A history of reproduction,
contraception and control.

1 Snake skins and crocodile dung
Women have always found ways of preventing unwanted babies. The 4,000-year-old Kahun Papyrus, the oldest written document on birth control, refers to vaginal pessaries made of crocodile dung and fermented dough. Arab traders were the first to use inter-uterine devices. When taking camels to market they placed small stones in the uterus of female animals to avoid them becoming pregnant on the way. Condoms made of linen and from the skin of sheep, goats and even snakes were used in many societies. In the ruins of Pompeii, the Italian city engulfed and preserved by volcanic lava 2000 years ago, dilators and curettes were found similar to those used for modern abortions. Other early forms of birth control included bloodletting, glass or metal diaphragms, cotton soaked in lemon, dried fish, mercury and a variety of other herbs and chemicals.

2 Malthusian misery
In 1789 the British economist and clergyman Thomas Malthus published figures that were to become the cornerstone of the population-control movement. Malthus maintained that world population would rapidly outpace the earth’s capacity for food production unless ‘preventive checks’ were put in place. Otherwise, he claimed, overpopulation would bring untold ‘misery’ in its wake – poverty, famine, pestilence and war.

3 Feminists and fascists
At the beginning of this century Margaret Sanger, a socialist and feminist from New York City, coined the term ‘birth control’. Sanger and her colleagues saw birth control as a way of freeing women from the yearly tyranny of pregnancy and birth. But there was a fine line between this and dictating who should be allowed to have babies.

The famous anarchist Emma Goldman was arrested for distributing a pamphlet entitled Why and How the Poor Should Not Have Many Children. And Sanger too moved in that direction.

From there it was a small step to ‘eugenics’ – the belief that society can be improved by selective breeding. Eugenicists felt that poverty was a sign of genetic inferiority. They maintained that rich people were superior to poor, whites superior to blacks and the able-bodied superior to the disabled. The eugenicists were to become a powerful force in the politics of population control. By 1932 compulsory sterilization laws for the ‘feeble-minded’ and ‘physically defective’ had been passed in 27 states in the US.

But it was German fascist leader Adolf Hitler who pushed eugenics to its most extreme. In 1933 Germany passed sterilization laws (modelled on those developed by the US Eugenics Record Office) which led to 200,000 sterilizations of ‘genetic inferiors’ and the murder of millions of Jews, Gypsies and homosexuals in Nazi gas chambers.

4 Mass sterilization
After World War Two the focus of population control moved to the Majority World, where populations were burgeoning while those in Europe and North America were slowing down. India became a keen advocate of birth control, a policy which eventually culminated in the mass sterilization of 6.5 million people in 1976 during the ‘Emergency’ of Indira Gandhi (below). Hundreds died from infections due to botched operations and the program sparked riots and demonstrations in many cities, leading to the Government’s fall in 1977.

In the same year Dr Reimert Ravenholt, the head of USAID’s population office, publicly hinted that the Agency intended to sterilize a quarter of all women in the developing world. Today 90 per cent of the 137 million women who have undergone surgical sterilizations are in the Majority World – 32.5 million as a result of mass campaigns in China in 1983 and 1991. In several Asian nations, substantial rewards, including cash hand-outs, have been offered to people who undergo permanent sterilizations. These financial incentives are difficult to resist when people are poor and hungry. Or indeed, if they are offered no other options for birth control.

5 Pro-natalism
While mass sterilizations and campaigns to reduce births were going on in some places, elsewhere women were encouraged, even coerced, to have more children. In Britain in 1944 a panel of ‘experts’ were convinced that the decline in the birth rate was due to birth control and that it heralded the ‘moral decline of the nation’.

Racial supremacy was also the issue in Europe and in the United States. In 1905 Theodore Roosevelt warned of the ‘race suicide’ of America’s Anglo-Saxon Protestants if they did not increase their birth rate relative to Asian, Italian and Jewish immigrants.

Where Governments feel under threat – from immigration as in the US, or conflict, or during and after wars – they often advocate an increase in population, encouraging women to have large families (especially sons) and to stay at home and look after them. In fact, this rarely occasions real demographic change.

Several European countries have adopted incentives to encourage births; giving government subsidies to those with larger families. Pro-natalist thinking is also returning to the national agenda in the US, where it is linked with the anti-immigration movement.

6 The Pill
In 1950 the American biologist Gregory Pincus was invited by the Planned Parenthood Federation in the US to develop an ideal contraceptive. Within a few years an oral birth control pill was being tested on 6,000 women – not Americans, but women from Puerto Rico and Haiti. In 1960, the first oral contraceptive (Enovid-10) was launched in the US market. The ‘Pill’ as it became known, heralded a revolution in birth control. Here at last, women were told, was a method that was both effective and safe. Women the world over embraced this new drug with enthusiasm. Within two years the Pill was being used by 1.2 million women and a decade later the numbers had risen to ten million.

Despite its popularity there were nagging worries about health risks. As early as 1961 studies showed that the Pill carried the risk of blood clots, heart attacks and strokes due to high levels of the hormone oestrogen. In 1962 there was evidence of at least 11 Pill-related deaths. Women activists in the US brought these dangers to public attention.

In the early 1970s a ‘mini-Pill’ with reduced oestrogen was finally introduced But at least three manufacturing companies continued to produce high-dose Pills until 1988. Scientific debate about the health risks of oral contraceptives continues, although it is now accepted that the Pill is unsuitable for certain groups of women (see page 14).

7 The business of birth control
The dictates of the market play a major part in family planning and population control. About $5 billion is spent each year on family planning in the Majority World; $1 billion of this is donated by Northern governments, multilateral agencies and private organizations.

Pharmaceutical companies have global contraceptive sales of $2.6 billion to $2.9 billion per year. This huge economic power enables them to influence the policies of Southern governments and the priorities of the medical establishment. International aid donors, national governments and businesses collude in dictating who shall have children.

In Asia, for example, it is common for employers to offer incentives for using birth control and disincentives for having large families. In South Korea, one company provided housing and loans for employees using birth control. Maternity care was withheld after the birth of a third child and workers having large families were not promoted. Those with more than four children had to leave the firm. In the Philippines, workers were obligated to attend lectures on the ‘need’ for birth control.

Many private-sector population projects are funded by government aid dollars from the West. According to the UN, contraceptive use in the southern hemisphere has increased five-fold in the past quarter century because of the intervention of foreign-aid donors and international institutions.

8 The future
The history of women’s reproductive health has been riddled with fear and force, ignorance and prejudice, and male control over women. It is easy to forget that women’s bodies and lives are at the heart of the debate. And that Malthusian statistics represent the births and deaths of real flesh-and-blood people.

Reproductive issues cannot be addressed in isolation from the wider context of gender and social equality, and of equal access to healthcare, education and economic opportunity. A worldwide women’s health movement now lobbies for what is best for women rather than just in the interests of limiting world population. Recent UN conferences have adopted some of the language and theories of this movement. In the meantime, women still have to negotiate their ways through the debates with information which is always complex and often unclear.

Sources:
Betsy Hartmann, Reproductive Rights and Wrongs (South End Press 1995);
Janet Hadley, Abortion: Between Freedom and Necessity (Virago 1996);
Sonia Corrêa Population and Reproductive Rights: Feminist Perspectives from the South (Zed Books 1994).
Thanks to Sara Chamberlain for research.

Background illustration: Mary Evans Picture Library