A History of Birth Control

Clearing Up Misconceptions

By Daniel DeNoon
WebMD Feature

Aug. 6, 2001 -- The controversial topic of birth control seems like a modern issue -- but it's not. Long before the pill, U.S. men and women wanted -- and successfully used -- a variety of contraceptive devices.

In her new book, Devices and Desires: A History of Contraceptives in America, historian Andrea Tone, PhD, notes that such devices were widely available in the U.S. both before and after the Comstock law of 1873 that declared contraception to be both obscene and illegal.

"Irrespective of the status of the law, men and women have used birth control -- and mostly it has been successful birth control," says Tone, of the Georgia Institute of Technology in Atlanta. "The law had very little impact on people's desires and ability to get their hands on what were contraband items. But illegality does not give people the advantage of using goods that are properly tested. Much of the history of black-market birth control involves needless suffering, pain, death in a few cases -- and pregnancy."

Dozens of Devices

Before the Industrial Revolution, birth control devices in America relied largely on condoms for men -- fashioned from linen or from animal intestines -- and on douches made for and by women from common household ingredients. Abortion-inducing herbs such as savin and pennyroyal also were used, as were pessaries -- substances or devices inserted into the vagina to block or kill sperm.

The invention of rubber vulcanization in 1839 soon led to the beginnings of a U.S. contraceptive industry producing condoms (now often called "rubbers"), intrauterine devices or IUDs, douching syringes, vaginal sponges, diaphragms and cervical caps (then called "womb veils"), and "male caps" that covered only the tip of the penis. British playwright and essayist George Bernard Shaw called the rubber condom the "greatest invention of the 19th century."

When these devices were declared illegal, the flourishing trade simply began selling them as "hygiene" products. For example, vaginal sponges were sold to protect women from "germs" instead of sperm. This led to misleading if not downright fraudulent advertising. From 1930 until 1960, the most popular female contraceptive was Lysol disinfectant -- advertised as a feminine hygiene product in ads featuring testimonials from prominent European "doctors." Later investigation by the American Medical Association showed that these experts did not exist.

"The fraud of the Lysol douche was a byproduct of illegality," Tone says. "Because birth control couldn't be advertised openly, manufacturers would use euphemisms to refer to birth control. They took advantage of consumers' hopes."

The Failure of Rhythm and 'Just Say No'

The rhythm method -- that is, having sex only during a woman's "safe period" when she is not ovulating -- was widely recommended by doctors. But doctors had it wrong. Based on animal observations, they thought women were "safe" at the midpoint of their menstrual cycle. This is precisely when women are most likely to conceive. So women who could afford medical advice actually were told to have sex at the exact time they were most likely to become pregnant.

Similarly, another early effort at behavioral birth control failed during the first World War. Dismayed at the high rates of sexually transmitted disease that were disabling their soldiers, armies and navies issued condoms to their fighting men. The U.S., however, attempted to teach "continence" -- that is, abstinence -- to their troops. Few U.S. troops obeyed this command, and many obtained condoms while abroad.

Ironically, these likely were American-made condoms, as the war made U.S. manufacturers the leaders in the field. After the war, soldiers brought their new-found knowledge home with them. Condoms became legal in 1918, the same year the war ended.

Tone sees a lesson in this experience.

"We are way behind in what we say to young people," she says. "The best example is World War I, where the official government line was that abstinence would make you stronger. But no more than 30% of soldiers were abstaining.

"We saw this in the Reagan era with the just-say-no approach to drugs, and this has carried over to sex," she continues. "We would prefer to think young people would be able to resist these urges that are universal, and we fool ourselves. We spend less money on birth control because we think if a person does get pregnant or an STD, it is just their own fault -- they weren't disciplined enough."

By the 1920s, the U.S. birth rate dropped by half -- statistical evidence that the explosion of condom sales and a more modern approach to the rhythm method were in widespread use. Condom reliability was still terrible by modern standards -- but people achieved effective birth control by combining use of condoms, the rhythm method, male withdrawal, diaphragms, and/or intrauterine devices.

Feminism and Contraception

Early feminists sought to improve the lot of women by gaining increased respect for their traditional roles. This strategy made it difficult for them to endorse contraception.

"In the late 19th century, many suffrage leaders frowned on birth control because that meant condoms: which they saw as linked to the brothel, to giving men free reign to cheat on their wives, and to a negative effect on the family," Tone says. "They felt it was important for women to gain political and social power by defending their roles as mothers and protectors of virtue."

Even Victoria Woodhull, who in the late 1900s advocated free love, felt that only "natural" contraception was acceptable. She nevertheless paved the way for future feminists by insisting that women should have the power to time their own pregnancies.

"Advocates of voluntary motherhood urged the use of birth control so their family could look like what they wanted it to look like -- three kids, say, and a woman without a ruined body," Tone says. "By the time of Emma Goldman and Margaret Sanger, feminists felt that all individuals should have access to safe birth control or else women -- working women in particular -- would be disadvantaged. That was one of Margaret Sanger's great contributions: She illuminated the struggle for control of women's bodies.

"Sanger and her patron Katharine McCormick felt that not only should women of all classes have quality birth control, but it should be a type of birth control that women have power over. They felt the only way women could be liberated was to have the unilateral power to control sexuality."

McCormick's husband, Cyrus McCormick -- heir to the International Harvester Company fortune -- was diagnosed with schizophrenia. Fearing that the disease was inherited, she resolved never to have children -- and dedicated huge sums to the search for woman-controlled contraception.

This research resulted in the development of the birth control pill. Early versions of the pill contained huge doses of estrogen -- and were approved after clinical tests that would be considered totally inadequate by today's standards for drug approval. The high rate of side effects from the pill -- and the later scandal involving the aggressive marketing and defense of the Dalkon Shield intrauterine device, despite the manufacturer's knowledge of safety problems -- led many women to question why birth control had to be aimed at women instead of men.

Full Circle to Today's World

Today it is well known that the condom is the only effective barrier to HIV and to many -- but not all -- other sexually transmitted diseases, or STDs.

Despite this, neither condoms nor other forms of contraception are used consistently by those who most need them. Some numbers, released in July 2001 by U.S. Surgeon General David Satcher:

• Nearly half of all U.S. pregnancies are unintended.
• Every year, 12-15 million Americans are infected with a new STD.
• Nearly 1 million Americans are infected with the AIDS virus -- and a third of these people don't even know it.
• According to the CDC, more than 65 million U.S. residents now are living with an incurable sexually transmitted disease.

"I would like to say today more men and women are turning to condoms as the answer to STDs, but the evidence shows that we are not seeing a dramatic increase in condom use equal to the dramatic increase in STDs," Tone says. "Before the pill, the condom was the most common method of birth control. Now people say men won't do this, but that hasn't always been the case. Today, two-thirds of condoms are purchased by women. Maybe men in the very recent past didn't enjoy taking charge of fertility, but they did it anyway. If we can change perceptions, maybe that time can come back again."