On October 6, the Trump administration rolled back a key facet of the Affordable Care Act that required employers to include free birth control as part of their health plans. The changed rule will allow employers to opt out of contraceptive coverage if they have a “sincerely held” moral or religious objection.
In the wake of this announcement, there has been predictable rhetoric among policymakers, pundits, and political activists. Should religious and moral positions allow an organization to opt out of legal mandates? Can these positions be asserted by for-profit businesses or just religious organizations? Should women’s health care be subject to the whims of their employers? Is health care a basic right and is contraception a part of that right?
And there’s one other issue that gets bandied about when the issue of contraception comes up – its relationship to abortion.
Many pro-choice advocates argue that restricting access to contraception will lead to an increase in the abortion rate. Studies have shown that access to no-cost contraception reduces unplanned pregnancies and abortion. Further, some argue that the most effective forms of contraception (like IUDs) carry a large initial expense and hence will be less used under the new rule. So though it’s true that contraception is far from infallible and that many women seeking abortion do so after contraception has failed, research largely supports the notion that less access to contraception will lead to more abortions.
Indeed, in the novel I’m now writing, my protagonist’s grandmother makes exactly this argument. Smart woman, I’d say. And she makes the argument in 1888.
We don’t think much about contraception and abortion as 19th century issues. But we should, not only because it’s fascinating but because what happened 150 plus years ago has resonance and relevance to our conversations today.*
You see, in 1800, most American women had 7-8 children. By 1900, that number had dropped to 3.5. That is a precipitous drop, and it didn’t come about because of lower levels of marriage or (I’m making an assumption here!) less sex. It happened because in the 19th century, women were interested in having fewer children.
So that’s interesting. But what’s even more interesting is how efforts to have fewer children changed over that hundred-year period.
In the early and middle decades of the 19th century, a number of contraceptive methods – of varying levels of effectiveness – were popular. There was douching, withdrawal (“coitus imperfect”), and the rhythm method. There were early forms of the diaphragm (“Victoria’s protector”) and condoms (“baud ruche”). There were vaginal sponges, moistened with various liquids to enhance effectiveness. But of course, these methods of contraception didn’t always work and a woman might find herself with child. And if that happened, she might feel compelled to “rid herself of the obstruction.”
In those decades, abortion was legal before the point of “quickening” when the movement of the fetus could be felt (typically the end of the first trimester). There were many methods available for a woman who wanted an abortion. There were pills and extracts that were marketed as “female regulators” with a prominent warning that if taken while pregnant, MISCARRIAGE WOULD ENSUE. There were midwives and physicians who would use surgical means to bring an end to the pregnancy.
Things started changing in the middle of the century, though, when talk of all of this became a bit too public. Pamphlets and booklets outlining methods of contraception were published and circulated. Suddenly ideas that had been whispered and tacitly understood were printed for all to see, and this just wouldn’t do for pillars of society advocating social purity – what might now be known as “family values.”
The tipping point came in 1873, when Congress enacted the Comstock Laws – anti-obscenity measures that were used to prohibit the dissemination of information about contraception and abortion. After the passage of the federal law, states began enacting similar statutes and during the last two decades of the 19th century, the publication of advice about contraception came to a virtual standstill. Further, as state after state criminalized the act, there was widespread prosecution of physicians and midwives who were willing to perform abortions.
When information about contraception became harder to come by, did abortions increase? I haven’t been able to find any data on this, but it seems like a clear possibility. In my novel, Grandma Ruth definitely thinks there’s a relationship. And Grandma Ruth is a force to be reckoned with.
* * * * *
There’s a saying often attributed to Mark Twain (with no proof): History doesn’t repeat itself, but it rhymes. When I think of this saying, I find myself wondering about the parallels that can be drawn between this 19th century history and today’s debates about reproductive rights. Methods of contraception and abortion are different. Women are dealing with radically different life choices. Changes in politics, methods of communication, and family structures might make one think that there’s nothing we can learn from history that seems ancient.
Then, as now, there are two basic facts. Women want to have sex. And women want to have control over the shape of their lives.
And because of these two basic and unchanging facts, we would do well to pay attention to past discussions of contraception, abortion, morality, religion, women’s health, and women’s opportunities. I think we will hear history rhyming.
*For more complete discussions of the history of contraception and abortion during this time period, I recommend two great books: Contraception and Abortion in 19th Century America by Janet Farrell Brodie and When Abortion was a Crime by Leslie J. Reagan. There’s also a wonderful novel on the topic, My Notorious Life by Kate Manning.