Abortion and Birth Control Have Always Been Linked

It’s been three weeks since SCOTUS overturned Roe v. Wade. To learn how the Dobbs v. Jackson decision could affect birth control access (and about birth control history in general), I spoke to Dr. Kelly O'Donnell and Professor Lauren MacIvor Thompson, two experts on reproductive history. Turns out, birth control is wrapped up with abortion in a bit of a “turducken” (you’ll see).

A condensed transcript edited for clarity is below. Paying subscribers to Skipped History can access audio of the full conversation here, as well as a written bit of Skipped History about the surprising big money, anti-abortion alliance here. This is the second in a series of conversations on how Roe fell, and where we go from here.

Ben: You’re both quite knowledgeable about the birth control movement and birth control history. To ground our conversation, let's start back in time with early views of birth control.

LMT: I can take that one. The biggest thing to know about birth control in the 17th, 18th and 19th centuries in colonial America and in the United States is for a long, long time women managed their own reproductive health. Care was not in the hands of physicians and it was not in the hands of the law. By and large, women were using herbs from their gardens, things like tansy and pennyroyal that grow and did grow in American gardens for centuries. 

Ben: Skipped gardening history.

LMT: Yeah. They're using these herbs in teas, and women soak sponges in solutions and insert those. They use douching mechanisms after sex. So women are really managing their reproductive health from start to finish. And before the early 19th century, the vast majority of women's pregnancies and births would have been handled by midwives.

So this is really a woman's space and it's not until the early 19th century that we begin to see a transition to men in the field. The earliest laws that we have about abortion and birth control on the books and state legislatures really have more to do with the fact that there are unscrupulous business owners and manufacturers who are mailing out contraceptives and abortifacients, along with like headache, remedies or gout remedies, or you name it.

None of these remedies are regulated, and so legislatures start passing laws that try to prevent people from being poisoned. So they're not actually concerned about abortion. They're not concerned that women are regulating their fertility. 

KOD: Yeah, and it’s really in the mid-19th century when we see more of a focus on regulating the practice of medicine in addition to the safety concerns. We get Anthony Comstock coming along, whom I know you talked about in your last interview.

LMT: Right, states passed their own mini Comstock laws regulating contraception, pornography, abortion, sex education materials—anything that has to do with sex under the umbrella of “obscenity.” This is in the 1870s, 1880s, and those laws remained on the books until the late 20th century. In some cases they’re still on the books, they're just not enforced. Of course, now that Roe has been overturned, it’s anyone’s guess if they’ll be enforced again.

KOD: Getting back to birth control, this is why you can't really separate out contraception and abortion. Dating back to the 19th century, anything related to sexuality, and any kind of regulation of not having children, is wrapped up into one obscenity constellation.

Ben: An obscenity burrito.

KOD: Right, a turducken of reproductive options.

Ben: Interesting. So, physicians and moral crusaders like Comstock push abortion outside of the women's sphere. It becomes a regulated, male-dominated action...

KOD: Yes, by the end of the 19th century, going into the 20th century, all management of reproduction is going towards a male-controlled, medicalized model. And there were some benefits to that, right? For some women, hospital births were safer. Not getting infections and dying in childbirth was obviously an improvement (that is, for women who weren’t discriminated against in hospitals). 

So, undoubtedly, there are good things that happen. But alongside that comes—how do I say this in a way that's not super nefarious sounding—a sort of medical surveillance regime.

Ben: Totally not nefarious. 

LMT: Yeah. Between the 1940s and the 1960s, the immediate two decades before the Roe decision, that’s when we see the most cracking down by police forces and the legal system. Police forces become devoted to rooting out abortionists and also putting women on trial for seeking abortions. And so, for example, women ended up going to the hospital for some awful septic abortion, and the hospital committee and police officers would interview them on their hospital bed going, who did this to you? Why did you do this? And then the next thing you know, you're in court. 

And here’s a really important thing to remember that helps explain where we are today. There’s this popular idea that Roe enshrined women's rights, but it didn't.

Ben: In the sense that the decision didn't enshrine women's rights, but rather a right to privacy? How would you phrase that?

LMT: Well, if you read the text of the Roe decision and the way Justice Harry Blackmun words the key portions of the majority opinion, it's really about granting physicians rights and upholding physicians’ professional expertise. In fact, Blackmun says, the feminist movement has argued that “a woman's right is absolute and that she is entitled to terminate her pregnancy at whatever time, in whatever way, and for whatever reason she alone chooses. With this, we do not agree.”

In other words, he’s explicitly saying, this isn't about feminism. It's not about women's rights. It’s about this practical medical matter that women need to take care of in consultation with their (male) physicians and their (male) physicians need to have full professional authority to make those decisions without fear of getting arrested.

KOD: Yeah, the quick story that people have about Roe is oh, right to privacy, now women can have abortions and it's legal.

But that really collapses a lot of the complexity of the history of abortion, which is very much more uneven than people realize. Dating back to the Comstock Laws, there’ve always been women who’ve had trouble accessing abortion—lower income, women of color in particular. 

So one point to take away as we're facing this absolute chaos post-Dobbs is that, in a lot of ways, there’s always been this chaotic patchwork of women with uneven access to abortion. It steadily improved over the years, but now we’re descending back into chaos—in a lot significantly worse ways due to the oversight and surveillance of people's bodies that are available today. 

Ben: This return to an earlier patchwork seems to suggest that maybe the shape of progress is less a straight line than... a rhombus, with lots of little unexpected and unwanted turns and pointy edges. Moving forward, how does the Dobbs decision affect birth control access?

KOD: Again, abortion and birth control have always been linked. Unsurprisingly, we’re already seeing increasing discomfort with birth control types like emergency contraceptives. Prescribers are also worried about things like IUDs because they can’t be sure if a court would view them as abortifacients and not contraceptives.

So I imagine we’ll see a lot of preemptive CYA (cover your ass) moves, just for fear that doctors are maybe getting a little too close to what some people in their brains think is abortion. 

LMT: Right, we’re also heading into an uncertain future regarding ectopic pregnancies, where the sperm meets the egg and implants accidentally in the fallopian tube, which is terrible and you bleed out if it's allowed to continue. Now, according to interpretations of some abortion laws, you may not remove that embryo even though it's implanted in a place where it’s going to kill the woman and itself. Legal experts warn that abortion laws can be interpreted to say that if you treat an ectopic pregnancy, that's the equivalent of an abortion. It is madness.

Ben: What would you say to people who want to reverse the madness?

LMT: I think we can learn from other countries. If you look at places like Argentina or Ireland, two very Catholic countries that have liberalized abortion laws, activists haven’t glommed onto that language of choice and citizenship.

Rather, they’ve attacked the pro-choice question from an empathy angle, pointing out that women will die. Their messaging is fundamentally different than how Americans are approaching this, and it’s been successful.

KOD: I agree, and generally, I think it’s important to remember that there are no simple answers. This history is complicated, and anyone who's trying to give you a black and white version of it, whether they're a Supreme Court justice or someone on Twitter, they’re wrong.

There's never really been a simple solution to granting (or removing) women’s reproductive autonomy. We would not be having this conversation if there were.

Ben: Okay, got it. Your reminders are nothing is simple and the past is chaos.

KOD: No! But maybe.

Ben: I will let you go from there. This was so fascinating. Disturbing but fascinating. Thank you both so much for your time.

LMT: Thank you.

KOD: Thanks for having us.