"Momma's Got the Pill": How Anthony Comstock and Griswold v. Connecticut Shaped US Childbearing

The 1960s ushered in a new era in US demographic history characterized by significantly lower fertility rates and smaller family sizes. What catalyzed these changes remains a matter of considerable debate. This paper exploits idiosyncratic variation in the language of "Comstock" statutes, enacted in the late 1800s, to quantify the role of the birth control pill in this transition. Almost 50 years after the contraceptive pill appeared on the US market, this analysis provides new evidence that it accelerated the post-1960 decline in marital fertility.

[The women and the right to contraceptives]

During the first decades of the 20th century, many Swedish women were severely injured or died in complications following illegal abortions. Since legal abortion was forbidden, contraceptives were the only way to avoid pregnancy. But in the year 1910, a new Swedish law "Preventivlagen" prohibited any kind of advertising och public information considering contraceptives. They could still be sold in pharmacies or special medical stores, but it was no longer allowed to speak publicly about contraceptives in a leading manner. The punishment for disobeying was prison or fines. Some physicians and people involved in women liberation, public health and/or public education, claimed that the law brought negative medical, social and economic consequences, while others opposed the law being too soft. The law made the more than 100 years old question about contraceptives or not, a part of the medical, political and social agenda for the society. Some argument against contraceptives was concerned about the decreasing nativity rate--more use of contraceptives could make an even worse situation. Another reason was the fear of an increasing promiscuity if the contraceptives were more available. Still, many physicians and womens liberators did not se this as any big and important problems. They were more concerned about the women's health and her right to give birth to children at the time she wanted. Women had their right to be in charge of their lives, and should no longer be seen as victims of their biological nature. The right to contraceptives was not the only topic to be discussed during the late 19th century and the first decades of the 20th century. Another central right to be claimed, was the possibility for people, especially young people, to be educated in sexual questions. Many women and also women physicians fought for young peoples right to this information. The law "Preventivlagen" was abolished in 1938. After that, women hade their legal right to choose for themselves at what time they wanted to get pregnant and also the number of children.

The promise and performance of progestogens as contraceptives

Progestogens were first suggested as possible contraceptives in the 1920s, but it was not until the early 1960s that effective progestogen-only contraceptive methods were developed. Since then it has become possible to deliver a range of different progestogens at varying doses, by a variety of routes, over greatly differing durations of time. Some of these systems have demonstrated extraordinarily high contraceptive efficacy with relatively few side-effects apart from unpredictable, but almost universal, disturbances of the menstrual pattern. It is now recognized that some systems may exhibit substantial non-contraceptive health benefits, which should become an important part of the overall performance profile of each method. The high technology and differing attributes associated with some of the systems raise important considerations in relation to user's perceptions and programmatic requirements. Overall, progestogens are able to offer women a varied range of valuable choices for contraception. The differing performance characteristics of these methods now provide women with a major portion of their current contraceptive choices.

Injectable contraception. New and existing options

DMPA and MPA/E2C contraception offer women safe, effective, convenient, and reversible birth control choices. The use of DMPA, a 3-month injectable, is characteristically associated with amenorrhea. Lactating women and women in whom contraceptive doses of estrogen are contraindicated can use this progestin-only birth control method. Return of fertility can be delayed in women discontinuing DMPA to become pregnant. In some cases, the use of DMPA also confers important noncontraceptive and therapeutic benefits. A monthly estrogen/progestin injectable contraceptive, MPA/E2C should appeal to women who are concerned about daily pill taking, who prefer regular cycles to amenorrhea, and who find monthly injections acceptable and accessible. As is true for oral contraceptives, MPA/E2C represents an appropriate choice for women who prefer a rapidly reversible contraceptive. Currently, the proposed contraindications for MPA/E2C parallel those for combined oral contraceptives. As MPA/E2C contraception becomes available for American women, clinicians will learn how to best include this new method among the array of contraceptive choices. By individualizing contraceptive selection, counseling, and management approaches based on the relevant behavioral and medical considerations reviewed herein, clinicians can maximize their patients' success with injectable contraceptives. The more innovative that clinicians, family planning agencies, and insurers are in facilitating access to care (including reinjections), the more women will be able to avail themselves of safe, effective, and reversible methods of contraception. In addition to the physician's office or health clinic, other sites at which women might receive contraceptive injections include employee health clinics, college health clinics, or perhaps the pharmacy where the prescription is filled. Self-administration may become an appropriate option for some users of injectable contraception.

Barrier contraception: a comprehensive overview

The barrier class of contraceptives used either alone or with supplementary spermicidal agents includes the most ancient of methods for the control of human fertility. Modern innovations have effected marked improvement in their efficacy and acceptability, so that they have become key means of controlling fertility in the world today. The traditional diaphragms and condoms decreased in popularity to some extent when methods such as the OCs and IUDs became available for general use. However, the plain or medicated barriers are regaining their rightful position in our contraceptive armamentarium as more and more questions are being raised about the real or potential adverse side effects of systemic and intrauterine contraceptives. There is evidence throughout the world of the growing popularity and use of locally acting mechanical and/or spermicidal contraceptive methods. Their impact upon the increasing world population can be expected to become even greater when the true need for the control of fertility becomes more generally recognized and appreciated.