Legal Battles and Rebellious Women: Birth Control in the United States
Pop quiz: What do the Barbasco root, Queen Anne’s Lace, and lead all have in common?
Answer: They have all been used as ancient methods of contraception.
And yes, that does say lead, the chemical that is toxic when ingested. Also included as ancient methods of birth control were mercury, silphium - a type of giant fennel that became extinct due to overharvesting - and lint or sponges soaked in a combination of honey, acacia fruit, and acacia leaves. These methods, along with others with varying levels of efficacy, were either taken orally or inserted into the vaginal cavity of the woman and used as a spermicide. Today, there are also a large number of contraception methods, many of which are detailed in another wonderful informative article from Be More here. Thankfully, these are much safer and effective than ancient methods.
A massive achievement in modern medicine'
With a name like “birth control,” some might wrongly assume that these methods are solely used for preventing pregnancy. In actuality, birth control, specifically the pill, is used for a variety of reasons, including but not limited to:
Treating endometriosis symptoms and reducing pain
Reducing Premenstrual Syndrome (PMS) symptoms and heavy menstrual flow
Treating severe acne
Treating Premenstrual Dysphoric Disorder (PMDD), a more severe form of PMS that carries psychological and physical impacts, including a marked increase in depression, emotional sensitivity, and anxiety
Decreases the risk of endocrine and uterine cancers
Due to the various reasons birth control can be used, it is important to understand that not only straight/cis women use and benefit from access to contraception. With that being said, increased access to birth control has allowed more women to control their fertility and effectively family plan, creating more options for women to join the labor force and get higher education without having to worry about unwanted pregnancies. Additionally, widespread access to birth control has resulted in decreased abortion rates in the US.
Well behaved women rarely make history - Margaret Sanger Edition
While knowledge of birth control is relatively widespread across the United States, it has a lesser-known history which - and this will come as a surprise to none - is riddled with legal battles and rebellious women. After condoms and knowledge of birth control methods began to spread around the 1860s, the Comstock Act was introduced in 1873 prohibiting contraception or information about it to be mailed via the US Postal Service; this was in effect until 1936. The term “birth control” was coined in 1914 by Margaret Sanger, an advocate for and pioneer in the development of modern contraception, specifically the pill. In 1916, Sanger established the first birth control clinic in the United States. She was legally persecuted for her actions and fled to England for several years before returning to the US. In the 1918 court case People v. Sanger, the state of New York ruled that placing limitations on birth control was unconstitutional because it limits the liberties of women by forcing them to have more children than they want to.
In 1953, Katherine McCormick, a longtime friend of Sanger, provided the funding to Drs. John Rock and Gregory Pincus to develop the first birth control pill. After clinical trials were conducted on Puerto Rican women in 1956, the pill, Enovid, gets approved by the FDA in 1960, followed by the first IUD in 1968. 1969 and 1970 brought a fight to lower the dangerous levels of estrogen in the pill to a healthy and safe amount, and also an outcry for more knowledge about the side effects of the pill. It wasn’t until 1972 that birth control was legalized for use by unmarried people, having only been legalized for married couples in 1965. The 1978 Carey v. Population Services case ruled that states cannot restrict the sale of contraception.
Co-pays, contraception, and Conservatives, oh my!
Fast forward to 2012 and the Women’s Health Amendment is added to the Affordable Care Act which, among other benefits, includes that all FDA-approved forms of birth control should be covered by employers without a copay. Not only did this radically improve access to birth control for approximately 62 million people, but also saved users $1.4 billion in one year in out-of-pocket costs for contraception. For any non-profit organizations that wanted the choice of whether or not to provide birth control to their employees, they would be able to fill out a form that then placed the coverage responsibility with the health insurance company instead of the organization. This accommodation was emphasized in the 2014 Burwell v. Hobby Lobby case.
Despite this accommodation, the Trump administration went even further, saying that employers can refuse to include contraception in their healthcare plans based on religious or moral objections. While this was considered a win for Conservatives, it caused a serious threat for many birth control users that they might lose access to their medication at any time based on their employers religious/moral beliefs. This decision was upheld in the Supreme Court in 2020, despite Liberal opposition and the dissent of Justices Ginsberg and Sotomayor.
The ones most at risk
As previously stated, not everyone who takes birth control uses it to prevent pregnancy, with many using it to treat various health concerns. When access to birth control is limited, it negatively impacts all who rely on it for whatever reason, but some more than others. Studies have shown that women from a low socioeconomic (SES) background, low education levels, and minority women are most at risk for “adverse reproductive health outcomes” (Committee on Health Care for Underserved Women, 2015). Women with these risk factors are less likely to be insured, which already decreases their access to birth control. Uninsured women are 30% less likely than those with health insurance to use prescription birth control, which leaves them with more unreliable and less effective methods at preventing pregnancies. There are more unintended pregnancies in Black and Hispanic women than in White women and this is largely due to access to, knowledge of, and utilization of effective contraception. Especially with the new exemptions provided by the Trump Administration and upheld by the Supreme Court, minority women and those from low SES are more at risk than ever of losing access to safe, reliable birth control.
Women throughout history have fought for equal rights in so many areas - voting, pay, healthcare. Great work has been done but there is still more work to do, more battles to fight. Equal and widespread access to contraception is not solely a “women’s problem,” but an issue that affects everyone who uses and benefits from birth control.