Ignorance, poverty, and vice must stop populating the world. Science must make woman the owner, the mistress of herself. Science, the only possible savior of mankind, must put it in the power of woman to decide for herself whether she will or will not become a mother.
—Margaret Sanger, c. 1920

Modern life is based on control and science. We control the speed of our automobile. We control machines. We endeavor to control disease and death. Let us control the size of our family to ensure health and happiness.
—American family planning poster, c. 1940

A few weeks ago, my wife and I made one of our rare pilgrimages to the nearest shopping mall. Bethany had been given a Victoria's Secret gift certificate at her bridal shower a year earlier, and was intent on finally redeeming it. The last time we visited a mall, she managed to lure me into Victoria's Secret, where my friends surprised me with a humiliating practical joke; having learned my lesson, this time I ducked into a bookstore and left her to her business.

When she returned, Bethany had a good time telling me about the various looks she attracted, browsing in Victoria's Secret with a round, pregnant belly. She had hoped to find some nursing bras; alas, they didn't sell them. "I guess they don't like to be reminded of where all that sexy lingerie leads."

Does making love still lead to making babies? Well, I suppose so. … if you're into that sort of thing. You know, like, whatever makes you happy.

In the decades since 1960, the year the FDA approved the first oral contraceptive drug, it has become quite common to think of sex and procreation as two separate phenomena. Today, when advertisements for condoms are no more unusual than ads for cigarettes and cellular phones, it is difficult to fathom the situation in 1960. At that time, 30 states prohibited the advertisement of contraceptives, and over 20 states restricted their sale. While these laws were often violated and seldom enforced, they still cast a shadow of ill repute over the burgeoning contraceptive industry. That shadow disappeared in 1964, when state laws restricting contraception were ruled unconstitutional.

Devices and Desires: A History of Contraceptives in America
by Andrea Tone
Hill & Wang, 2001
366 pp.; $30

Devices and Desires, a new history by Andrea Tone of the Georgia Institute of Technology, is a fascinating account of our quest to separate sex from procreation. Tone traces the rise of the American contraceptive trade from its bootleg beginnings to the major pharmaceutical industry it has become. In an engaging narrative style, Tone combines biographical sketches of pivotal figures with meticulous research drawn from often-overlooked sources—everything from newspaper advertisements to private correspondence. Among the many surprises in the story of contraception are the roles of two evangelical Christians.

Comstock's Crusade

The nineteenth-century laws banning the advertisement and sale of contraceptives were largely the legacy of one man, Anthony Comstock. Tone describes Comstock as an evangelical and a tireless crusader against all manner of vice. The law he drafted, known as the Comstock Act, was a broad statute banning not only contraception but also indecent photographs and instruments used to perform abortions. The Comstock Act was passed by Congress in 1873; subsequently, many states used it as a model, enacting their own "mini-Comstock" laws. While earlier laws had criminalized abortion, these were the first to address contraception. [1]

In his crusade, Comstock was joined by a wide and diverse coalition, including women's suffragists, purity reformers, and feminists. It was not until the twentieth century that feminists became champions of birth control. In the early days, Tone writes, women's rights advocates "tended to support natural family planning methods but not contraceptives, which they associated with promiscuity, particularly with men's license to have sex outside the bonds of marriage." Even some radical "free love" advocates condemned contraception, insisting that the acceptance and celebration of a woman's natural sexuality and fertility were essential to her spiritual and physiological well-being.

As Tone points out, Comstock was not motivated by a desire to oppress women or force them into bearing more children. Rather, "What Comstock and his cronies found so threatening was the prominence of contraceptives in the vice trade—a robust and increasingly visible commerce in illicit products and pleasures that seemed to encourage sexual license by freeing sex from marriage and childbearing."

Like the early feminists and purity reformers, Comstock upheld means of fertility regulation that rely on self-discipline, such as abstinence during the suspected fertile time of a woman's cycle. "For Comstock," Tone writes, "such acts of self-restraint were permissible when they occurred between wedded men and women in the sanctity of the marriage bed. Indeed, given his affection for self-control, he may have believed them to be character building."

Devices and Desires is a powerful corrective to Margaret Sanger's widely believed claim that before the opening of her birth control clinics in the 1920s, contraceptive techniques were unknown among the poor and working classes. Tone brings to light the massive underground contraceptive trade that flourished even in the heyday of "Comstockery." The obvious parallel is the bootleg alcohol trade under Prohibition. Where there's a will, there's a way; and the will to subvert procreation was especially strong in urban, industrial areas, where children were viewed as economic parasites rather than assets. "Not just a pregnancy preventative," Tone explains, "contraceptives promised families barely making do a prophylactic against economic ruin."

Tone provides several memorable vignettes of contraceptive entrepreneurs, but none more memorable than Julius Schmid. A poor Jewish immigrant in New York City in the late 1800s, Schmid found work at a sausage factory, cleaning animal intestines to be used as casings. To make some money on the side, he brought the extra intestines home and fashioned them into condoms—"skins," as they were called in the days before "rubbers." When his basement operation was raided, Schmid paid his fines and returned to his lucrative business. Schmid eventually expanded into rubber and latex; today, his "Ramses" and "Sheiks" brands are sold on drugstore and supermarket shelves worldwide.

To avoid prosecution, many contraceptive entrepreneurs used subtle advertising. One "sanitary sponge for ladies," for example, was advertised in newspapers as a means of keeping a woman's body "germ free." Larger companies used this same technique. Under the Comstock Act, Tone writes, "established pharmaceutical and rubber firms made devices and chemicals known to have contraceptive benefits but did not market them as birth control. Intrauterine devices (IUDs) were sold to correct prolapsed uteri. Carbolic acid, an antiseptic commonly used for contraceptive douching, was marketed for burns, scalds, whooping cough, diphtheria, and morning sickness." The list of respected companies selling contraceptives in the late 1800s and early 1900s includes names like Goodyear, B.F. Goodrich, Johnson & Johnson, and Sears & Roebuck.

Both Goodyear and B.F. Goodrich manufactured rubber IUDs. They were also crafted in entrepreneurs' basements from common household materials and sold on the black market. "Intrauterine stem pessaries, as physicians called the devices, could span five inches," Tone writes. "They consisted of a rubber, metal, or glass stem attached to a cup or button that held the stem upright and prevented it from becoming lost in the uterus."

Devices and Desires includes photos of a wide array of IUDs, which resemble medieval instruments of torture. How exactly does an IUD prevent conception? Usually, it doesn't. Rather, the introduction of a foreign object, such as an IUD, into the uterus "causes a local inflammation, or chronic, low-grade infection. … that makes egg implantation impossible." An IUD works after conception, denying a newly fertilized embryo the ability to implant and grow in the lining of the uterus. Smaller, plastic IUDs are still used today.

Making America Safe for Contraception

In 1909, the U.S. Army and Navy began distributing chemical prophylactics for soldiers to apply to their genitals after intercourse. These medical preparations, which were not pleasant on the skin, were designed to protect against syphilis, gonorrhea, and chancroid, venereal diseases that had plagued the military since the Civil War.

Upon his appointment to Secretary of the Navy in 1913, Josephus Daniels was horrified to learn that such "preventative packets" were widely distributed on America's ships. Like Comstock, Daniels was an evangelical. "It is wicked," he wrote, "to encourage and approve placing in the hands of the men an appliance which will lead them to think that they may indulge in practices which are not sanctioned by moral, military, or civil law, with impunity, and the use of which would tend to subvert and destroy the very foundations of our moral and Christian beliefs and teachings in regard to these sexual matters."

Within two years, Daniels succeeded in banning the sale of prophylactics to America's fighting men. In their place, Tone writes, he advocated abstinence-based programs. Daniels "pledged to augment Navy efforts to teach men self-control through talks and pamphlets, a strategy he called 'moral prophylaxis.'" In addition, rather than banishing chemical prophylactics altogether, Daniels put them in the hands of Navy doctors, who would administer them to men who admitted having engaged in illicit intercourse. This policy, he believed, would protect health without promoting immorality.

Daniels's strategy failed. "Between April 1917 and December 1919," Tone writes, "380,000 soldiers—roughly one in eleven—were diagnosed with syphilis, gonorrhea, or chancroid. … The Army estimated that every case of venereal disease cost it approximately $231. At the end of the war, it had spent over $50 million on treatment."

In the wake of financial and public health disasters, the military reversed its policy. "By the 1940s," Tone writes, "not only had condoms become an approved prophylactic, but military officials complained that they could not get them to the troops fast enough." To ensure that our troops' condoms were reliable, the FDA began inspecting and regulating their quality, making condoms the first contraceptives to receive the government's stamp of approval. During the 1930s and 1940s, U.S. condom production more than doubled, giving new meaning to the public service campaign urging citizens to conserve and donate rubber for the war effort.

Long before World War II, however, the venereal disease crisis had a profound impact on how Americans viewed and acquired contraception. In 1918, a New York State court decision legalized condoms—not for the prevention of pregnancy, but for the prevention of disease. This ruling opened the door for Margaret Sanger to legally operate her birth control clinics. Though Sanger had defended her clinics on grounds of reproductive rights, she was exonerated by a judge's ruling that contraception, when used "for the cure or prevention of disease," was not "indecent or immoral." For many years thereafter, condom packages were labeled "for the prevention of disease only."

Early in her career, Sanger became convinced that contraceptives must be brought under the supervision of medical doctors rather than sold over-the-counter. At Sanger's birth control clinics, trained personnel fitted diaphragms and instructed women in their use, operating legally under the rubric of "protecting women from life-threatening pregnancies."

In 1937, the American Medical Association first endorsed contraception as a legitimate part of medical practice. The medicalization of contraception was part of a larger movement in the mid-twentieth century, in which all aspects of women's reproductive health came under the control of doctors. Fueled in part by sensationalist claims about the "risks" of pregnancy, childbirth rapidly moved out of the home and into the hospital. Tone quotes one physician who, in 1920, described childbirth as a "pathologic process." Birth is so risky, he declared, "that I have often wondered whether Nature did not deliberately intend women should be used up in the process of reproduction, in a manner analogous to that of salmon, which die after spawning."

Doctors' influence over women's health was radically extended in 1960 by the Pill, which was available by prescription only and required careful medical supervision, including frequent cervical smears and breast exams. By bringing in female patients on a regular basis, dispensing medical contraception was a boon for family physicians.

A Singular Pill

Sexual Chemistry: A History of the Contraceptive Pill
by Lara V. Marks
Yale Univ. Press, 2001
372 pp.; $29.95

Complementing Tone's study, a second new history focuses on the most popular contraceptive of all. Sexual Chemistry is the work of British historian Lara V. Marks, former research fellow in the history of twentieth-century medicine at Imperial College. Marks provides a thorough, dispassionate account of a drug that has provoked passionate responses from its inception.

The Pill was pharmacologically unique. Unlike previous drugs, which were designed to cure organic diseases, the Pill was intended for long-term use by healthy women. For this reason, Marks calls the Pill the first "designer" or "lifestyle" drug. The Pill was designed to vaccinate against pregnancy, "a condition," Marks says, "not usually considered an illness." Throughout her book, Marks uses the phrase "falling pregnant" in place of "getting" or "becoming" pregnant—as if it were a condition that creeps up on unsuspecting women.

Unlike any previous contraceptive, the Pill was taken orally, and not did not physically intrude upon the act of intercourse. Fulfilling Margaret Sanger's dream of a "magic pill," the Pill put contraception entirely in the hands of women. A man might not even know his partner was using the drug.

The impetus for creating the Pill went beyond the liberation of women, however. The main reason the Pill was developed, approved, and manufactured, Marks argues, was its potential for halting population growth. At the start of the Cold War, it was feared that overpopulation would provide conditions ripe for communist revolution. Sanger announced in 1950, "The world and almost all our civilization for the next twenty-five years, is going to depend on a simple, cheap, safe contraceptive to be used in poverty-stricken slums and jungles, among the most ignorant people." [2]

When the first oral contraceptive, Enovid, was approved by the FDA in 1960, it was marketed primarily to married women who already had at least one child. But, as Marks shows, the Pill rapidly became the contraceptive of choice for single women. While the number of married women using the Pill declined in the 1970s after the drug's health risks were widely publicized, the number of single women on the Pill continued to rise. The Pill was especially popular among college-educated singles, many of whom were introduced to the Pill by university health centers. For these women, it meant the power to pursue a career without sacrificing an active sex life. By 1982 an astonishing 80 percent of American women born after 1945 had swallowed the Pill.

While Devices and Desires tells of Protestants who crusaded against contraception, Sexual Chemistry explores further ironies in the story of Christians and contraception: particularly the roles of three Catholics in developing the drug that ignited one of the most divisive episodes in the history of their church. First was lapsed Catholic Margaret Sanger, one of eleven children. Sanger initiated the project, recruiting maverick reproductive biologist Gregory Pincus to conduct research into the possibility of a contraceptive pill. As Pincus later put it, he "invented the Pill at the request of a woman." Second was Pincus's right-hand man, renowned Harvard obstetrician John Rock, who conducted the human testing for the Pill. A devout Catholic, Rock attended Mass daily. A crucifix hung above the desk where he examined data culled from the Puerto Rican women and American psychiatric patients who were the first to swallow the Pill. In 1959, Rock traveled to Washington, D.C., and pleaded for FDA officials to approve Enovid. Within the FDA, it was a third Catholic, Pasquale DeFelice, who reviewed and approved the initial application.

In 1963, Rock published his manifesto, The Time Has Come: A Catholic Doctor's Proposals to End the Battle over Birth Control. He argued that the Catholic Church should endorse the Pill because, unlike the condom or IUD, the Pill is "natural." That is, the Pill uses naturally occurring sex hormones to fool a woman's body into a state of pseudo-pregnancy, resulting in temporary sterility. "It is my confident hope that the medication will prove acceptable to my church," Rock wrote,

since it merely gives to the human intellect the means to suppress ovulation; these means have heretofore come only from the ovary and, during pregnancy, the placenta. These unthinking organs supply their hormone, progesterone, at those times when nature seeks to protect a fertilized ovum or growing foetus from competition for the woman's resources. The oral contraceptive simply duplicates the action of this natural hormone, when the woman herself feels the necessity for protection of her young—present or prospective.

Rock's reasoning was clever but erroneous. Oral contraceptives are not hormones naturally produced by the body; they are synthetic steroids, different in both structure and effect from natural hormones. The introduction of progesterone into a woman's bloodstream to induce a sterility can in no way be equated with the natural ebbs of a woman's fertility before and after ovulation, during pregnancy and breastfeeding, and after menopause.

Moreover, contrary to Rock's simplified explanation of how it works, the Pill does not always suppress ovulation. All oral contraceptives (both "combination" Pills, containing estrogen and progesterone, and "progesterone-only" Pills) have two backup mechanisms in case ovulation occurs. As Tone writes, "Progesterone also checks conception by thickening the cervical mucus, which inhibits sperm penetrability, and by preventing the full development of the uterine lining, without which a fertilized egg cannot implant." The latter mechanism—preventing the implantation of a newly fertilized embryo—makes the Pill inherently problematic for those who believe that life begins at conception. [3]

For the most part, however, Christians have been content to brush aside such ethical concerns. As Marks documents, Catholic laymen began using the Pill as soon as it became available, in numbers closely corresponding to those of the general population. In 1965, a Newsweek survey found that 38 percent of American Catholics were using the Pill or other artificial contraceptives; of those under age 35, 60 percent were using contraception, and 80 percent hoped that the church would endorse the Pill. Their contraceptive habits went largely unaffected by the 1968 encyclical Humanae Vitae, which reaffirmed the traditional teaching against contraception. Pope Paul VI was too late—the people had already chosen.

While Marks does not address the evangelical reception of the Pill, we know that Protestants reached the same consensus as Catholic laymen, though not in opposition to their churches. All of the major Protestant denominations endorsed contraception by the 1970s. When asked to comment on Humanae Vitae, evangelical leader Billy Graham expressed his disagreement, citing the "population explosion." In the 1970s, evangelical "sex guides" began to appear, lauding contraception as a means of elevating the meaning of sex above mere procreation. The most popular of these, The Act of Marriage by Tim and Beverly LaHaye, is still available in a revised edition, boasting over 2,500,000 copies in print. The LaHayes gave newlyweds this advice: "Because of its safety and simplicity, we consider the pill the preferred method for a new bride in the early stages of marriage. Then, after she and her husband have learned the art of married love, she may decide on some other method."

But the unsettling ethical questions raised by the Pill are now more pressing than ever. They carry implications for a host of bioethical issues, from embryonic stem-cell research to human cloning—implications made clear in a new memoir from Carl Djerassi, the self-proclaimed "mother of the Pill."

Sex and Reproduction—Filing for Divorce?

This Man's Pill: Reflections on the 50th Birthday of the Pill
by Carl Djerassi
Oxford Univ. Press, 2001
308 pp.; $22.50

Djerassi has a prodigious intellect and an ego to match. Both are on glorious display in This Man's Pill, a collection of autobiographical essays full of revealing insights into the creation of the Pill, its influence on society, and where contraceptive technology is headed.

Djerassi would be the first to point out a significant oversight in Tone's and Marks's histories: while acknowledging the work of others, they give Sanger, Katherine McCormick (Sanger's ally and benefactor), Gregory Pincus, and John Rock the lion's share of credit for developing the Pill. In a chapter titled "Genealogy and Birth of the Pill," Djerassi explains why he deserves to be called the mother of the Pill.

In the 1940s and early 1950s, the hormone progesterone was in demand for treating menstrual disorders and infertility. Natural progesterone, which could be harvested only in minute quantities from animal glands, was scarce and expensive; to retain its potency, it also had to be injected into the body, which could be very painful. Building off of recent advances in steroid production, in which hormones were developed from compounds found in plants, Djerassi and his team of researchers in Mexico City were looking for a way to synthesize progesterone from wild, inedible Mexican yams. On October 15, 1951, they succeeded in creating a progesterone that could be cheaply produced in mass quantities. Far more potent than natural progesterone, Djerassi's steroid could also be effectively taken by mouth.

At that same time, unbeknown to Djerassi and his team, Gregory Pincus was studying the ability of progesterone to suppress ovulation. When Pincus learned of Djerassi's work, he found that Sanger's "magic pill" had, in effect, already been invented. It was left up to Pincus, Rock, and others to test the drug and determine what dosage to prescribe. They discovered that adding a second hormone, estrogen, was necessary for reliable contraception (though later, in the mid-1960s, progesterone-only Pills were developed). Thus, Djerassi calls Pincus a "father" of the Pill, and Rock its "metaphorical obstetrician."

In recent years, Djerassi has abandoned "hard chemistry" to focus on bioethics, writing novels and plays that explore the opportunities and dilemmas created by science. Djerassi argues that the Pill has sparked the most significant technological revolution of the twentieth century: "the gradual divorce of sex from reproduction." While earlier contraceptives attempted to separate sex and reproduction, the "true realization of 'sex for fun' occurred only about forty years ago with the introduction of the Pill." Women who used the Pill "were temporarily sterile, and thus could indulge in sexual pleasure without the fear of an unintended pregnancy."

But engaging in sex without the "fear" of procreation is only one side of the coin. The complete separation of sex and fertility comes only when we can reproduce without having sex. This possibility became reality with in vitro fertilization. In 1978, Djerassi recounts, Louise Joy Brown "was conceived under a microscope, where her mother's egg was fertilized with her father's sperm; the fertilized egg was reintroduced into the mother's womb two days later, and, after an otherwise conventional pregnancy, a normal girl baby was born nine months later. This technique has since become widely known as in vitro fertilization (IVF)—an event that has now been replicated several hundred thousand times through the birth of that many IVF babies."

"Whereas reproductive technology's focus during the latter half of the twentieth century was contraception," Djerassi writes, "the technological challenge of the new millennium may well be conception." In the near future, he suggests, young men and women will have their sperm and eggs frozen, then undergo sterilization. The Pill will become obsolete as couples engage freely in sterile sex, then "resurrect" their gametes and reproduce through in vitro fertilization. The attractiveness of this option is enhanced considerably, Djerassi suggests, by genetic screening; parents can weed out "defective" embryos and even choose the sex of their children—all before implantation. No longer will reproduction be left to the "random" collision of a sperm and egg.

Has the link between sex and procreation truly been severed? Despite the claims of men like Djerassi, evangelical natural law scholar J. Budziszewski insists otherwise. "The spirit of the age has most burdened people with a false picture of nature," Budziszewski explains. "Their eyes dazzled by what technology can do, when they gaze upon human nature they see not a Design, but a canvas for their own designs. Because they can sever the causal link between sex and procreation, they suppose they have severed the link between sex and procreation."

As Aristole taught, and Christian tradition affirms, man will not find happiness except by living in harmony with his created nature (as opposed to his fallen or "sin nature," Christians would clarify). If this way of thinking is right, we cannot change the reality that sex is, by nature, the procreative act. If sex and fertility are inseparable by nature, then all attempts to control fertility by "liberating" it from sex will prove ultimately unsatisfying and destructive.

Does the history of contraception bear this out? Is it, as Djerassi proudly proclaims, a story of increasing liberation and fulfillment? Or is it better described as a story of increasing bondage to doctors, scientists, and corporations, and increasing disregard for the sanctity of life and the human person?

Sam Torode lives and works in rural Wisconsin, with his wife, Bethany. Together, they are authors of Open Embrace: A Protestant Couple Rethinks Contraception (Eerdmans, 2002).

Footnotes

1. A strong Protestant, Comstock was deeply suspicious of the Catholic Church. He once attended Sunday Mass out of curiosity, noting that night in his diary that it "Seemed much like Theater." One wonders what Comstock would have thought had he lived to see the Protestant churches embrace contraception, while—nearly alone—the Catholic Magisterium stubbornly insisted on periodic abstinence as the only acceptable means of child spacing.

2. At the same time Sanger was moving contraception into medical clinics, Tone writes, "the scientific credibility of the birth control movement was enhanced by the search to limit the procreation of undesirable groups, and its leaders appropriated the eugenic language to promote their goals." Like other eugenists, Sanger sought the improvement of the race through selective breeding. "Birth control," Sanger once said, "is nothing more or less than the facilitation of the process of weeding out the unfit [and] of preventing defectives." Particularly, Sanger believed it necessary to reduce the birth rate among African Americans—a need that, in her words, "the race did not recognize" itself.

Though eugenics lost favor after World War II, when its implications were made manifest by the Nazi atrocities, similar attitudes persist today. Advances in fetal testing and genetic screening have breathed new life into eugenics. Routine ultrasounds and tests such as amniocentesis allow parents to detect "defects" while a child is still in the womb. Nearly all babies identified as having Down Syndrome are aborted. With in vitro fertilization, well-to-do parents can now fertilize several embryos and discard those predisposed to various health problems or otherwise genetically "unfit."

3. Today, John Rock is recognized not only for his role in creating the Pill but also for his pioneering efforts in treating infertility, paving the way for in vitro fertilization. In 1944, Rock and his team at Harvard Medical School, for the first time ever, fertilized four human embryos in a dish. The embryos were subsequently destroyed. The Pill, it turns out, was not the first technology Rock developed in violation of his church's teachings on the sanctity of all human life from its earliest stages.

Copyright © 2001 by the author or Christianity Today/Books & Culture magazine.
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