Let me begin today by stating what I do not intend to deal with, namely the ethical and moral aspects of the current birth control issue. I fully realize that there are several highly sensitive topics that we will be examining today, and my major objective is not to convince you about a particular position on these matters but, rather, to trace the chronological evolution of these issues in the context of American history, focusing both on the important themes which occurred and the prominent people who helped shape the changing American beliefs about birth control.

In reality, the birth control movement has been and remains more a question of social values and contrasting human motives rather than the story of technical medical advances. We also have to accept the fact that American sexual norms have changed radically over the past 2 centuries. In this lecture I intend to deal with the wide variety of birth control techniques used for various reasons by the American public in the 19th and 20th centuries, including the various methods of contraception, abstinence, marriage late in life, and abortion.

In 19th century America family size was drastically reduced long before the advent of large-scale industrialization and urbanization, as well·as the public health reforms which occurred near the end of that century. While the United States’ birth rate in 1800 was 7.04 children/family, this figure declined to 5.21 children/family in 1860, and by 1900 the birth rate had been cut roughly in half from the
1800 number to stand at only 3.56 children/family. These figures show that the
American public had obviously decided that smaller families were desirable. There were several reasons for this dramatic downward trend in family-size.

One primary reason was that the emerging middle class in the United States came to see large families as a threat to their socio-economic ambitions. Secondly, the shift throughout the 19th century from a rural, agrarian lifestyle to an urban, industrial society meant large families were no longer needed to work the farms. Thirdly, the essential character of the American family was changing to a unit based more on romantic love which allowed for the separation of sex and procreation.

Finally, information about available forms of birth control techniques was more accessible to the general public than ever before. Marriage manuals, commercial advertisements, and lectures by health reformers, such as Sylvester Graham, who we discussed earlier in this course when we examined health fads, provided information about available contraceptive methods, advised abstinence or late marriages to prevent unwanted children, or, if these methods failed, explained the ease of getting an abortion.

Let's begin by examining the abortion issue in
19th century America, as this part of the birth control picture was firmly settled, at least for the next 60 years, by 1900. In 1800 American women were legally free to terminate a pregnancy via an abortion unti1 the existence of that pregnancy was incontrovertibly confirmed by the perception of fetal movement, which was known as the doctrine of quickening. This legal view allowing abortion prior to quickening, which usually occurred late in the 4th or early in the 5th month of pregnancy, was firmly based on
British common law.

Traditional physicians of this era, though powerless to change this public opinion, basically opposed abortions because it violated the Oath of Hippocrates, because they rejected the doctrine of quickening as being unscientific, and because abortions were often performed by midwives or irregular doctors, thus giving an economic edge to the traditional physicians' competition.

Between 1840 and 1860 the American public's opinion about accepting abortions prior to quickening was drastically altered by 4 factors.
First, abortions came out into public view as a social reality. Newspapers of that era widely advertised commercial abortionists, as well as covered trials of quacks caught butchering patients seeking abortions. Secondly, the number of abortions supposedly sharply increased. It was estimated that prior to 1840 the abortion rate was
1/25 to 1/30 live births, whereas, in the 1850's and
1860's, this rate had supposedly shot up to 1 abortion per 5 to 6 live births. Whether these figures are accurate or exaggerated they were used effectively by the forces pushing for anti-abortion laws.

A third major perceived change in abortion tendencies in mid-19th century America was in who was having abortions. As I stated, prior to
1840 the public believed abortions were sought only by the unfortunate few. However, after 1840 it became widely accepted that abortions were mostly being sought by middle and upper class
White Protestant women seeking merely to limit family size for their own selfish socio-economic reasons. There was tremendous concern that this pattern of abortions among old-line
American women would permit Catholics and immigrant groups to take over as a dominant socio-political force in the United States.

The fourth and most effective factor leading to changes in both the public’s perception of abortion and the laws dealing with this situation was the expanding role played by the traditional medical profession in opposing this practice. Working through the
AMA and state and local medical societies the American medical community actively sought to limit the practice of abortion to a medical procedure carried out only by a traditional physician.

This anti-abortion movement was lead by
Dr. Horatio R. Storer of Massachusetts beginning in 1857. Storer published numerous journal articles stirring the medical profession to action on the abortion issue. Through his efforts the
AMA, in 1859, adopted a 3-fold antiabortion report which rejected the doctrine of quickening and encouraged both the national AMA, and the state and local medical societies to lobby state legislatures for anti- abortion laws.

Primarily because of the effectiveness of the medical comunity's efforts and the public’s growing concern over the supposed changes both in terms of the numbers of and who were having abortions, state legislatures between 1860 and 1900 passed stringent anti-abortion laws. By 1900 abortion was officially, legally prohibited in all states in the U.S.

Interestingly enough organized religion played little if any part in the 19th century abortion debate.
Even though the Catholic church in 1869 officially denounced all forms of abortion, even to save the mother's life, the Protestant churches refused to enter this debate. We can therefore say that it was the medical profession, seeking to extend its control over this medical procedure, which effectively lead the anti-abortion efforts in the second half of the 19th century. The anti-abortion state laws in place by
1900 would not be effectively legally challenged or altered until the 1960's, and not until the landmark l973 Supreme Court Roe v Wade decision were these
19th century anti-abortion laws finally struck down and replaced by a more tolerant legal position on abortion.

Turning from the abortion issue we find that information about other types of birth control was also widely available in the United States into the 1870's. Beginning with Robert Dale
Owen 's 1831 book entitle Moral Physiology, non-medical marriage advice manuals had a major impact by providing interested women with knowledge about their bodies and how to prevent pregnancies. Physicians, also, published books and pamphlets explaining available birth control techniques to the public. The 2 best known such works were
Fruits of Philosophy by Charles Knowlton in
1832 and Medical Common Sense, by Edward
B. Foote in 1858.

In the 1870's the United States was undergoing a great crusade, in many ways reminiscent of the anti-slavery campaign prior to the Civil War. This new crusade was to make this nation live up to the supposed sexual ideals of Victorian society.
Conservative businessmen and doctors joined with the emerging feminists of that time in opposing not only abortions but also easy access to birth control information and products. Into this era ready to accept blatant censorship in the name of a just cause came
Anthony Comstock to galvanize these factions into effective legal opposition to all forms of birth control.

Comstock, who lived from 1844 to 1915, was born in New Canaan, CT., and became
America’s most famous, or infamous, anti-vise crusader. At the age of 18 he broke into a local saloon and destroyed all its liquor. After serving in the Union Army during the Civil War he moved to N.Y.C. to seek economic opportunities. There he became active in the YMCA and in public crusades to protect immigrants from the city’s lure of sex and alcohol. Comstock became convinced that obscene literature was the core of this problem, as he stated:
(quote, Cirillo, p. 262).

In 1865 and 1872 he went to court against the circulation of what he judged to be obscene materials, but he lost both trials. Embittered by these defeats and now funded by wealthy, conservative business interests Comstock lobbied Congress for a new obscenity law and achieved success with the May, 1873 passage of the stringent anti-obscenity federal law which came popularly to be called the Comstock Law.
This law forbid the use of the federal mail to send out a wide variety of supposed obscene materials, including anything which even mentioned abortion or birth control.

Thus at the start of the 20th century the following impediments stood in the way of birth control advocates. One, state laws prohibited abortions.
Two, the Comstock Law effectively banned birth control information and products from the federal mail. Three, there was a lack of control over the quality of contraceptive products, as some were blatantly ineffective. Four, the declining birth rate was perceived by the public to be a threat to the social order via differential fertility, thus making birth control appear as a threat to traditional
American society. Five, the lack of medical research on birth control techniques meant even those physicians providing birth control information to their patients could not be sure of its accuracy.

During the first decade of the 20th century the birth control cause was only openly championed by a few anarchists and labor leaders, such as
Emma Goldman. Her efforts and those of her radical colleagues probably brought more discredit on the birth control movement than helped further this cause.
Yet there were forces in American society which supported the infant birth control movement. First, there was a growing problem of the seeming surplus of children in a rapidly urbanizing society. Secondly, there was the concern over the physical hazards of child birth, as large families were dangerous for both the mothers' and her children’s health.

Into this confusing, highly charged atmosphere, both prohibiting and promoting birth control, stepped one of the most influential women in
American and possibly world history: Margaret
Sanger, who lived from 1879 to 1966. Between
1914 and 1937 she helped remove the stigma of obscenity from contraception, lead the fight to establish a nation-wide system of clinics where women could receive reliable birth control services, spearheaded the overturning of the
Comstock Law, and helped lay the groundwork for organized medicine's acceptance of birth control in 1937. After WW II Sanger helped in the creation of the international planned parenthood movement and the development of the birth control pill.

Sanger was born in Corning, N.Y., as
Margaret Higgins, and grew up with a father who espoused numerous radical social causes. She attended Claverack College, then trained as a nurse in a hospital diploma program. She then married a young architect, William Sanger, and the couple had 3 children. After recovering from an attack of tuberculosis Sanger felt, like many women of that era, trapped into a life of domesticity. In 1910 she attended a
Socialist party meeting in N. Y. C. which started her on the path to becoming a militant social crusader.

Sanger began her birth control crusade by trying to publish a newsletter and pamphlets describing available contraceptive techniques. These efforts brought her into immediate conflict with the
Comstock Law and its main proponent, Anthony
Comstock. In 1914, facing a possible 45 year jail sentence for mailing supposed obscene material on birth control, Sanger fled to Europe, where for
2 year she lived with and learned from some of the
European leaders in the birth control and sexual freedom movements, including Marie Stopes and
Havelock Ellis. She returned to the United States, now convinced that to win her birth control crusade she needed to win the support of the wealthy social elite and to gain acceptance of birth control from the medical profession.

From 1921, when she created it, through 1927, when internal politics created a division within its ranks,
Sanger ran the American Birth Control League. Her major weakness was that she always demanded to be recognized as the sole leader of the American birth control movement, and her inability to be a team player in national birth control organizational politics caused considerable friction with other birth control advocates. In 1936 she finally was able to have the
Comstock Law declared unconstitutional in the famous court decision, U.S, One Package, that now permitted the mailing of contraceptive information and devices. Still it was not until 1971 that it became legal for an individual to bring a contraceptive device into the United States from abroad.

This individual was Dr. Robert L. Dickinson, a highly respected Brooklyn obstetrics and gynecological expert who lived from 1861 to
1950. Prior to his efforts the traditional medical community had refused to recognize birth control as a legitimate function of physicians because it might jeopardize their acceptance by upper and middle class Americans, because physicians were concerned about retaining women's traditional role in American society as the bearers of children, and because many physician saw birth control as the realm of the quack, the midwife, or the ignorant lay reformer, such as Margaret Sanger.

Dickinson left his profitable Brooklyn medical practice to work full-time promoting the cause of and researching in the field of birth control. At first he rejected the plea from Sanger to work with her and her colleagues. Instead of using Sanger's early birth control clinics Dickinson, in 1923, created the Committee on Maternal Health (CMH) composed of noted physicians to study the feasibility of the then current contraceptive devices on the market. It soon became clear to him, however, that a combination of conservative physicians and hospital administrators would prohibit this research so, in 1930, he officially joined Sanger's Clinical Research Bureau run by the American Birth Control League.

Since 1925 Dickinson and his allies had attempted to have the AMA officially endorse birth control as a legitimate medical activity. Finally, in 1937, the
AMA accepted a report which 1. called for AMA sponsored research on contraceptive devices
2. urged medical school instruction about birth control 3. omitted any criticisms of lay-run birth control clinics, thus tacitly accepting Sanger's work, and 4. told physicians to give contraception advice based primarily on the wishes of their patients. Organized medicine had now legitimized contraception and Dickinson had been the mediator through which this had occurred, and his pioneering work in sexology was the example for
Alfred Kinsey and other later sex researchers.

Even with the successes by Sanger and
Dickinson which we have already mentioned, birth control advocates faced 5 major obstacles in 1940 in their continuing drive to make safe, effective birth control available to all families who sought this type of information and products. First was the serious concern about depopulation in the United States. During the
Great Depression the American birth rate in 1936 actually dropped below 2 children/family, or the replacement level. There was also the continued strong concern over differential fertility rates, as
American eugenicists feared that birth control would allow inferior groups within America to become predominant.

Between 1940 and 1960 occurred a major new impetus to the birth control movement with the world-wide population explosion. Although after
W. W. II the Communist and the Catholic nations blocked initial efforts for world-wide birth control activities, the free-Western nations saw the desperate need for action on the birth control front.
In 1942, 2 of the competing American birth control groups merged to created the still prospering
Planned Parenthood Federation of America, thus removing the stigma of the term birth control from its title. In 1952, through the inspiration of
Margaret Sanger, the International Planned
Parenthood Federation was launched at a Bombay,
India conference.

Sanger was very anxious for the success of this work but realized that neither the medical nor the pharmaceutical industries would adequately fund this research. She therefore persuaded her long-time ally in the birth control crusade, Katherine Dexter
McCormick, to provide the necessary funds.
McCormick was a graduate of MIT and had married into the wealthy McCormick family of International Harvester fame and fortune.
Between 1953 and 1960 she poured millions of dollars into the research which produced the anovulant pill.

The actual research which developed the birth control pill was spearheaded by a brilliant scientist and shrewd politician, Gregory Goodwin
Pincus. Pincus received his Ph.D. in the biology of genetics from Harvard and headed a major laboratory studying hormonal physiology.
Besides gaining the financial support, via Sanger, of McCormick, Pincus also received much needed supplies, equipment, and expertise from G. D.
Searle and Co., a major pharmaceutical firm. After successful clinical trials in Peurto Rico in 1958/59, and dogged lobbying of the FDA, the first commercial contraceptive pill was approved for marketing in May, 1960, thus opening up an entire new era in birth control.

Contraception was now easy and aesthetic for both the public and for physicians. Today millions of women world-wide are using the pill. The major drawbacks in birth control today are the lack of either education about or motivation to use available birth control resources.