The Legal Evolution of Birth Control

Healthcare, Politics, Rights

While a House committee hears testimony from a panel of male religious leaders this week, drawing fire from women’s groups as well as female members of Congress, let’s take a look back at where birth control started and where we’ve ended up.

How Far We’ve Come

The birth control pill wasn’t the first attempt at contraception. Since ancient times, both men and women have tried various methods. Ancient Egyptian women used cotton suppositories containing a mixture of dates, honey, and acacia; Greek women coated their cervixes with olive oil. Early condoms, in the Renaissance era, were made of animal intestines, and once rubber began to be mass produced in the 19th century condoms and diaphragms, called “womb veils,” were readily available.

None of these methods was surefire at preventing pregnancy, of course, and the ever-popular rhythm method often failed–in part because it wasn’t until the 1930s that science figured out women ovulated in the middle of their cycles, not during menstruation.

Just Say No?

A growing Puritanical movement in late 19th-century America made even these rudimentary attempts at birth control out of reach for many women in the U.S. Anthony Comstock was a crusader against anything he believed immoral; he believed that widespread access to condoms and “obscene literature” was causing the downfall of society.

Comstock founded the New York Society for the Suppression of Vice and had such influence that in 1873 Congress passed what was popularly known as the Comstock Law. This made it illegal to distribute or sell any “obscene literature” or “immoral articles,” which included not just birth control devices themselves, but printed information about contraception, sexually transmitted diseases, human sexuality, and abortion.

Welcome to the 20th Century

The Comstock Laws were unchallenged until birth-control advocate Margaret Sanger took it upon herself to oppose the Comstock Act. She challenged the law in 1916 by opening up the first birth control clinic in the U.S. in Brooklyn. Sanger was arrested, but the publicity brought birth control into the public debate. Her case eventually resulted in the 1918 Crane decision, which legalized birth control for medicinal purposes.

Sanger founded the American Birth Control League in 1921 and began her next challenge: finding researchers willing to work on formulating an oral contraceptive for women. The next amendment came in 1936 with a U.S. Court of Appeals decision that allowed doctors to mail birth control devices and contraceptive information. Finally, in 1965, the Supreme Court case of Griswold v. Connecticut overturned the Comstock Law, ruling that married couples had a constitutional right to use birth control.

The Birth of the Pill

The first human trials on the birth control pill were in 1954, on 50 women in Massachusetts. In 1956, large-scale trials were conducted in Puerto Rico, where there were no anti-birth control laws on the books. In 1957 the FDA approved the Pill, but only for severe menstrual disorders, not as a contraceptive. Finally, in 1960, the Pill was approved for use as a contraceptive.

It wasn’t without controversy, however; in the early 1960s the Pill was still illegal in eight states. However, increasingly outdated moral standards couldn’t compete with the first method of contraception deemed nearly 100 percent effective when taken correctly.  After two years, 1.2 million Americans women were on the Pill; by 1965 that number had risen to 6.5 million.

Controversy and Risk

Along with controversy, taking the Pill meant taking some risks. The first birth control pills had high hormonal doses, up to 10 milligrams. Side effects included nausea, blurred vision, bloating, weight gain, mood swings, and depression; even more serious were potentially fatal risks like blood clots and stroke. Women taking the Pill were often unaware of these risks, as doctors routinely believed their patients unable to make informed judgments about such things.

After nearly a decade of rising popularity and acceptance, the first real challenge to the Pill appeared in the form of Barbara Seaman’s book The Doctor’s Case Against the Pill. The book talks about what women on the Pill already knew about side effects, including weight gain, loss of libido, and depression; it also exposed the serious risks of blood clots, heart attack, and stroke. The Senate held hearings on the safety of the birth control pill in 1970; by 1979 sales had dropped more than a quarter due to publicity about health risks.

The Pill Today

The approval of the birth control pill is widely acknowledge as playing a major role in the sexual liberation movement of the 1960s. For the first time, women were as free as men to enjoy sex without fear of pregnancy.

Improvements to the formulation continued; in 1988 the original formulation of the pill was taken off the market for good. An FDA study showed that the benefits of new low-dose pills–with as little as one milligram of active ingredients–included a decreased risk of uterine and ovarian cancers, iron deficiency anemia, and pelvic inflammatory disease.

In 2000, the Equal Employment Opportunity Commission ruled that prescription contraception must be covered by employer-offered health insurance. In 2010 it was estimated that about 16 million women use the Pill.

While there appears to be a divide on Capitol Hill over the Obama administration’s requirement that health insurance plans cover the cost of prescription birth control, a majority of Americans appear to support the policy. A recent New York Times poll showed 65 percent of voters agreeing that employer-provided health insurance plans should cover prescription contraceptives, and 59 percent agreed that the plans of religiously affiliated employers should not be exempt.