The History of The Concept of Birth Control in The United States

Modern birth control went through many obstacles before it was available to the public. In the United States during the 19th and 20th centuries, birth control and contraceptives were social issues that were fraught with controversy. This backlash led to legislation (e.g. Comstock Law) being passed that barred people, including doctors, from talking about contraceptives on the grounds of obscenity (Bone, 2010). For most the 20th century, birth control education and counseling was legally excluded as a part of what a nurse’s responsibility and practice should be (Lagerwey, 1999). Despite this, nurses played a huge role in the movement to improve education and availability for birth control. Eventually these limits on reproductive rights would lead to a counter culture movement that fought for the right to discuss contraceptives and “birth control”, a term which activist Margaret Sanger coined.

Margaret Sanger was a pioneer for the reproductive rights movement and advocated for awareness and availability of birth control in the United States. As an obstetrical nurse, Sanger sympathized with the plight of the low-class women which she served (Wardell, 1980). During the 1910s, she started to write about birth control methods and published multiple pamphlets and articles regarding the subject. She was targeted by the U.S. government and their obscenity laws, which led to her facing a multitude of legal battles over the years. After fleeing to Europe from legal persecution in the U.S., Margaret Sanger learned about “modern” birth control practices from European health clinics and brought this information back to America (Takeuchi-Demirci, 2010).

In 1916, Margaret Sanger opened the first U.S. birth control clinic but was later arrested and sentenced to 30 days in jail for being a “public nuisance” (Lagerwey, 1999). Despite this, she persevered in her activism and led the fight for birth control. She founded the American Birth Control League in 1921, which later changed its name to become the organization Planned Parenthood Federation of America in 1942 (Hyde & DeLamater, 2014). Planned Parenthood is still active over 100 years later and is the largest single provider of reproductive health services in the United States (Planned Parenthood, 2016).

In 1938, a judge lifted the federal ban on birth control (Thompson, 2013). This led to the popularity of diaphragms as a form of birth control. Diaphragms are a vaginal barrier device consisting of a silicone or rubber dome which is used with a spermicide and inserted into the vagina (Hyde & DeLamater, 2014). When in place inside the vagina it covers the cervix, and prevents sperm from entering the uterus. The use of spermicide provides extra protection by causing the sperm to stop moving, further preventing it from entering the uterus and causing pregnancy. The typical user-failure rate of the diaphragm is estimated to be about 12 percent, with most failures being due to improper use (Hyde & DeLamater, 2014). The main side effects of the diaphragm are possible irritation of the vagina or penis due to the spermicide used. Today’s more common counterparts to the diaphragm are the FemCap and the Sponge.

During the early 20th century, scientists in Europe were conducting experiments which explored the effect of the hormone progesterone on ovulation (Dhont, 2010). This research paved the way for the development of the birth control pill (oral contraception). In 1951, Margaret Sanger approached biologist and researcher Dr. Gregory Goodwin Pincus with a grant to fund the development of a hormonal contraceptive. What resulted was a formulation of progesterone and estrogen, which when taken orally, suppressed ovulation in women. In 1957, the FDA approved the first contraceptive pill, Enovid. This pill was approved for the treatment of menstrual disorders and was later expanded for use as contraception. Initially, the birth control pill was only approved for married women, but in 1972, the birth control pill was legalized for all women despite their marital status (Thompson, 2013).

Oral contraceptives, or as they’re known now, combination birth control pills, is now the most commonly used form of hormonal birth control (Hyde & DeLamater, 2014). It is on average 95 percent effective, though this number may be higher or lower due based on how effectively the user uses it. Side effects vary from person to person and even depending on which form of the pill they take. Nowadays there are many different formulations of the combination pill which have slight variations in their usage and hormone levels. Triphasic pills are another type of birth control pills which contain a steady level of estrogen and different levels of progesterone. There are also progestin-only pills which contain only a low dose of progestin and no estrogen and are designed to avoid estrogen-related side effects of combination pills. Progestin-only pills have a higher failure rate than that of combination pills.

In 1968, the FDA approved intrauterine devices (IUD) for use (Thompson, 2013). IUDs are a small piece of plastic (sometimes containing metal or hormones) which is inserted into the uterus by a doctor or nurse and remains in place until the woman has it removed (Hyde & DeLamater, 2014). This foreign body in the uterus creates a toxic environment for both sperm and eggs, which prevents fertilization and implantation. It is highly effective with a low failure rate and convenient due to its long-term effectiveness, being able to stay in place and prevent pregnancy for years at a time. Its side effects vary, with the most common being increased menstrual cramps, irregular bleeding, and increased menstrual flow.

In the 1990s, more methods of birth control were introduced, such as the Depo Provera shot, female condom, and Plan B (Thompson, 2013). Depo-Provera is a shot containing progestin which provides contraception for 3-month time periods (Hyde & DeLamater, 2014). It is slightly more effective than the pill, with a failure rate of 6 percent. Plan B is a form of emergency contraception which is available in pill form for emergencies such as rape or a condom breaking. It is most effective when begun within 12 to 24 hours and can be taken up to 120 after the instance of unprotected sex. Emergency contraception is between 75 and 89 percent effective.

In the 2000s to the present, rapid expansion of the different types of birth control occurred and different types of IUDs were introduced, and the hormonal patch and vaginal ring were introduced as new forms of hormonal birth control (Thompson, 2013). Now we live in an age where birth control is readily available. New and improved forms of birth control and constantly being developed and/or improved upon for better methods of family planning and contraception.