Early birth control

Historically, contraception came in many forms, from condoms to spermicides to cervical caps to the withdrawal method. The use of condoms as contraception dates to approximately 3000 bce, when they were made from fish bladders, animal intestines, linen, or other materials. The Kahun Gynaecological Papyrus (also called the Petrie Medical Papyrus after British Egyptologist Sir Flinders Petrie, who discovered the Egyptian document) is the oldest known medical text and the earliest known discussion of contraception, written around 1825 bce. It suggested vaginal suppositories made of crocodile dung and gum or a honey mixture. [81] [82]

Around 1500 bce the first spermicides appeared, which required soaking linen condoms in a solution and drying them before use. In the 4th century bce Aristotle wrote about women using olive oil as a contraceptive. Women in preindustrial West Africa used plugs made of crushed roots, Japanese women used bamboo tissue, and women of Easter Island used algae and seaweed. [81] [82]

By the 1870s mail-order catalogs like Sears and Roebuck, pharmacies, and rubber vendors sold cervical caps, condoms, diaphragms, douching syringes and solutions, and vaginal sponges. Journalist Lisa Fogarty notes, “Some of the most popular birth control methods and devices in the 1910s included spermicides, douches, an early diaphragm called the Dutch pessary, and ergot pills, which induced abortions.” Most medical professionals, well into the 1960s, were not trained about reproductive health, much less contraception. [82] [83]

Margaret Sanger and Planned Parenthood

In 1914 nurse and social activist Margaret Sanger revolutionized the birth control debate by distributing the 16-page pamphlet Family Limitation, which included technical information about preventing pregnancy and a political statement about a woman’s right to have and use birth control. (Sanger is credited with originating the term birth control.) Due to the existing “obscenity” laws that banned the distribution of material about contraception, printers refused to print the pamphlet; one said, “This is a Sing-Sing job,” meaning the printing of the pamphlet would land him in Sing Sing, a maximum-security prison and one of the oldest penal institutions in the United States (it opened in 1826 in Sing Sing, New York, a village some 30 miles north of Midtown Manhattan that changed its name to Ossining in 1901 to avoid association with the notorious institution). She finally found a Socialist lithographer to print the publication, but only in secret, at night. The pamphlet became an international sensation, revised in 18 editions, in multiple languages. It is considered one of the most significant publications in women’s history. [151]

Fearing arrest and imprisonment, Sanger fled to Canada and then to England, returning to the United States in 1915. Charges against her were dropped, because the prosecutor did not want to make Sanger into a martyr and her trial a public forum for publicizing her beliefs. Sanger then opened the first birth control clinic in the United States on October 16, 1916, in the Brownsville neighborhood of Brooklyn, New York. The clinic offered information from trained nurses on birth control, how to use it, and how the reproductive system works.[81] [82] [84] [85] [90]

Within days of its opening, the clinic was raided, and Sanger and her sister, who helped her at the clinic, were arrested, convicted of violating the 1873 Comstock Act that prohibited the distribution of “obscene” material such as contraception information and devices. They went on trail in January 1917, and her sister was pardoned. Sanger, however, refused a plea deal and served 30 days in a workhouse. Sanger’s conviction was upheld on appeal in 1918, but in his ruling, Judge Frederick Crane also declared that physicians could legally provide contraception to married couples. Sanger’s arrest and trial and Crane’s seminal court ruling gave new life to the birth control movement.[81] [86] [87] [88] [89]

In 1921, Sanger founded the American Birth Control League, a lobbying group, and opened in 1923 in Manhattan, New York, the first legal birth control clinic in the United States, the Clinical Research Bureau (later renamed the Birth Control Clinical Research Bureau); the clinic studied birth control and dispensed contraceptives under the supervision of licensed doctors, and by the 1930s, it was serving over 10,000 patients a year and training thousands of doctors and nurses. By 1929 New York had nine other clinics, and nearly 30 such clinics had opened across the country. In 1930, Sanger opened a clinic in Harlem, New York, staffed by a Black doctor, that had the support of African American leader W.E.B. Du Bois. [82] [89] [90] [91]

By April 1938, there were over 350 birth control clinics in the United States. The birth control industry reported annual sales of over $250 million, and Fortunemagazine declared the industry one of the most prosperous of the decade. Birth control laws varied from state to state: 21 states had legal birth control, but all other states had laws limiting or outright outlawing contraception.[82] [92]

Planned Parenthood was founded in 1942 when the American Birth Control League and the Birth Control Clinical Research Bureau joined forces. [93]

Invention and rise of the pill

In 1950, Margaret Sanger began funding the development of a birth control pill. Reliable birth control could be hard to get at the time. Diaphragms required a doctor’s prescription, and doctors normally required that the woman be married to obtain one. Abortion was illegal and dangerous, and quacks with questionable herbs and contraptions were plentiful. With Gregory Goodwin Pincus and staff doing the research, Roman Catholic doctor John Rock helping with medical trials, and additional funding from Katharine McCormick and drug manufacturer G.D. Searle, the birth control pill was developed. [90]

The development of the Pill was controversial. Sanger courted and obtained the financial and advocacy support of racist eugenicists for her project. The drug was also tested in Puerto Rico and Haiti using methods that were questionable at the time and would not meet modern ethical standards. The Pill was tested on poor women without their knowledge and without knowing about the risks and possible side effects of the drug; some died during the drug trials.[84] [90] [94]

On June 10, 1957, the Food and Drug Administration (FDA) approved Enovid, known thereafter as “the Pill,” for infertility and menstrual irregularities. The FDA required that Enovid include a warning that contraception could be a side effect of the medication. As a G.D. Searle employee, I.C. Winters, said, “It was like a free ad,” because the Pill was being used for contraception anyway.[90]

The FDA approved Enovid again on May 9, 1960, this time for contraceptive use, making it the first FDA-approved contraceptive drug and the first FDA-approved drug that does not treat an illness. Within a year of its approval, 400,000 women (0.4 percent of the U.S. female population) were taking the Pill for birth control, a number that increased to 1.2 million (1.3 percent) the next year, and to almost 6.5 million (6.6 percent) by 1965. [81] [85] [90] [95]

In the early 1960s, David P. Wagner of Geneva, Illinois, distrusted that his wife Doris was taking the Pill correctly. To solve this problem, he drew a calendar on paper and laid each pill out by day, which worked for the Wagners until the paper fell off the dresser. In 1962, Wagner applied for a patent for the circular pill dispenser still common today. [90]

Birth control boom and key Supreme Court cases

In Griswold v. Connecticut (1965), the U.S. Supreme Court ruled that the right of married couples to use birth control was protected under the Constitution’s right to privacy. This ruling did not affect the millions of unmarried women in 26 states who were still prohibited from receiving birth control.[81] [85] [96]

The FDA’s approval of the Pill for contraceptive use in 1960 opened the door for the approval of other birth control methods including intrauterine devices (IUDs) such as Lippes Loop and Copper 7. In 1968, Dalkon shields were introduced, but after 200,000 lawsuits filed on behalf of women who were injured or died as a result of their use, it was taken off the market in 1974. Uncertainty about the safety of birth control methods was fairly common, and the 1970 Nelson Hearings were held in Congress to address the concerns. Although no women were allowed to testify during the hearings, the formulation of the Pill was changed, and the first package insert was required to inform women of the drug’s possible side effects and health risks.[81] [85] [97]

In 1972, with the Baird v. Eisenstadt ruling, the U.S. Supreme Court legalized birth control for everyone, regardless of marital status.[81]

As a result, the birth control market exploded. Low-dose hormone pills were introduced in the 1980s, as were copper IUDs. The 1990s brought the first contraceptive implant, Norplant; the injectable Depo-Provera; a female condom, FC1/Reality; and Plan B, an emergency contraception.[81] [85]

By 1995, only 27 percent of women who used contraceptives used the Pill thanks to increased condom use amid fears of HIV and other sexually transmitted infections (STIs).[98]

21st century

The 2000s saw even more birth control options, including the IUD Mirena, hormonal patch Ortho Evra, vaginal ring Nuvaring, female sterilization Essure, rod implant Implanon, and female condom FC2. [81]

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, which stated contraception is a form of preventative care and would be available without a copay, making most forms of birth control free to women with insurance. On June 30, 2014, the U.S. Supreme Court ruled in Burwell v. Hobby Lobby, Stores, Inc. that corporations run by religious families cannot be required to provide contraception coverage. Additionally, the May 16, 2016, U.S. Supreme Court ruling in Zubik v. Burwell (also known as the Little Sisters case) stated that religious institutions could be exempt from providing birth control coverage to employees. [85] [99] [100]

In February 2025, the FDA approved a new copper, hormone-free IUD, Miudella. Another popular copper IUD is Paragard (approved in 1984); the two differ in copper content and duration of effectiveness. There are also several hormonal IUDs available. [135]