What to Know About the Surprising Modern History of Contraception

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When the birth control pill hit its 50th anniversary of its 1960 FDA approval, TIME commemorated its influence on the world as having “rearranged the furniture of human relations.”

But as influential as the pill was and continues to be, it’s only one small slice of the enormous influence contraception has had on modern history. Few people know that as well as Donna Drucker, a historian who is currently writing a book about its history. As it turns out, that history is just as complex as you probably think, but in ways that may still surprise you.

Drucker says she started studying contraception in a roundabout way: after the 2014 release of her book The Classification of Sex: Alfred Kinsey and the Organization of Knowledge, she saw that there was a missing element in the story of the famous sex researcher. “I realized how little attention Kinsey paid to contraception in the role of particularly women’s pleasure and general satisfaction,” she says. “Looking back, I thought he’d really underplayed the role of safe contraception in women’s decisions to have heterosexual sex or not.”

For World Contraception Day on Wednesday, Drucker talked to TIME about contraception’s complicated past.

TIME: Where would you place the beginning of the modern history of contraception?

DRUCKER: I would place it at the first clinic where a woman could get a diaphragm on her own from a female doctor. That was in Amsterdam in 1882 and the doctor’s name was Aletta Jacobs. That door opening was the first time that a woman could get a mechanical contraceptive fitted by a doctor for her and not need anyone’s approval.

This history is obviously a huge topic and really complex. Are there any overarching trends that you’ve noticed showing up throughout time?

One is the back-and-forth tussle between men and women over who controls contraception in a heterosexual relationship. For most of recorded history and even into the ancient past, men had total control over whether they used withdrawal. Condoms became part of the reproductive repertoire somewhere around the 18th century. Some women did use herbal methods, like pennyroyal, but they tended to be very dangerous. When diaphragms were first developed and became popularly manufactured in the 1880s and 1890s, that was the first time women had a device they had control over. There are waves back and forth over who should have that control. You hear women in the present saying that men should take responsibility, but men were given responsibility for millennia and they didn’t do it very well.

Is the history of contraception generally something that varies a lot from region to region?

Very much. I can give you two examples to compare and contrast. In Ireland, all contraception was made illegal in 1935 and condoms weren’t legalized [until 1985], but you could get a pill for a menstrual disorder. On the other hand, in Japan, the Japanese Health and Welfare Ministry only legalized the birth control pill in 1999. The pill had been available in the U.S. for almost 40 years. A lot of the ways people think about contraception are very much embedded in their national legal and medical context.

How much of a modern phenomenon is government involvement in these questions?

It ebbs and flows. The classic example in American history is the Comstock Act, in 1873, when basically it became illegal to manufacture, sell, distribute or mail any sexual or contraceptive devices. It was more or less on the books until 1936 and it got overturned by a case called U.S. v. One Package, which was about a shipment of diaphragms that was coming into the U.S. to a physician. Those laws were weakened in the 1920s or ‘30s, but really even though you could get condoms as disease preventatives, you could not get condoms as contraceptives. There’s a historian named Rachel Maines who argues there are lots of technologies that have a secret life outside their public face. Condoms were among those.

What tends to inspire laws like the Comstock Act? Is that usually about the law responding to a technology, or is it more frequently about changing social norms?

The Comstock Act wasn’t a direct response to a particular technology, since rubber condoms were available soon after the vulcanization of rubber in the 1840s, but Anthony Comstock himself was very determined to stamp out vice and anything that promoted vice, so that law was more of a social response. You could say the same thing for Ireland also. After the Republic was founded, they thought that one thing they wanted was to be a Catholic nation. Forbidding contraceptive technologies was one signal to the world and to Irish people that it was falling in line with Catholic teaching.

Speaking of Catholicism, what’s the historical background on the link between faith and ideas about contraception?

The Catholic Church more or less allowed, throughout the 19th century, a kind of periodic abstinence as a way to limit families. If you confessed that, you were O.K. In 1930, Pope Pius XI puts forward an encyclical called Casti Connubii, which is the church’s first declaration of its stance on marriage and the family and contraception. Really the only method the church allows is periodic abstinence, because the only acceptable use of sex is for procreation. You can abstain or roll the dice. That’s it. That gets confirmed in Humanae Vitae from Paul VI in 1968, after a very long process with priests and nuns and laypeople trying to advise the pope, a lot of them coming out and saying that the Pill doesn’t interfere with consummation and could be good for people who can’t afford to have any more children or women who were ill. That was a major way for the church to slam the door shut. But on the flip side of that, something like 90% of American Catholics [approve of the use of] so-called artificial birth control. That encyclical was a real challenge for a lot of people who wanted to stay faithful to their beliefs but didn’t want to have more children than they could afford.

Are there any moments you see as the stand-out episodes that exemplify the history of contraceptives?

The first one was a protest by Irish feminists in 1971 who were calling attention to the absurdity of condoms being illegal in Ireland. A group of women from the Republic of Ireland took a train to Belfast, which isn’t very far, and bought all the contraceptives they could find and brought them all back to Dublin intending to get arrested for illegal transit of goods. But the customs officials just weren’t going to touch it. They didn’t want to pick a fight in that way. It doesn’t change the law for another 20 years, but it does raise awareness about the absurdity of not being allowed this kind of basic contraceptive.

The other one is when Margaret Sanger was arrested for distributing flyers for her new birth control clinic in Brooklyn in 1916. That was a moment where a woman out of her own conviction really stepped up to confront powers that were preventing women from being able to have healthy pregnancies and space them the way they wanted. Margaret Sanger is a very problematic figure in a lot of ways, but at that time she was purely advocating for women’s health and safety.

Is there anything people tend to get wrong about the story of contraception?

It’s easy to see contraception as a sign of progress, that we’re continually moving forward, finding new technologies. That’s a mistake in two ways. The first is an over-dependence on technology without thinking about the science. For example, you may have seen that there was a new app approved by the FDA that allows anybody with a uterus and ovaries to plot out so-called safe periods when they might not be ovulating, but it’s very problematic. In a way, it’s a step backwards in knowledge about natural family planning. The other thing is that access to contraception should never be taken for granted. It’s clear in the U.S. — there are plenty of pharmacies that have pharmacists who can refuse to give you medicine if it disturbs their conscience.

It’s obvious why this subject might be interesting in a salacious sense, but what makes contraception interesting to a historian?

It provides a way to think about so many things, encapsulated in something as mundane as a condom — ideas about heterosexuality, marriage, feminism, manufacturing, technology. Also, contraceptives have been the tools of many negative movements in history. For example, forced sterilization in the U.S. and in countries like Peru and India. It’s provided incredible benefits to people but at the same time it’s also been a tool of control and dehumanization. It provides a window into how a particular country at a particular time valued women’s rights and, more broadly, human rights.

Correction appended: Sept. 26, 2018

The original version of this story misstated the timing of the introduction of the diaphragm. That technology was developed and popularly manufactured in the 1880s and 1890s, not the 1880s and 1980s.

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Write to Lily Rothman at lily.rothman@time.com