Contraceptive policy and ethics Illustrations from American History

While the technology of long-term contraceptives is relatively new, many of the ethical and policy dilemmas surrounding their use are not. The history of the birth control movement in this country over the past 125 years provides clear examples of the tensions that have always existed between empowering women to control their fertility and promoting limitations on fertility for the disadvantaged. While this is not an exhaustive survey, several important developments in the history of the American birth control movement have been chosen to illustrate these tensions. In the late nineteenth century, Victorian opinion tolerated promiscuity among men and promoted sexual self-control among women. Prostitutes were a common and accepted solution to this dichotomy. Despite the view that female sexuality was to serve the end of reproduction rather than the woman's pleasure, contraception was widely practiced among all social classes. The methods employed varied by class, however, due to cost and availability. The upper classes were more likely to use relatively expensive methods of contraception such as condoms, spermicides, and douches. They might also have had access to diaphragms and cervical caps, which were smuggled in from Europe at a high cost. Withdrawal and rhythm were often the only methods available to the poor. In an era when menstrual cycles were poorly understood, pregnancies often resulted. Abortion, often self-induced and always dangerous, was resorted to frequently. It is estimated that by the 1850s one out of every five to six pregnancies in America ended with an abortion.[1] Mortality from septic abortions was extremely high. In 1888, death from abortion was estimated to be fifteen times greater than maternal mortality.[2] During this era, American feminists supported the concept of "voluntary motherhood."[3] Far from empowering women and providing them with sexual freedom, however, voluntary motherhood sustained traditional family roles for women. According to this concept, limiting family size enhanced women's ability to fulfill their societal roles as wives and mothers. Feminists were joined by moral reformers, who were concerned about excessive breeding among the lower classes, particularly immigrants. Targeting the lower class and members of minority groups in the effort to reduce fertility has strong historical roots in the late nineteenth century. Although contraception was widely practiced in private, many were not willing to risk public expressions of support for it or admit to its use. This reluctance influenced public policy. Abortion was declared illegal for the first time in the United States in 1830. A majority of states had declared it so by 1970.[4] A great legal blow was dealt to contraception in 1873 with the passage of what came to be known as the Comstock laws - a federal statute that made it illegal to transport obscene materials through the mail. Contraceptive devices such as condoms and diaphragms, as well as sexually explicit literature, were confiscated under this law. It took the work of one of birth control's leading proponents, Margaret Sanger, to weaken its effects. Margaret Sanger and the Movement for Planned Parenthood Perhaps no name is more closely associated with birth control, family planning, and reproductive freedom for women than Margaret Sanger. The daughter of Irish immigrants, Sanger was born in 1879 and played a strong role in the birth control movement in the United States and abroad until her death in 1966. While she promoted access to birth control for all women, she focused particularly on the poor, as upper-class women had some access to contraception from their private physicians. Poor women did not. Sanger believed that uncontrolled fertility and large families were inextricably linked to poverty. Her efforts to empower poor women, however, had affinities with the eugenics movement. Many eugenicists supported the idea of limiting population growth, particularly among those they viewed as undesirable. …