Birth Control in America: A Brief History of Contraception

Let’s look at how far women’s reproductive health options have come in the last 100 years. In an era when people have a number of effective, available options to prevent unwanted pregnancy, it’s easy to forget that this wasn’t always the case. In fact, before the introduction of the birth control pill in 1960, sexually active people accepted the reality that intercourse could — and did! — regularly lead to parenthood.

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Sex and Pregnancy Before the Birth Control Pill

Prior to the pill’s approval, “American women were extremely constrained in their ability to delay, space, or prevent pregnancies,” says Megan L. Kavanaugh, a principal research scientist at the Guttmacher Institute, a research organization in New York.

And as you’ll see below, men didn’t have it so great either.

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Withdrawal and Abstinence Were the Primary Birth Control Methods

With reliable contraception scarce, people often practiced abstinence to avoid having children, according to the nonprofit sexual health organization Our Bodies Ourselves.

After all, this is the only method guaranteed to prevent pregnancy.

Withdrawal, or stopping intercourse before ejaculation, is another long-used method, the group says. According to sexual and reproductive health research group the Guttmacher Institute, the withdrawal method has a failure rate of up to 20 percent with typical use (typical use includes people who use the method inconsistently and incorrectly).

Some romantic partners tried to time their sexual activity for times when the woman was less likely to get pregnant. Called natural family planning, or the Billings Ovulation Method, in this method a woman looks at the consistency of her cervical mucus (long and stringy just before ovulation) to predict the time with the lowest odds for pregnancy, according to the Mayo Clinic.

The Billings Method is sometimes combined with other natural family planning methods, such as tracking your resting body temperature (which rises a small amount during ovulation).

According to the Guttmacher Institute, the effectiveness of fertility-awareness-based methods including the Billings Method and other methods varies widely, with a failure rate of less than 1 percent to up to 12 percent with perfect use, and from 2 percent all the way up to 34 percent with typical use.

Despite the limited effectiveness of these methods, Americans were not getting accurate information in schools. Sex education in schools didn’t gain significant support until the 1960s, according to Planned Parenthood,

with widespread implementation in the 1980s and beyond, according to a 2016 article published in the Journal of Adolescent Health.

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Early Versions of Condoms and Spermicide to Help Prevent Pregnancy

Comfortable condoms may be a relatively recent invention, but couples have used rudimentary versions for thousands of years. Animal intestines, fish bladders, and linen were some of the materials used for sheaths, notes Our Bodies Ourselves. (Ouch!) Sometimes, the item was soaked with one or more chemicals to provide a spermicide.

Vulcanized Rubber Revolutionized Condoms

Condoms took a major leap forward in the mid-1800s, when Charles Goodyear created a process whereby natural rubber could be made more durable, so it didn’t crack as it previously had. This “vulcanized” rubber not only revolutionized tires, sneakers, and athletic gear, it ushered in a new age for birth control. This discovery allowed rubber condoms (as well as the less widely used diaphragms) to become mass produced and wildly popular (despite federal and state anti-birth-control laws), according to a PBS documentary on the topic.

If used perfectly, today’s male condoms have a failure rate of 2 percent, or up to 13 percent if used typically, notes the Guttmacher Institute.

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The Comstock Act of 1873 Made Birth Control Illegal

One of the broadest laws that made birth control illegal was the Comstock Act. Passed by the federal government in 1873, it made it a crime to possess, distribute, or provide information about contraception or abortion. Penalties for breaking the law were steep: up to five years in jail and a large fine.

In 1936, the U.S. Court of Appeals for the Second Circuit ruled that the federal Comstock law violated the Constitution, per Our Bodies Ourselves.

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Women Used Homemade Douches to Help Prevent Pregnancy

With women bearing the brunt of an unwanted pregnancy, and condoms dependent on the cooperation of the man, it’s not surprising that women long tried to concoct their own chemical brews to prevent pregnancy. Unfortunately, for the most part, these were not very effective.

In preindustrial America, for example, homemade herbal douches were mixed and inserted before sex. If an unwanted pregnancy occurred, other strong herbs, like pennyroyal, were ingested in the hope it would terminate the pregnancy.

In the early 20th century, products that could be purchased without a prescription in the drugstore were popular. To stay within the law, they were sold as feminine hygiene rather than contraception. These items, mostly ineffective as birth control, included suppository pills, vaginal jellies, and cleansing douches.

The Quest for a Pill to Prevent Pregnancy

With medicines for many conditions becoming available in the 20th century, people began to yearn for a pill that would effectively prevent unplanned pregnancies.

That hope began to seem like a reality in the late 1930s, when animal experiments demonstrated that high doses of the hormone progesterone could stop a woman’s ovulation. A decade later, a chemist was able to make a synthetic version of progesterone, called progestin, and the pill moved one step closer to reality, according to an article published in Canadian Family Physician.

The People Behind the Development of the Birth Control Pill

Margaret Sanger was a longtime birth control advocate. She opened the first birth control clinic in 1916, earning her a sentence of 30 days in jail.

She also raised money for research and supported John Rock, MD, a devout Catholic who conducted an early trial of the pill under the ruse that it was a fertility study, notes the article in Canadian Family Physician.

Early Clinical Research on the Birth Control Pill

The first large-scale trial of the pill was performed in Puerto Rico, partly because the island had no anticontraception laws, and was not too far from the mainland United States, according to an article in The Washington Post. But the research was later criticized because participants were not told of the risks and had not given informed consent.

Effectiveness and Side Effects of the Birth Control Pill

These trials proved the effectiveness of the pill, but early versions were not without significant side effects, including nausea, dizziness, headaches, and vomiting.

Finally, in 1960, the first hormonal birth control pill was approved by the U.S. Food and Drug Administration (FDA), ushering in a new era of reliable contraception.

Continued improvements in the pill, as well as the other hormonal methods that followed, have had a major impact, not only on childbearing but on society and on women’s lives.

The Birth Control Pill Changed Everything

The impact of hormonal birth control on women’s (and men’s) lives cannot be overstated, says Kavanaugh.

The ability to delay and space childbearing is not only crucial to a woman’s health, it directly affects her social and economic advancement, Kavanaugh says. “Women’s ability to obtain and effectively use contraceptives has a positive impact on their education and workforce participation, as well as on subsequent outcomes related to income, family stability, mental health, and children’s well-being,” she explains.

The Pill Has Greatly Shaped American Women’s Lives

According to Planned Parenthood, fully one-third of the wage gains made by American women since the 1960s can be traced to oral contraceptives. Between 1970 and 1990, hormonal birth control accounted for some 30 percent of the increase in the rate of women entering skilled careers like medicine and law. It has also been the most influential factor enabling women to stay in college.

Women recognized the benefits of the pill right away. Three years before the pill was officially approved by the FDA in 1960, the agency gave it the nod to “regulate menstruation” — the package was required to bear a warning about its “contraceptive activity.” Some 500,000 women used the pill during these years.

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Early Oral Contraception Side Effect Risks Were Significant

Enovid was the pill approved in 1960 for contraception. That pill, along with others in those early years, had very high doses of hormones. This led to side effects like dizziness and vomiting, and a rare but risky increase in heart attacks and strokes.

It took more than a decade — and a lot of public prodding from women — for scientists to become concerned enough about these problems to study lower doses of hormones, which proved to be just as effective and had a much lower risk of side effects. These lower doses are what are used in birth control pills today.

Finally, All Women Could Get the Birth Control Pill

It wasn’t until 1965 that the law banning birth control was struck down by the U.S. Supreme Court.

This case, however, Griswold v. Connecticut, applied only to married couples. Millions of unmarried women were still denied the pill. Finally, in 1972, the Supreme Court case Baird v. Eisenstadt legalized birth control for everyone, notes Our Bodies Ourselves.

Manufacturers worked hard in the 1980s to improve the pill, offering women new dosages, new progestins, and multiphasic pills.

According to the Guttmacher Institute, today’s birth control pills have a failure rate of 0.3 percent with perfect use, and a 7 percent failure rate with typical use.

The pill remains a sought-after method of reversible birth control. Between 2017 and 2019, 14 percent of all women ages 15–49 were on the pill in the United States, according to the Centers for Disease Control and Prevention (CDC).

In 2018, 21 percent of contraceptive users ages 15–49 used the pill, making it the second-most popular form of birth control after female permanent contraception (28 percent), per the Guttmacher Institute.

The First Intrauterine Birth Control Devices Faced a Rocky Road

With women clamoring for additional birth control choices, the FDA approved the first intrauterine devices (IUDs) in 1968, notes Our Bodies Ourselves.

These early devices did not use hormones, primarily serving to prevent fertilization.

In 1974, however, sales of one of these IUDs, the Dalkon Shield, were suspended after it was linked to numerous infections and seven deaths. Although only that one brand was implicated, other manufacturers feared expensive lawsuits and also pulled their IUDs from the market.

In the 1980s, a new copper IUD called Paragard was approved. The Paragard nonhormonal IUD (also called the copper IUD) is a small piece of flexible plastic shaped like a T that has copper wrapped around it.

The copper IUD can be used as a regular form of birth control, or as a form of emergency contraception. Per Planned Parenthood, Paragard IUDs are the most effective form of emergency contraception. If you have one inserted within five days after having unprotected sex, it’s more than 99.9 percent effective against pregnancy and then provides very reliable contraception for up to 10 years.

In 2000, the Mirena IUD came on the market. Like the nonhormonal IUD, Mirena and other hormonal IUDs are a small piece of flexible plastic shaped like a T. They release a tiny amount of progestin into your body over several years, which helps prevent pregnancy, notes Planned Parenthood.

According to the Guttmacher Institute, hormone-releasing IUDs have a failure rate that ranges from 0.1 to 0.4 percent.

Among contraceptive users ages 15–49 in 2018, 13 percent relied on an IUD.

Low-Tech Birth Control Methods Are Still Around

Coital methods of contraception — which are methods used at the time of intercourse such as condoms and withdrawal — remain in use today, but the effectiveness of these methods varies widely. In 2016, one-quarter of all contraceptive users ages 15–44 relied on a coital method as their primary form of contraception, according to the Guttmacher Institute.

Condoms were the most commonly used primary coital method (15 percent), followed by withdrawal (7 percent).

More Hormone Delivery Systems Keep Coming

Over the last few decades, hormonal contraceptives have become available in methods beyond an oral pill. These range from injectables and vaginal rings to hormonal patches and implants.

In the United States, the term "injectables" refers to the Depo-Provera shot or birth control shot, which contains progestin to prevent ovulation, notes Planned Parenthood.

According to the Guttmacher Institute, injectables, if used perfectly, have a 0.2 percent failure rate, and a 4 percent failure rate if used typically.

The vaginal ring, also known as the birth control ring and by brand names NuvaRing and Annovera, is a small ring that a woman wears inside her vagina. The ring contains estrogen and progestin to prevent ovulation, explains Planned Parenthood.

Like the vaginal ring, the patch (brand names Xulane or Twirla) releases estrogen and progestin, but through a patch worn on your stomach, buttocks, or back, notes Planned Parenthood.

Vaginal rings and patches both have a 0.3 percent failure rate if used perfectly, and a 7 percent failure rate if used typically.

According to Planned Parenthood, the birth control implant, also called Nexplanon, is inserted under the skin of your upper arm. It releases progestin to prevent pregnancy, and it’s more than 99 percent effective.

Other Forms of Emergency Contraception

Emergency contraceptive pills, designed to be taken after unprotected sex, first emerged in the late 1990s, according to Our Bodies Ourselves.

The FDA approved the brands Preven in 1998 and Plan B in 1999. But their availability greatly improved in 2006 when the FDA approved over-the-counter sales of Plan B for people ages 18 and over, and again in 2013, when it approved over-the-counter sales for people under 18.

According to Planned Parenthood, levonorgestrel morning-after pills including Plan B One-Step and other brands can lower your chance of getting pregnant by 75 to 89 percent if you take them within three days after unprotected sex.

If you weigh 155 pounds or more, the copper IUD or Ella are better emergency contraception options for you, notes Planned Parenthood. Ella reduces your chances of getting pregnant by 85 percent if you take it within five days after unprotected sex, but you need a prescription to get it.

According to Planned Parenthood, Ella contains ulipristal, which delays or possibly prevents ovulation, while Plan B and similar brands contain levonorgestrel, which is similar to what’s in the birth control pill but with a higher amount.

Sterilization Is Still the Contraception King

Permanent contraceptive methods, sometimes called female or male sterilization, include tubal ligation (tying tubes) and partner vasectomy, according to the Guttmacher Institute.

Among contraceptive users ages 15–49 in 2018, female permanent contraception was the most common method used (28 percent), followed by pills (21 percent), male condoms, and IUDs (both 13 percent), notes the Guttmacher Institute.

In 2018, more than one-third (36 percent) of users ages 15–49 relied on some form of permanent contraception, although it was much more common among users ages 40 and over.

The popularity of these methods is likely due in large part to how effective they are. According to the Guttmacher Institute, tubal sterilization and vasectomy both have a failure rate of close to 0 percent.

Resources We Love

Planned Parenthood

Planned Parenthood is a nonprofit organization with the mission of ensuring that everyone has access to the care and resources they need to make informed decisions about their bodies, their lives, and their futures. Planned Parenthood delivers sexual and reproductive healthcare, sex education, and information to millions of people every year.

Guttmacher Institute

The Guttmacher Institute is a leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide. The institute dreams of a future in which everyone can realize their rights and access the resources they need to achieve sexual and reproductive health.