Need to pick up condoms? Pop on down to the neighborhood druggist -- heck, just stop at the corner convenience store. Americans take their right to contraceptive freedom as for granted as their ability to grab a twelve-pack of beer at the grocer's or bottle of wine from the liquor store. But, like alcohol, contraceptives were once the objects of legal prohibition in the U.S. The long, strange history of contraception in the States, circa 1873 to the present, is the fascinating subject of Andrea Tone's Devices and Desires.
Currently an associate professor at the Georgia Institute of Technology, the author's fascination with her topic began way back in 1992 when she worked at a nonprofit reproductive health clinic in Atlanta. Years of copious research (Tone devotes nearly a full page of acknowledgments to individual librarians, and the bibliography/"Notes" section is 60 pages long) have yielded this highly accessibly examination of a mostly forgotten facet of U.S. history. Previous titles by the author -- The Business of Benevolence: Industrial Paternalism in Progressive America and Controlling Reproduction: An American History, which she edited -- provide a hint of what comes in Devices and Desires.
The result of morals crusader Anthony Comstock's tireless Victorian prudishness, a law defining contraceptives as obscene went into effect early in 1873, just before Ulysses S. Grant's second inauguration. The bill's quiet passage ushered in an era of entrepreneurial innovation and marketing creativity for what was for many years a black market cottage industry. Demand for "skins" (condoms from animal intestines) and eventually "rubbers" remained high -- from well-to-do marrieds who feared possibly deadly childbirths, to immigrant women desperate to minimize the number of children in already large families, to World War One generals trying to keep the soldiers in their ranks syphillis-free. The courts eventually found devices such as diaphragms and condoms legal for disease prophylaxis or medical treatment, but their use as contraceptives remained illegitimate.
Beginning in the 1920s, a feverishly dedicated birth control proponent named Margaret Sanger made it her life's mission to make contraceptives legal, affordable and accessible, especially to poor and immigrant women. Post-suffrage, she also strove to make the idea of birth control more palatable to the paternalistic and disapproving powers of the times; to that end, Sanger (a nurse by trade) tried to angle birth control toward a position of medical dispensation. While Sanger longed for legitimized contraceptives on social principles, the companies cranking out condoms were in it for the bottom line -- since the Comstock Act of 1873, the business of birth control (however it was marketed) had become a highly lucrative and fiercely competitive one. From rubbers and diaphragms, to the Pill and IUDs, to Norplant and Depo-Provera, profits have driven product innovation and -- thanks to the Dalkon Shield and the myriad lawsuits it provoked -- the recent lack of product innovation as well.
Dotted with illustrations of past and present contraceptives, their packaging and the people who played vital roles in their controversial development and use, Devices and Desires ultimately draws conclusions that are controversial even as they are common-sensical. Undeniable are certain facts: the US has the second-highest unwanted-pregnancy rates in the Western world (following Hungary); sixty percent of pregnancies in the US are unwanted or unplanned. Why, Tone asks? She answers herself in the epilogue:
In the United States, more than seventy years after the military quietly acknowledged that asking young male recruits "to just say no" does little except increase the incidence of VD, we still cling to the belief that abstinence is an effective medical and social policy. Birth control education in U.S. public schools is minimal, the distribution of free contraceptives unheard of... At the same time, politicians opposed to the diffusion of contraceptive programs profess great shock when teenage girls become "welfare moms."
Affordability of contraceptives is the twin to accessibility here, and with many HMOs and health insurance companies, which cover prescription drugs (including Viagra!) failing to cover prescription contraceptives, the Pill remains out of reach to a large segment of the population. Apparently, we've still got some lessons to learn on the road to true contraceptive freedom.