Birth Control and Family Planning. Americans have practiced birth control throughout their history. Women in the Colonial Era, relying on centuries‐old techniques, used sponges and suppositories to prevent pregnancy. Traditional folk medicine offered recipes for abortifacient brews of aloes, pennyroyal, and extracts from wild juniper bushes that so poisoned or irritated the system that miscarriages occurred as a side effect. Mechanical abortions, performed without anesthesia or antibiotics, were rare, painful, and dangerous.

The Nineteenth Century.

In the nineteenth century, the fertility rate of American women fell from around 7 children per mother in 1800 to 3.5 in 1900. This decline can be attributed to periodic abstinence from sexual intercourse, coitus interruptus (male withdrawal before ejaculation), placing objects in the vagina to create a barrier between sperm and uterus, and inducing abortion through drugs or mechanical means. While all such methods violated official standards of sexual conduct, a few freethinkers began in the 1830s to argue for family limitation to restrict the labor supply and ease the economic burdens of the poor. Also contributing to changing attitudes was the fact that marriage began to be seen as an expression of romantic love rather than merely an economic alliance.

As the century wore on, the declining fertility of native‐born white women alarmed social leaders. Francis A. Walker, director of the 1870 U.S. Census, in noting the higher fertility of immigrant newcomers compared to native‐born couples, called for restriction on immigration. Concerns about “race suicide” and exhortations to native‐born couples of Anglo‐Saxon origins to have more children persisted into the Progressive Era. This preoccupation, in turn, affected attitudes toward abortion. Prior to 1840, U.S. law, drawn from English common law, generally allowed abortion before quickening (the first fetal movement felt by the mother). At midcentury, however, physicians campaigned successfully to outlaw all induced abortions. This campaign allowed the medical profession to extend its authority while also addressing disturbing demographic trends. By the 1880s, most states had outlawed induced abortion except for therapeutic purposes. The 1873 Comstock Law, a federal obscenity law named for Anthony Comstock (1844–1915) of New York's Society for the Suppression of Vice, prohibited the mailing of abortifacients, contraceptives, or information about abortion or contraception.

From 1900 to World War II.

The modern American family‐planning movement emerged from three distinct although overlapping forces: the early twentieth century birth‐control advocacy of Margaret Sanger and other feminists; a Progressive Era eugenics campaign; and a post–World War II population‐control movement. Sanger, a nurse active in New York's socialist and radical labor movements, became increasingly concerned about the plight of working‐class mothers who bore the burden of uncontrolled fecundity. Her 1914 pamplet “Family Limitation” forced her to flee to Europe to avoid prosecution under the Comstock Law. Upon her return she launched the Birth Control Review (1917), organized the American Birth Control Conference (1921), and otherwise devoted herself to the cause. Meanwhile, Sanger's rival Mary Ware Dennett (1872–1947) had formed the Voluntary Parenthood League, which campaigned for the repeal of federal laws against birth control. In 1925, Dr. Robert Latou Dickinson (1861–1950), concerned that birth control was acquiring a “bad name,” organized the Committee on Maternal Health to sponsor research on fertility and sterility. In 1939, facing financial difficulties, these three groups merged to form the Birth Control Federation of America. Renamed the Planned Parenthood Federation in 1942, it pursued the cautious goal of providing contraceptive services to married women in physician‐directed clinics.

By 1937, Americans spent $38 million on condoms and more than $200 million on “feminine hygiene” (contraceptive douching). Despite liberalization by some state and lower federal courts, however, contraceptives—many unsafe and defective—could still be purchased only with a prescription, and at inflated prices. Through the efforts of Clarence J. Gamble, an heir to the Ivory Soap fortune, the Food and Drug Administration (FDA) began to test condoms and other contraceptive devices in the late 1930s. The birth‐control movement took heart from federal judge Augustus Hand's 1937 ruling in United States v. One Package that Congress in enacting the Comstock law had lacked crucial information about the risks of pregnancy and the usefulness of contraceptives. Nevertheless, complete birth‐control bans remained in effect in Connecticut and Massachusetts into the 1960s. In a landmark victory for reproductive rights, the Supreme Court in Griswold v. Connecticut (1965) struck down the Connecticut law banning the distribution of contraceptive devices or information as a violation of married couples' right to privacy. The same principle, extended to unmarried persons in Eisenstadt v. Baird (1972), later formed the basis for Roe v. Wade (1973), which established a constitutional right to abortion.

Post–World War II Developments.

Meanwhile, the post–World War II concerns about overpopulation led philanthropic foundations and activist organizations, including the Population Council, the Ford Foundation, and the Population Crisis Committee, to join Planned Parenthood in calling for federal support for international and domestic birth‐control programs and reproductive services. In 1951, the chemist Carl Djerassi and his team at Syntex, a small Mexico City chemical company, synthesized a drug that would prove effective as an oral contraceptive. The endocrinologist and biotechnology entrepreneur Gregory Pincus (1903–1967) of Worcester, Massachusetts, and others conducted the experiments that established the drug's effectiveness and appropriate use. Thanks to Pincus's research, financed by Sanger and Katharine Dexter McCormick, the drug gained FDA approval and was marketed in 1960 by G.D. Searle and Company. The “pill,” along with effective intrauterine devices (IUDs), transformed contraceptive practices in the United States.

By linking birth control to the War on Poverty, the Lyndon B. Johnson administration initiated federally supported family‐planning programs in the mid‐1960s. The Family Planning Service and Population Research Act of 1970 gave legislative support for such programs. The Roman Catholic hierarchy opposed federal involvement in family planning, however, favoring instead the “rhythm method” by which married couples abstained from sexual intercourse during the fertile period of the woman's menstrual cycle. Pope Paul VI's 1968 encyclical Humanae Vitae indicated the divisiveness of the issue even within the Catholic church, however.

The family‐planning debate was transformed in the late 1960s as feminists defined abortion as a women's rights issue. The abortion‐reform movement, led by women's groups and such organizations as Planned Parenthood, Zero Population Growth (founded 1968), and the National Abortion and Reproductive Action League (known as NARAL), secured liberalized legislation in many states. The landmark Roe v. Wade decision, however, also mobilized the anti‐abortion forces. Congress restricted Medicaid funds for abortion, and many states placed stringent restrictions on abortion procedures. Although the federal courts overturned many of these state regulations, others were upheld. While most anti‐abortion activists confined themselves to rallies and peaceful demonstrations, a few violence‐prone loners on the movement's fringes bombed abortion clinics and even murdered physicians and other providers of abortion services.

By the 1990s, about 60 percent of American women used artificial contraception, with little difference among Protestants, Catholics, and Jews, and the federal government was spending $700 million annually on family‐planning programs that included oral and mechanical birth control, sterilization, and abortion. While the abortion controversy raged on, the debate over contraception appeared largely settled as the twentieth century ended.
See also Biological Sciences; Biotechnology Industry; Censorship; Feminism; Marriage and Divorce; Medicare and Medicaid; Roman Catholicism.

Bibliography

David M. Kennedy , Birth Control in America: The Career of Margaret Sanger, 1970.
Linda Gordon , Woman's Body, Woman's Right: Birth Control in America, 1976; rev. ed. 1990.
James Mohr , Abortion in America: The Origins and Evolution of National Policy, 1978.
James Reed , From Private Vice to Public Virtue: The Birth Control Movement and American Society since 1830, 1978.
Ellen Chesler , Woman of Valor: Margaret Sanger and the Birth Control Movement in America, 1992.
David Garrow , Liberty and Sexuality: The Right to Privacy and the Making of “Roe v. Wade,” 1994.
Donald T. Critchlow , Intended Consequences: Birth Control, Abortion, and the Federal Government, 1999.

Donald T. Critchlow