The Strange History of Birth Control

In the 1920s it was illegal to advertise contraceptive diaphragms in the US or send them through the mail, and anyone who wrote about them risked imprisonment for indecency. The devices were entirely banned in some states, and in others doctors prescribed them only to women for whom pregnancy posed a clear health risk, if at all. Most couples relied on condoms, withdrawal, and douches, including the popular disinfectant Lysol, which was advertised in magazines along with “fountain syringes.”1

Margaret Sanger, the founder of the American Birth Control League, which became Planned Parenthood, and her allies eventually succeeded in making safe, reliable contraceptives— including condoms, diaphragms, intrauterine devices (IUDs), and hormonal pills and injections—accessible to millions of people throughout the world. But for years their campaign was opposed by two powerful forces. Eugenicists knew that white, middle-class women were more likely to use birth control than other ethnic groups or the poor. Making contraceptives more available would therefore only exacerbate what they saw as the problem: the swamping of the Nordic and Anglo-Saxon races by imbeciles, blacks, Asians, and eastern and southern Europeans. Meanwhile, the Catholic Church, bent on preserving its doctrine that procreation must be the primary purpose of sex, declared contraception sinful.

Two fascinating new books, Fatal Misconception: The Struggle to Control World Population by Matthew Connelly and Reproducing Inequities: Poverty and the Politics of Population in Haiti by M. Catherine Maternowska, show how this impasse was finally, if imperfectly, resolved. Today, family planning services are available throughout the US and even in remote parts of many developing countries. This is largely the result of an extensive, US-led effort during the 1960s, 1970s, and 1980s. Researchers invented cheap, easy-to-use contraceptives, and a global network of governmental and nongovernmental agencies, research centers, and think tanks developed the means to deliver them through specialized clinics, mobile vans, and door-to-door community distribution programs.

The family planning movement is one of the great success stories of public health. Birth control enables women to be more economically and socially independent, which may be crucial for sustainable development in general.2 It also enables them to lengthen the intervals between pregnancies, which improves child health and reduces the risk of fatal birth complications and abortion. However, the books under review remind us that at one time, these benefits were seen by many US family planning officials as secondary to the goal of reducing the absolute numbers of people in developing countries. The urgency of what came to be known as the “population control movement” contributed to a climate of coercion and led to a number of serious human rights abuses, especially in Asian countries. Family planning experts, in promoting the distribution of new contraceptives, sometimes failed to ensure their safety, and the staffs of local programs sometimes bullied people into using them, or even into being sterilized. Coercion was never a stated US family planning policy, but in their zeal to fight overpopulation, American policymakers, agency bureaucrats, and researchers often overlooked how local…

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