Family Planning

Family Planning

BIBLIOGRAPHY

Family planning is a term created in the mid-twentieth century to refer to the ability to control reproduction through access to contraception, abortion, and sterilization, in addition to access to information and education. Reproductive control allows a woman to determine when and whether she will have children. A woman’s ability to control the birth and spacing of her children has a direct impact on her educational, economic, and social opportunities. A woman’s enjoyment of heterosexual activity can be affected by the fear of becoming pregnant if she lacks information about, or access to, contraception and abortion.

Women have found ways to control their reproduction since the earliest days of recorded history. However, these methods have not always been safe or effective. By 1900, every method of contraception (chemical, barrier, and natural means) had been invented, except for the anovulant method (the contraceptive pill and related methods of hormone regulation developed in the mid-twentieth century). Access to contraception was limited by law or by technological inferiority. In the United States, contraception and abortion were available through midwives, with a variety of contraceptive methods also available in the open market and through the advice of friends and family. With industrialization, urbanization, and the advent of new reproductive technologies, there was a shift away from women’s ability to control their reproductive lives. By 1900, every state had criminalized abortion in most circumstances. In 1873 Congress passed the Act of the Suppression of Trade in and Circulation of, Obscene Literature and Articles of Immoral Use. The Comstock Law, as it was known, was named for the U.S. Postal agent, Anthony Comstock (1844–1915), who lobbied for the bill’s passage. The law criminalized, among other things, the distribution of information and materials related to contraception and abortion through the U.S. mail. Legal or not, women often found means of controlling their reproduction, utilizing methods which were sometimes ineffective, dangerous, or in some cases deadly.

In the first decades of the twentieth century, social activists such as Margaret Sanger (1879–1966) and some members of the medical profession initiated a campaign for legalized contraception. Sanger was born into a large working-class family. She attended nursing school and later served as an obstetrical nurse in the Lower East Side of New York City. From her experiences as a nurse and as a child among eleven in her family of origin (her mother died at a young age as a result of multiple pregnancies within a short span of years), Sanger recognized the connection between the inability to regulate fertility and families’ economic struggles as well as women’s health. Later in life, Sanger would recall stories of women who begged her for information on how to avoid having more children or who fell ill and in some cases died as a result of a botched, illegal abortion.

Sanger’s efforts to find information on safe, legal, and effective means to regulate women’s fertility merged easily with her socialist perspective. In her socialist-feminist periodical, The Woman Rebel, Sanger first coined the term birth control in 1914. In the same year, she authored and published a pamphlet on methods of contraception, Family Limitation, based on her research on techniques and technologies of contraception available around the world. With her international research in hand, Sanger opened the first birth control clinic in the United States in 1916. One year later, she began to publish the periodical Birth Control Review. For more than a decade, the Birth Control Review provided readers with news and information on the fight for the legalization of contraception in the United States and overseas. In addition, Sanger traveled widely, organizing speaking tours and international conferences in an effort to coordinate the efforts of medical and social advocates for birth control. Thanks to the work of Sanger and others like her, by the mid-1930s various court rulings allowed contraception to be more widely available in the United States. Sanger’s American Birth Control League (founded in 1921) merged with other advocacy groups to become the Planned Parenthood Federation of America in 1942.

Sanger’s socialist roots in the birth control movement later evolved into a mainstream call for “planned parenthood”—the appropriate spacing of pregnancies to protect the health of mothers and children. The advent of the contraceptive pill in the United States in the 1960s led to a philosophical shift from birth control as a means of spacing pregnancies to a connection with the women’s liberation movement—freeing women from a fear of pregnancy, allowing them to focus on their careers and shape their own destiny.

Sanger remains a controversial figure in American history. Because she founded Planned Parenthood, critics of abortion connect her work with the abortion services offered at Planned Parenthood clinics across the country. In vilifying its founder, they attempt to discredit her organization. However, Sanger repeatedly separated the provision of abortion from contraception. She believed that contraception was the best way to prevent abortion. A second controversy attached to Sanger is the assertion that she was racist. This is the result of her reliance on eugenics discourse in her speeches and articles in the 1920s and 1930s. Her support for the provision of contraception in the African American community and overseas (in China, for example) has fueled this argument. Eugenics, the science of selective breeding, has a long history. Before World War II (1939–1945), it was a term invoked by many in mainstream society, including politicians, physicians, and professors. Eugenicists often called for the use (sometimes compulsory) of birth control (sterilization or contraception) to create a more stable, wealthier society by eliminating society’s weakest elements. While some in the eugenics movement focused on health concerns (mental and physical problems), others concentrated on moral concerns (alcoholism and criminal behavior). At its most extreme, racial prejudice led Caucasian middle- and upper-class eugenicists to blame the burgeoning African American and immigrant communities for the nation’s problems. An examination of Sanger’s perspective on eugenics reveals that her focus was on health and economic improvement (smaller families have a higher standard of living) and was not specifically connected with race.

Contraception was still illegal in many states in the mid-twentieth century until the U.S. Supreme Court, in Griswold v. Connecticut, overturned a Connecticut law banning contraceptive use in 1965. The Court ruling legalized contraceptive access for all married persons, based on the right to privacy. In 1972, in Eisenstadt v. Baird, the Court expanded the right to access to contraceptives to include unmarried people—again, based on the right to privacy. The same right was invoked in the Roe v. Wade decision in 1973, when the U.S. Supreme Court legalized abortion in the first two trimesters of a pregnancy.

Within years of the Roe v. Wade ruling, reproductive rights were again limited by law. Between 1996 and 2004, 335 new state laws were created to restrict access to abortion services. Access to abortion was limited by income (the prohibition on Medicaid funding for abortions) and age (parental consent laws instituted at the state level). Other obstacles to access were also created in many states, such as waiting periods mandated between the time of the consultation and the procedure. By 2004 just 13 percent of U.S. counties had an abortion provider. This was the result of both restrictive state legislative action and violence (and the threat of violence) against clinics and clinic personnel.

In 1999 the U.S. Food and Drug Administration approved emergency contraceptives (the “morning-after pill”) for distribution with a prescription. Emergency contraception is a stronger dose of the standard contraceptive (anovulant) pill and is effective within seventy-two hours of unprotected intercourse. It prevents the implantation of a zygote (if there is one) on the uterine wall. As its name suggests, it is intended to prevent pregnancy if contraception fails or in the case of sexual assault. In 2006, following years of politically charged debate, the FDA approved emergency contraception for over-the-counter sales (without a prescription) for women over age eighteen.

A chemical abortifacient, RU-486 (named for the French pharmaceutical company Roussel-Uclaf, which patented it), was approved by the FDA in 2000. Women in Europe had used the drug since 1988. In U.S. tests, RU-486 was shown to be 92 percent effective in terminating pregnancies before the seventh week of gestation. The abortion pill was heralded as an alternative to surgical abortion, providing a more private experience—away from the clinics that are the focal point for abortion protesters.

Immediately following the Roe v. Wade decision, the religious and conservative right organized opposition to abortion. However, legislative lobbying and clinic protests against abortion have widened in scope to attacks on certain contraceptive methods. Those who believe life begins at conception see some methods—the contraceptive pill, the “morning-after pill,” and intrauterine devices—as abortifacients because they act to prevent pregnancy after a zygote has been created. Physicians and pharmacists opposed to abortion may refuse to prescribe, or fill prescriptions for, these forms of contraception. Pro-choice forces, on the other hand, hope to prevent abortion through increased access to contraception and comprehensive sex education. Because abortion is a debate of absolutes, pro-life and pro-choice forces will continue to be engaged in this issue.

SEE ALSO Abortion; Birth Control; Contraception; Eugenics; Family Structure; Fertility, Human; Population Control; Population Growth; Pro-Choice/Pro-Life; Roe v. Wade; Supreme Court, U.S.

BIBLIOGRAPHY

Chesler, Ellen. 1992. Woman of Valor: Margaret Sanger and the Birth Control Movement in America. New York: Simon & Schuster.

Feldt, Gloria, with Laura Fraser. 2004. The War on Choice: The Right Wing Attack on Women’s Rights and How to Fight Back. New York: Bantam Books.

Gordon, Linda. 2002. The Moral Property of Women: A History of Birth Control Politics in America, 3rd ed. Urbana and Chicago: University of Illinois Press.

McCann, Carole R. 1994. Birth Control Politics in the United States, 1916–1945. Ithaca, NY: Cornell University Press.

Reagan, Leslie J. 1997. When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973. Berkeley: University of California Press.

Sanger, Margaret. 1938. Margaret Sanger: An Autobiography. New York: Norton.

Julie L. Thomas