The Liberating but Racist History Behind Birth Control

I can’t stress enough how far we’ve come with birth control. So instead of going on for way too long about it, I’m just going to start this off with a list of birth control methods people used throughout history.

  • Drinking liquid mercury, arsenic, lead, or a cocktail of all three 
  • Spermicide made of crocodile sh*t
  • Squatting and then sneezing the sperm out after sex
  • Hanging weasel testicles around a woman’s neck or thigh
  • Smearing wine or lead inside a woman’s cervix
  • Dipping the penis into vinegar before sex

So yeah, the science around birth control and our understanding of reproductive health has made huge leaps. What’s been pretty stagnant though, is the responsibility of birth control falling on women, often times to the detriment of our health. Except with that vinegar penis thing. That was admittedly a pretty dark, and I imagine painful, period for men’s health.

Today though, the responsibility put on women is made safer thanks to activists and scientists that brought us one of the most effective birth control methods we have today – the pill.

One of the main advocates for not just the pill, but a new cultural view of birth control and women’s health, was Margaret Sanger. Sanger grew familiar with the challenges of female reproductive health from an early age. She watched her mother experience multiple miscarriages and saw firsthand the toll they took both mentally and physically on her mother. But it wasn’t until working as a nurse in Greenwich village that birth control became a focus for Sanger. Sanger often came across low-income women dealing with unexpected pregnancy. She often heard about them dying from botched abortions.Sanger working as a nurse back in 1916.

To Sanger, the ability for women to “consciously choose whether she will or will not be a mother,” was a fundamental part of women’s liberation. Even before research around an oral contraceptive came onto Sanger’s radar, she was providing other means of birth control and keeping women informed. Sanger got into legal trouble for writing on birth control in her own feminist magazine, The Woman Rebel. She escaped to Europe and upon return, smuggled in other forms of contraceptives for women, like diaphragms secretly sewed into dresses and coats. And of course, she founded the American Birth Control League, that has evolved into what we know today as Planned Parenthood. 

A page out of Sanger's publication The Woman Rebel

The pill and all the research that went into it couldn’t have happened without serious funding. A lot of it came from Sanger’s friend and fellow leading feminist Katharine Dexter McCormick. Before becoming the money behind the American Birth Control League, McCormick was a prominent figure in the League of Women Voters. McCormick funded an annual $180,000 research grant that made the research and clinical trials for the pill possible.

It’s hard to nail down the invention of the pill to just a few scientists. Around this time of the early 50’s, there was a lot of scientific work that went into developing the pill. Just two of them though, funded by McCormick’s grant, were Gregory Pincus and Min Chueh Chang. Both scientists already had a history of working in fertility and were then just exploring the idea of an oral contraceptive. A big part of the breakthrough came from chemist Russel Marker. Marker showed Chang and Pincus the history of Mexican woman eating the Barbasco root, a plant that contained the progestin necessary to create the pill in combination with estrogen.

After the research and production of the pill came the clinical trials. This was lead by Dr. John Rock. After initial trouble in finding a place where the pill could be tested, Rock eventually settled on Puerto Rico. Puerto Rico was the perfect grounds for the tests for a number of reasons. It was close to the U.S. which made reporting back to the research team easier, there were no laws against contraceptives, and they already had a number of prominent birth control clinics. So, once Rock selected candidates, 221 Puerto Rican women became the first to take the risk and test the pill over a number of years.

A lesson on birth control methods in Puerto Rico

By today’s standards though, it’s debatable whether these women were able to give informed consent. The formal process used today in drug tests of laying out any risks in detail and signing forms, just didn’t exist back then. This is especially alarming given how much stronger the pill was in its first iteration. The first pill was made up of 10,000 micrograms of progestin and 150 micrograms of estrogen. Today’s pills only contain at maximum, 150 micrograms of progestin and 50 micrograms of estrogen.

Many of the Puerto Rican women in the clinical trials reported nausea, headaches, and vomiting. It was so severe that a portion of women left the study, one died of heart failure, and another developed tuberculosis as a result. Dr. Edris Rice-Wray, another leading doctor in the drug test, reported this back to Pincus but she was largely ignored. At the end of the day, Pincus saw the development of the pill firstly as an advancement in biological studies, not a break through in women’s health. So, regardless of the side effects, the trials continued and by the late 50’s, the pill was FDA approved. It was first approved as a means of regulating periods, then later as a contraceptive and became a large part of the sexual revolution.

But this is only one line of story about the pill, the most famous one. Sanger’s journey, the connections she made and the conversations she started, totally re-shaped society's views of sex and gave women more agency. Yet some of what Sanger was fighting for, the medical practices and ideologies she bought into, were harmful to or excluded disabled and/or women of color.

The most debated aspect of Sanger’s legacy, her vocal support of eugenics. There’s still a lot of debate today about how much race played into Sanger’s support of eugenics. Historian Ellen Chesler says it was more just that eugenics was popular at the time, so playing into it served as a way for Sanger to popularize her own cause of reproductive rights. And while politicians like Ted Cruz and Ben Carson have pointed to Sanger’s support of eugenics to discredit Planned Parenthood, in her time Sanger actually saw support from Martin Luther King Jr. and sought to help minorities. King said there was “a strong kinship” between his civil rights movement and Sanger’s fight for birth control. All that said, Sanger’s eugenic writing was still very harmful. She supported the idea that “the most urgent problem today is how to limit and discourage the over-fertility of the mentally and physically defective.”

Outside of controversy about Sanger herself, priorities for white woman at the time were different from that of women of color. Because for many women of color, specifically Black, Puerto Rican, and Native American women, the fight for birth control was rendered a moot point when the government sterilized them as part of eugenics programs. The government did this not just by misinforming women of color but operating without any discussion at all.

Elaine Riddick was one of the thousands of Black women sterilized in North Caroline back in the 60’s and 70's. Riddick became pregnant after being raped by her neighbor. As soon as she gave birth, doctors went back in to sterilize her. She was 14 years old. She didn’t know she was sterilized until years later. She told NBC News, “I was raped by a perpetrator [who was never charged] and then I was raped by the state of North Carolina.”

Elaine Riddick at a State Panel held to hear from victims of the sterilization

Throughout the 70’s, around 25% of Native American women ages 15-44 were sterilized without their consent. Jane Lawrence wrote in a piece published by The University of Nebraska about the different ways these women were misinformed and coerced into sterilization. Sterilization was sometimes used to treat complex problems like addiction. Lawrence starts her writing with the story of a woman sterilized by an Indian Health Service physician as a way to treat her problems with alcohol. Later in life, the woman would ask for a “womb transplant” to start a family. She left crying when she learned the procedure didn't exist.

In Puerto Rico, the same place the first pill was tested, around one-third of mothers ages 20-49 were sterilized. The government tried to frame this as necessary to keep Puerto Rico stable. They cited concerns that overpopulation would throw Puerto Rico into social and economic turmoil. Women were misinformed about the permeance of the sterilizing procedure, told that it could be reversed. These women were not even offered the option of the birth control they helped test for safety. While Sanger's fight for birth control was important, it was at the repeated expense of the Puerto Rican women who helped make the pill possible and then didn't even get the same wide access to it. Sanger herself may not have been a racist eugenicist, and she may have only supported eugenics as a means to advance women’s liberation. But even so, what was a convenient means of gaining a bigger platform for Sanger, was the driving force behind the mass sterilization of women of color. This is not to say Sanger isn’t still an important figure or that her accomplishments should be written out of history. Because the control we’re afforded today over our sex lives is still because of all the work Sanger did, and organizations like Planned Parenthood continue to do. But the debate around birth control has grown bigger than Sanger. It's now even more complicated and tangled, but also more inclusive.

The pill is still not perfect. Its side effects are still being explored and debated. There’s still a disparity in race and class when it comes to access to birth control. But today, we get to plan our lives and have casual sex without dying from lead poisoning or wearing weasel testicles. And it’s very expensive and rarely insured, but birth control can now just be a block or so away at your local Duane Reade or CVS. Its history intertwined in racist rhetoric and practices, but hopefully, now we get to create a more ethical future for reproductive health. We have to talk, write, and vote on it until one day every woman has access to birth control without it being at the expense of other women.