed to population control efforts, and others continued to argue that contraception was not a matter for public policy. Anticommunist crusaders could also be found on both sides of the issue. Some argued that contraception and population control were essential to stop the spread of communism, but a smaller group, including Senator Joseph McCarthy, claimed that birth control was a communist plot to weaken the country and spread immorality.¹⁰ Population alarmists, however, seemed to dominate the debate.

McCarthy’s opposition notwithstanding, anticommunism fueled much of this alarm. The Hugh Moore Fund distributed a pamphlet, The Population Bomb, frequently reprinted through the 1950s and 1960s, claiming that there would be “300 million more mouths to feed in the world four years from now—most of them hungry. Hunger brings turmoil—and turmoil, as we have learned, creates the atmosphere in which the communists seek to conquer the earth.”¹¹ Moore and his allies made it clear that they were not particularly concerned about human suffering: “We’re not primarily interested in the sociological or humanitarian aspects of birth control. We are interested in the use . . . which the Communists make of hungry people in their drive to conquer the earth.”¹²

While Moore’s views were extreme, he was not alone. Popular magazines pumped up the volume with headlines that announced, “Surging Population—An ‘Erupting Volcano,’” “An Overcrowded World?” “Asia’s ‘Boom’ in Babies,” “World Choice: Limit Population or Face Famine.” Articles also highlighted the increasing American population, asking “Where Will U.S. Put 60 Million More People?” and “How the Population Boom Will Change America.” Prophets of doom warned that “The Human Race Has, Maybe, Thirty-Five Years Left.”¹³

In spite of the alarms raised by the media, the U.S. government was initially reluctant to fund birth control efforts at home or abroad. Worries about alienating the Catholic Church, added to the aura of illegality and immorality that still surrounded contraception, kept investment in population control efforts at low levels. By the mid-1960s, however, the tide had turned. The widespread acceptance and use of the pill, along with increasing concerns about world population, had made contraception a legitimate subject for national policy. President Lyndon Johnson placed population control at the center of his program for foreign aid as well as his domestic War on Poverty. The results were dramatic. Between 1965 and 1969 government funding for domestic family planning programs grew from $8.6 million to $56.3 million. During those same years, U.S. support for similar efforts in the developing world grew from $2.1 million to $131.7 million.¹⁴ Even Dwight D. Eisenhower changed his mind. In the mid-1960s he admitted, “Once as President, I thought and said that birth control was not the business of our federal government. The facts changed my mind. . . . Governments must act. . . . Failure would limit the expectations of future generations to abject poverty and suffering and bring down upon us history’s condemnation.”¹⁵

Eisenhower’s change of heart indicates the extent to which expert and official opinion had accepted the imperative of population control. As Edward Stockwell warned in his 1968 book Population and People, “Regardless of whether or not the ‘population bomb’ represents a greater threat to the peace and security of mankind than the hydrogen bomb . . . the inescapable fact is that the rapid and accelerating rate of population growth in recent years has created an extremely dangerous situation in many parts of the world.”¹⁶

Far more influential than Stockwell’s book was Paul Ehrlich’s 1968 best seller, The Population Bomb. Ehrlich warned that within a decade “hundreds of millions of people are going to starve to death” and predicted that a nuclear war would be fought over resources before the end of the twentieth century unless poverty in the developing world could be alleviated. But unlike the humanitarians who called for population control, Ehrlich’s warnings were tinged with disdain for the poor. He predicted that armies of poor people would “attempt to overwhelm us in order to get what they consider to be their fair share.”¹⁷ Ehrlich clearly believed that we deserve our fair share, but they do not. Ehrlich did not represent the views of all advocates of population control. But he had a huge following. In the midst of social and political turmoil of the late 1960s, Ehrlich’s warnings struck a chord. His book sold 2 million copies by 1974.

Ehrlich was one of the founders of Zero Population Growth (ZPG), a movement that took shape in 1968.¹⁸ In the spring of 1970, Life magazine ran a feature on ZPG, noting that the movement challenged the United States to stop growing. While cold war imperatives led some population planners to focus on the developing world, an entirely different group began advocating population control at home, motivated by environmental concerns. Gaining support among the young, especially on college campuses, ZPG advocates called on Americans to limit the size of their families to two children as a way to keep the population stable. According to Life, ZPG called for abortion reform, legalization of birth control, and changes in welfare regulations and tax exemptions for children—a collection of policy initiatives that spanned the political spectrum.

The tactics of ZPG included street theater and other forms of grassroots activism. At the University of Pennsylvania, women students organized a “Lysistrata Day,” complete with toga costumes, in which they pledged “to avoid contact with men—for a day, at least.” (In Aristophanes’ play, the women refused sex until the men gave up war.) Life quoted Ehrlich, who had a vasectomy after fathering one child: “The mother of the year should be a sterilized woman with two adopted children.” He warned that the “cancer of population growth . . . must be cut out.” Life retorted, “A certain cold and dispassionate cast of mind is required in order to regard the birth of human life not as a joyous event but as the proliferation of some deadly malignancy.”¹⁹

Although Life bristled at the tone of the ZPG advocates, many other observers agreed that the American birthrate had to be brought under control. Concerns about overpopulation in the United States differed from those expressed about the same phenomenon in the developing world. As the focus of concern in poor countries, the problems appeared dire: more poverty, starvation, disease, and political turmoil—leading to massive suffering as well as wars and possible communist takeover. By contrast, overpopulation in the United States and other Western countries might entail discomfort, psychological distress, crime, and social unrest. In 1970 Ladies Home Journal ran an article by British scientist Gordon Rattray Taylor arguing that overpopulation in cities creates stress that “scars our minds and bodies” and leads to higher rates of crime, disease, and mental disturbances. Taylor quoted Dr. Paul Leyhausen, “a leading German ethologist,” who asserted, “What every normal man wants for himself and his family is a detached house in an adequate garden, with neighbors close enough to be found if needed, or if one feels like a social call, yet far enough away to be avoided at other times.”²⁰ By these standards, only affluent suburbanites were “normal.”

WHILE THE EXPERTS WHOSE THOUGHTS APPEARED in the Ladies Home Journal presumed that everyone could afford a single-family home in the suburbs if there was enough open space, others worried about the economic effects of overpopulation. ²¹ Some arguments for domestic population control carried explicitly racial overtones. An expert quoted in Esquire said that population growth in the United States will “greatly increase the magnitude of juvenile delinquency, exacerbate already dangerous race tensions, inundate the secondary schools and colleges . . . and further subvert the traditional American Government system. . . . In Washington ninety percent of the schoolchildren are Negro, in Manhattan seventy-five percent are Negro or Puerto Rican—indicating the future city population.” Warning of high unemployment and frustration for urban blacks, the author predicted that “the crowd, or the mob, seems likely to reappear as a force in politics.” Referring to the 1965 riots in the mostly black Watts neighborhood of Los Angeles, the author concluded ominously, “Watts was a prelude.”²²

While some feared the eruption of urban violence, others resented the cost to society of the high birthrate of the poor. Although the majority of poor people were white, minorities were overrepresented on welfare rolls. Opponents of the welfare state complained that taxpayers were supporting the children of the poor and wanted to curb their fertility. Some proponents of birth control for the poor, like eugenicist Clarence J. Gamble, encouraged inexpensive contraceptives as well as sterilization for poor women.²³ These efforts had eugenic and racial overtones both in the United States and overseas. Concerns about the proliferation of nonwhite people fueled public policies encouraging poor people of color to curb their fertility, sometimes coercing them to do so.

At the same time, contraception was “a great thing for poor folks,” in the words of one African American woman. But poor women were rarely able to gain access to these technologies on their own terms.²⁴ Regardless of the motives of advocates, poor women took advantage of whatever contraceptive services were available to them. Some wanted sterilization; others resisted it. Some eagerly sought to be part of clinical trials of oral contraceptives; others rejected the idea of being “human guinea pigs.” Proponents and activists often disagreed on which women should have access and what contraceptive options should be offered.²⁵

Women of color were justifiably dubious of the motives of family planning advocates. Black women in particular had reasons to be distrustful after centuries of manipulation of their fertility, beginning with slave breeding. Well into the late twentieth century, black women were subjected to forced sterilizations. Nevertheless, many were as eager for birth control as their white counterparts. Ebony assured its readers that contraception helped parents “space babies to make them a blessing rather than a burden.”²⁶ Tensions remained between the desire for access to contraception and suspicions of the motives of birth controllers.

Margaret Sanger exemplified this tension between choice and coercion. There is no doubt that her early radicalism faded in the service of more conservative and eugenic rationales for contraception, as the birth control movement shifted to a more mainstream focus on family planning.²⁷ But Sanger’s interest in contraception for the poor characterized her efforts from the very beginning. In 1938, she turned her attention to a “Negro Project.” The proposal stated, “The mass of Negroes, particularly in the South, still breed carelessly and disastrously, with the result that the increase among Negroes, even more than among whites, is from that portion of the population least intelligent and fit, and least able to rear children properly.” For all the racist overtones of that statement, the words were not those of a white bigot: Sanger was quoting verbatim W. E. B. DuBois, the renowned African American civil rights leader. DuBois was concerned that among black Americans, those with the highest fertility rates had the fewest resources to provide well for their families. Without access to contraception, he argued, they would be doomed to live in poverty.²⁸

Sanger wrote that her goal was “helping Negroes to control their birthrate, to reduce their high infant and maternal death rate, to maintain better standards of health and living for those already born, and to create better opportunities to help themselves, and to rise to their own heights through education and the principles of a democracy.”²⁹ Many birth controllers shared Sanger’s concerns. Although some were more interested in reducing the fertility of those they considered to be undesirable, coercive policies never took hold in the United States.

Yet when the pill arrived, some saw it as a potential tool of racist social engineers. In the late 1960s, male leaders of the Black Power movement charged that the pill promoted genocide, and they encouraged black women to refuse to take it. In 1967, a Black Power conference in Newark, New Jersey, orga - nized by writer and activist Amiri Baraka,³⁰ passed a resolution denouncing birth control. Even mainstream organizations such as the NAACP and the Urban League backed away from their previous support of contraception. Marvin Dawes of the Florida NAACP asserted, “Our women need to produce more babies, not less . . . and until we comprise 30 to 35 percent of the population, we won’t really be able to affect the power structure in this country.”³¹

Black women, however, resisted such claims. Although they were aware that some white proponents of the birth control pill and other forms of contraception hoped to reduce the numbers of black babies, they wanted the pill and saw it as essential to their reproductive freedom. In 1970, writer and activist Toni Cade responded to the male Black Power leaders by asking, “What plans do you have for the care of me and the child?” Frances Beal, head of the Black Women’s Liberation Committee of the Southern Nonviolent Coordinating Committee (SNCC), insisted, “Black women have the right and the responsibility to determine when it is in the interest of the struggle to have children or not to have them and this right must not be relinquished to any . . . to determine when it is in her own best interests to have children.”³²

The conflict between women and men in the movement went beyond rhetoric. In Pittsburgh, William “Bouie” Haden, leader of the United Movement for Progress, threatened to firebomb a clinic. In Cleveland, a family planning center in a black neighborhood burned to the ground after accusations of “black genocide.” Meanwhile, black female leaders like Congresswoman Shirley Chisholm pushed for increased access to birth control. A 1970 study found that 80 percent of black women in Chicago approved of birth control and 75 percent were using contraception.³³

Lack of access to reproductive health care remained a serious problem for poor women, whether black or white. A study by the Department of Health, Education, and Welfare (HEW) found that only 850,000 out of 5.3 million poor women in the United States received family planning services, and most of them were white. The Nation observed in 1969, “Caught in the middle is the indigent American woman who wishes to have the same freedom to choose sex without conception that her middle-class counterpart enjoys.”³⁴

Proponents of population control encountered ambivalent reactions from the people they hoped to reach. Women eagerly sought birth control wherever it was available. But their motives were personal. They used contraceptives to control their own fertility, not to control world population. Officials from governments at the receiving end of international family planning efforts did not necessarily agree that population control was the best way to reduce poverty. In 1974, when the world population reached 4 billion, the United Nations held a conference in Bucharest on population and development. Delegates from developing nations claimed that population control was an attempt to conceal the huge gap in wealth between rich and poor countries. They argued that the best contraceptive is development. Pointing to trends in Europe and North America, they noted that population growth slowed as a result of economic development and education.³⁵

In spite of suspicions about Western motives, the most draconian efforts at population control were promoted not by American or other Western agencies but by governments in Asia. Some governments offered incentives such as money or transistor radios as rewards for sterilization, or provided “finder’s fees” to anyone who brought a man to a vasectomy clinic. The Population Council and the Rockefeller Foundation opposed all such forms of coercion or financial incentives in family planning programs in developing countries. As Frank Notestein, Princeton demographer and former president of the Population Council, said in 1974: “Coercion or the perception of coercion will bring down a government before it brings down the birth rate.” He was right. In 1977 Prime Minister Indira Gandhi of India was not returned to office in large part because of her imposition of mandatory family planning measures. ³⁶ The most coercive measure to be officially enacted is China’s “one child per couple” policy, instituted in 1979. At that time the population of China was growing by 20 million each year. Twenty years later China’s fertility rate had dramatically declined.

But such coercive policies were rare. By the end of the twentieth century, most governments in the developing world provided birth control services to their citizens. Access to contraception alone did not reduce population growth. The most important factor in lowering the birth rate was the education of women. As women gained more rights, opportunities, and access to education, they were able to assert themselves more fully in their families and society and to take more control over their lives. Contraception was critical to women’s emancipation in the developing world. Without the ability to control their fertility, women would not have been able to take advantage of new opportunities for employment and participation in public life.

Sheldon Segal of the Population Council criticized those who promoted contraceptive saturation programs: “They seemed to have a dogged concern for numbers rather than for people and their needs. . . . Women were seen as objects through which to implement population programs and policies.”³⁷ Segal noted the direct correlation between female illiteracy and fertility rates, demonstrating that when women are educated they have more opportunities and motivation to limit the number of children they bear.³⁸ He said that if he had one dollar to spend on population control efforts, he would spend it on the education of women.³⁹

The fertility rate declined dramatically in the last half of the twentieth century, even if the population did not. The World Health Organization estimated that in developing countries the average number of children per woman declined from 6.1 in 1970 to 3.9 in 1990. In the 1960s, fewer than 10 percent of couples in the developing world used birth control; by 2000 nearly 60 percent did.⁴⁰ The availability of the pill (as well as the IUD and other forms of contraception) had been critical both in emancipating women and in reducing the fertility rate. One could not have happened without the other.

AS IT TURNED OUT, THE PILL PLAYED A MINOR ROLE in curbing population growth. It did not live up to dramatic predictions that it would solve the problems of overpopulation, poverty, and hunger. Across the world, middle-class women were much more likely to use the pill than poor women. Population planners saw the pill as part of the solution, but not necessarily the most practical contraceptive for use among the poor. In fact, in the early 1960s, the pill was rarely used in population control programs. Many preferred the IUD, because it required only one visit to a clinic and could remain in place for years. Using the IUD, women did not need to remember to take a pill every day, nor did they need to see a doctor for prescription refills. The pill was one among several contraceptive options available to women who wanted to control their fertility, assuming they had the opportunities that made fertility control possible for them.

In many areas, access to birth control depended on foreign aid provided by Western countries. In the United States, after Eisenhower’s initial refusal to consider contraception as part of public policy, John F. Kennedy, the nation’s first Catholic president, supported family planning programs as part of foreign aid, as did every president who followed until the United Nations conference on population in Mexico City in 1984. At that time, President Ronald Reagan reversed the United States’ position. This reversal of long-standing policy was a direct result of abortion politics within the United States. The U.S. delegation to Mexico City included the Conservative Party senator James Buckley of New York and Republican Allan Keyes, both ardent foes of abortion. At the conference they established what came to be known as the “Mexico City policy”: a global gag rule that refused U.S. government support to any agency, American or foreign, that used its own funds to support abortion services, counseling, or referral, even though these services would be legal and no U.S. money was involved. Many clinics that provided contraceptives also offered abortion services. The Mexico City policy prohibited these facilities from receiving any U.S. funds for family planning, even if those funds would not be used for abortion-related services. The vast majority of Americans opposed Reagan’s gag rule, favoring the inclusion of family planning information and supplies as part of foreign aid, and disapproved of withholding funds to health organizations that provided abortion services with non-U.S. funds.⁴¹ Nevertheless, the rule prevailed through the Reagan years and the presidency of George H. W. Bush.

In 1993, five days after taking office, President Bill Clinton dropped the Mexico City policy. The following year, the United Nations sponsored a population conference in Cairo. The “Cairo Agenda” focused on issues of women’s rights, including reproductive rights, “free of discrimination, coercion, and violence.” In spite of widespread support for Clinton’s policies and the Cairo Agenda, President George W. Bush restored the Reagan-era gag rule three days after he took office in 2001. One staunch anti-abortion physician told a television news reporter that “the United States has to stop all those abortions caused by contraceptives, like the pill and the IUD.” Sheldon Segal, who worked for decades to make contraception available to women throughout the world, was “astonished” by the lack of scientific accuracy as well as the hostility to women’s reproductive rights that supporters of the gag rule expressed. The official position of the United States had come full circle—from initial reluctance to strong promotion of foreign aid for contraceptive services, then to a policy that deprived women throughout the world of access to birth control because of ideological hostility to abortion rights. During the administration of President George W. Bush, funding for family planning programs, including contraceptive services within the United States, declined in favor of “abstinence only” programs, which have been proven to be unsuccessful. The Bush administration’s refusal to support any “unnatural” forms of birth control severely diminished worldwide efforts to make contraceptives available to poor women, including methods that inhibit the spread of AIDS.⁴²

On January 24, 2009, four days after taking office, President Barack Obama reversed the policy once again, lifting the gag rule. Politically, the pill has traveled a bumpy road. But politics has not stopped women the world over from using birth control. There is no question that access to safe and reliable contraception, including the pill, has shown major benefit to women’s lives. Today, over 60 percent of the world’s married women in their reproductive years use contraception, and 90 percent of them use the pill, the IUD, implants, or injectables. Fertility rates changed not because of the efforts of experts and population planners, but because at last women could decide whether they wanted more or fewer children.⁴³ Of course, the extent to which women could exercise their contraceptive options depended upon many circumstances, public policies among them. But besides her own desires, the most significant influence on a woman’s use of birth control was likely to be her sexual partner. To understand the role of the pill in women’s lives, it is necessary to consider men.