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B I R T H C O N T ROL

Aharon W. Zorea

Health and Medical Issues Today

Copyright 2012 by Aharon W. Zorea
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, except for the inclusion of brief quotations in a
review, without prior permission in writing from the publisher.
Library of Congress Cataloging-in-Publication Data
Zorea, Aharon W.
Birth control / Aharon W. Zorea.
p. cm. — (Health and medical issues today)
Includes bibliographical references and index.
ISBN 978–0–313–36254–5 (hard copy : alk. paper) — ISBN 978–0–313–36255–2
(ebook)
1. Birth control—United States. 2. Birth control—Government policy—United States.
I. Title.
HQ766.5.U5Z67 2012
363.90 60973—dc23 2011043157
ISBN: 978–0–313–36254–5
EISBN: 978–0–313–36255–2
16 15 14 13 12 1 2 3 4 5
This book is also available on the World Wide Web as an eBook.
Visit www.abc-clio.com for details.
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This book is printed on acid-free paper
Manufactured in the United States of America
C O N T E N TS

Series Foreword ix
Introduction xi

Section I: Historical Overview 1

1 Types of Birth Control and Their Controversies 3
Natural Birth Control Methods 4
Early Artificial Birth Control Methods 6
Intrauterine Devices 8
Hormonal-Based Contraceptives 10
Long-Acting Hormone-Based Contraceptives 12
“Emergency” Contraceptives 14
Recent Innovations and Marketing 17
Sterilization 19
Conclusion 23
2 History of Birth Control—From the American Revolution
to World War II 27
Republican Motherhood 28
Social Science Reform 29
Temperance and Purity Movements 33
Comstock and Contraception 35
The Progressive Era 38
vi CONTENTS

Sanger, Science, and Radicalism 39

The Town Hall Raid 44
The Sanger Effect 48
Aftermath: Before World War II 50
3 Birth Control Policy since 1945 53
Contraceptive Research and Development 54
Population Control and Federal Policy 57
From Legalization to Public Funding 59
Humanae Vitae 61
Abortion versus Birth Control 64
Funding and Culture Wars 66

Section II: Contemporary Controversies and Issues

Relating to Birth Control 69
4 Consumer Protection 71
Original Promise for Women’s Health 72
Unknown Variables 73
Birth Control and Cancer Risk 74
Incomplete Disclosure 75
Target Markets 77
Concluding Thoughts 78
5 Government Policy 81
Government Funding and Objectivity 82
“Civil Rights” or “Public Health” 83
“Family Planning” or Eugenics 85
Long-Acting Contraceptives and Voluntariness 88
Voluntariness: Doctors and the “Conscience Clause” 90
Other Factors: Foreign Aid, Environmentalism, and Youth 92
6 Social Impact of Birth Control 95
Birth Control and Feminism 96
Lack of Male Contraceptives 98
Recent Innovations in Male Contraception 99
Environmentalism and Birth Control 100
Feminism and Marketing 103
Youth Appropriateness and Advertising 105
Birth Control and Sex Education 107
Abstinence-Only Sex Education: No Birth Control 110
Birth Control Access and Youth Rights 112
CONTENTS vii

Pluralism and Modern Society 113

Concluding Thoughts 115

Section III: Primary Documents 117

A Early Motivations for Birth Control—Part I: Science or
Pornography? 119
Excerpt from Fruits of Philosophy 119
Excerpt from The Book of Nature 124
B Early Opposition to Birth Control—Moral Temperance
or Public Interference? 131
Comstock Law of 1873 131
Excerpt from Frauds Exposed 132
C Early Motivations for Birth Control—Part II: Feminism,
Radicalism, or Public Health? 139
Margaret Sanger’s The Woman Rebel 139
Excerpt from Family Limitation 142
Excerpts from What Every Girl Should Know 144
Excerpt from the Sanger-Russell Debate on Birth Control 146
D Supreme Court Cases—From Public Health to Civil Rights 153
Excerpt from Buck v. Bell 154
Excerpt from United States v. One Package 156
Excerpt from Griswold v. Connecticut 159
E Religious Reactions—Free Choice or Intrinsic Evil? 173
Excerpt from Humanae Vitae 173
F Birth Control as a Political Issue—Is Abortion a Form of Birth
Control? 181
Hyde Amendment 182
Reagan’s Mexico City Policy 182
President William Clinton’s Mexico City Policy 188
President George W. Bush’s Policy 189
President Barack Obama’s Policy 189

Timeline for Birth Control Issues 191

Glossary 197
Further Reading 203
Index 207
S ERIES F O RE WO R D

Every day, the public is bombarded with information on developments in

medicine and health care. Whether it is on the latest techniques in treat-
ment or research or on concerns over public health threats, this informa-
tion directly affects the lives of people more than almost any other issue.
Although there are many sources for understanding these topics—from
websites and blogs to newspapers and magazines—students and ordinary
citizens often need one resource that makes sense of the complex health
and medical issues affecting their daily lives.
The Health and Medical Issues Today series provides just such a one-
stop resource for obtaining a solid overview of the most controversial
areas of health care in the twenty-first century. Each volume addresses
one topic and provides a balanced summary of what is known. These vol-
umes provide an excellent first step for students and laypeople interested
in understanding how health care works in our society today.
Each volume is broken into several sections to provide readers and
researchers with easy access to the information they need:

• Section I provides overview chapters on background information—

including chapters on such areas as the historical, scientific, medical,
social, and legal issues involved—that a citizen needs to intelligently
understand the topic.
• Section II provides capsule examinations of the most heated contem-
porary issues and debates and analyzes in a balanced manner the
viewpoints held by various advocates in the debates.
• Section III provides a selection of reference material, such as anno-
tated primary source documents, a time line of important events,
x SERIES FOREWORD

and a directory of organizations that serve as the best next step in

learning about the topic at hand.

The Health and Medical Issues Today series strives to provide readers
with all the information needed to begin making sense of some of the most
important debates going on in the world today. The series includes vol-
umes on such topics as stem-cell research, obesity, gene therapy, alterna-
tive medicine, organ transplantation, mental health, and more.
I N T RO D U C T I O N

Artificial forms of birth control are now a common part of modern

American life. As of 2010, the National Center for Health Statistics
reported that 99 percent of sexually experienced women aged 15 to 44
have used some form of contraceptive at least once in their lives.
Without the benefit of historical context, this simple statistic might sug-
gest that birth control is now universally accepted and free from contro-
versy. But a little more than a half century ago, when the first oral
contraceptive was introduced, there were at least three states that outlawed
the public sale and distribution of birth control. Just over a century ago,
every church opposed birth control, every state had some prohibition
against its dissemination as a form of obscenity, and certain sectors of
the federal government actively monitored violations. The fact that birth
control is now so common reflects a history of dramatic moral, social,
political, and economic changes over the course of the twentieth century.
Even today, the predominance of birth control does not accurately
reflect the level of controversy that is still associated with it. It is true that
almost all women have used some form of birth control, but there are
differences among methods and practice among sexually active women,
suggesting greater diversity of opinion. At least 20 percent of sexually
active women choose to permanently eliminate any chance of conception
by sterilizing themselves or their partners. A majority of sexually active
women (about 56 percent) remain open to conception in the future but
choose one or more contraceptive methods. A large minority of sexually
active women (about 20 percent) choose not to use any contraceptives at
all. Although statistics provide little insight into personal motivation, the
distribution of these results suggests a lack of consensus among
xii INTRODUCTION

American men and women on the role of contraceptives in their lives.

Despite the nearly universal experimentation, birth control remains con-
troversial for a variety of moral, political, and economic reasons.
Historically, the practice and promotion of birth control has never been
without some level of controversy. Contraceptives are not new, and refer-
ences can be traced back to ancient times, with the earliest description of
pessaries in Egypt dating from around 1850 BCE. Similar accounts found
in ancient Roman, Indian and Chinese texts suggest that the practice was
not limited to any single culture or era, but their scarcity also indicates that
the dissemination of birth control information was usually limited or
deliberately kept away from the mainstream of social discussion.
In more recent times, especially in the United States, birth control was
regarded as immoral and unsafe. By modern standards, many methods
used prior to the 1800s were unreliable and unsanitary. Such remedies
included ritualistic charms, mercury-based potions, herbal mixtures, and
pessaries made from any number of substances ranging from acacia gum
to crocodile dung. Some of the social prohibitions against contraceptives
certainly arose from twin concerns about consumer fraud and public
safety. Doctors warned patients of the dangers of magical cures and their
snake-oil salesmen, while the legal system prosecuted the purveyors of
contraceptive manuals and devices under decency laws as an offense
against the public order.
Yet even beyond the obvious risks to health and pocketbook, popular
culture in the nineteenth century generally disapproved of artificial birth
control as an offense against nature. The religious community viewed
conception as a miracle that was only partially the result of human sexual-
ity. The political community viewed population growth and its related
increase in human labor as a key to national prosperity. For most
Americans in the early 1800s, the idea of limiting family size seemed both
selfish and a little unpatriotic. In this environment, birth control had very
few advocates.
The turn of the twentieth century brought with it new perspectives on
how scientific methods might be used to improve the social conditions of
human society. Some social scientists argued that there was a correlation
between poverty, criminality, and irresponsible reproduction. Others
linked unregulated births to industrial exploitation and political oppres-
sion of both men and women. These were minority voices, but they were
sufficient to shift the context of birth control away from questions of pub-
lic decency toward new questions of public health.
By the mid-1920s, the question of legal dissemination of birth control
information emerged as a matter of public debate. The majority of
INTRODUCTION xiii

churches restated their traditional opposition, but they faced an increasing

number of supporters from among the scientific community. Arguments in
support of legal birth control varied—some relied on compassionate con-
cern for mothers and others on the fear of unchecked immigrant popula-
tions, and still others feared the influence of organized religion on a free
society. By the mid-1930s, the social environment had changed. More
than half the protestant denominations came out in support of birth control
on humanitarian grounds, and the remaining minority joined the Catholic
Church in strong opposition. The scientific and legal community moved to
open toleration.
The greatest pressures for public acceptance of contraceptives came
during the 1950s as a result of an unusual confluence of technological
breakthroughs and the emerging Cold War. Modern intrauterine devices
and oral contraceptives transformed birth control into an almost sterile
practice that involved little direct intrusion on sexual activity. At the same
time, broad fears of unstable population explosions in the nonaligned
world encouraged Western nations to pour millions of dollars into
international family planning programs as part of their foreign policy
objectives. By the late 1960s, birth control was legal and practiced by a
vast majority of Americans of all faiths.
Although the 1960s ushered in a revolution in practice, it did not
entirely resolve age-old questions of morality and ethics. The Catholic
Church explicitly reaffirmed its opposition to contraception and abortion
in 1968, and the 1973 Supreme Court decision of Roe v. Wade imbued
the larger question of reproduction into political and social divisions.
Since then, the trend in public support for birth control has not been
entirely static one way or another. There was steady support for contracep-
tives as an alternative to abortion during the 1970s and 1980s, but the
1990s and 2000s saw a slight reversal in the trend as certain brands of
birth control became increasing linked to abortion practice or ideology.
The public continues to be mostly supportive, but the basis of support is
no longer as consistent as it once was.
Since the 1970s, birth control has not only been legal in all 50 states,
but it has also been partially subsidized by federal and state budgets. The
addition of economic considerations opened the way for political contro-
versy removed from obvious moral objections. Once in the political arena,
the question of birth control became subject to partisan conflicts that
remain a significant source of debate today. In 2011, strong political pres-
sures led to proposals to completely defund Planned Parenthood and other
agencies directly or indirectly linked to abortion services.
xiv INTRODUCTION

New advances in delivery methods in the 1990s also triggered a series

of national debates highlighting the dynamic tension between the pharma-
ceutical industry, public demand, and the federal government’s role in
monitoring the safety and effectiveness of each new innovation.
Consumer protection advocates raised questions about the amount of re-
sources devoted to long-term testing and product liability. Certain devel-
opments, like long-acting contraceptives, raised questions about
balancing the need for government policy designed to promote family
planning against the individual’s right to voluntarily halt their birth con-
trol method at will. Similarly, the introduction of multifunction contracep-
tive drugs led to national debates over how, where, and to whom birth
control is marketed and sold.
Since the 1970s, birth control has also become a litmus test for various
deeply rooted ideologies, including feminism, environmentalism, and the
pro-family movements. Advocates and opponents may present contracep-
tive policy as a simple matter of public health, civil rights, or individual
morality, but it is a difficult argument to make. The ideological diversity
of American society prevents easy reconciliation between advocates and
critics. Discussions over the direction of contraceptive technologies, over
the manner in which they are marketed and sold, and over the degree of
open access and the level of public subsidies all require a broad pluralist
view that takes into account multiple perspectives. This book strives to
provide a balanced discussion but leaves final conclusions to the personal
reflection of the reader.
SECTION I

Historical Overview
CHAPTER 1

Types of Birth Control

and Their Controversies

The intentional prevention and control of human conception is identified

by many names but is today most commonly referred to as birth control.
That particular term, however, dates back to 1914 when Margaret Sanger
first used it in an essay she wrote for Woman Rebel. Prior to that point,
advocates used much less explicit phrases that conveyed a sense of scien-
tific objectivity, such as “reproductive control” or “birth regulation.”
Today, the term “birth control” is often used synonymously with “the pill,”
an oral contraceptive that synthesizes the progestin and estrogen
hormones to chemically prevent conception. Chemical-based contraception,
however, is only one form of birth control.
The specific distinctions between types of birth control are not trivial.
As the president of Planned Parenthood, Alan Guttmacher, noted in the
1960s, much of the resistance to legalized and state-funded family plan-
ning policies arose from the stigma attached to artificial birth control
devices. He claimed that all societies and all religions, from ancient to
modern, have regulated human conception in some manner but that artifi-
cial birth control devices, especially the pill, seem more unnatural than
other forms and thus face greater public scrutiny and resistance.
Guttmacher argued that if the public recognized the commonalities
between all forms of birth control, then the chemical versions would not
seem so controversial.
Guttmacher focused on only a narrow point of dissension between
opponents and advocates, but his larger point that semantic confusion
underlay some of the conflict over birth control is well taken.
Understanding the different methods of birth control will help to better