birth control


All living things from microbes to humans have to reproduce themselves to maintain survival of the species. In the higher animals, although it takes two individuals of different sex to engage in reproduction, most of the burden falls on the female, from the egg-laying birds to the pregnant mammals. Pregnancy then is a natural, although not necessarily inevitable, biological process for most females. Any human female who engages in intercourse with any regularity could spend most of the years of her life between the ages of fifteen and forty-five either pregnant or nursing a newborn infant. It is estimated that under optimal circumstances the average woman would become pregnant every other year during her reproductive life and, if she did not give birth to twins or have other forms of multiple births and if she nursed her infants, she would give birth to fifteen children during her lifetime. Obviously some women would become pregnant more often than others, with a theoretical maximum of about twenty pregnancies for one woman. But what is theoretical is not always actual. The largest number of live births recorded for any one woman is sixty-nine by the first wife of Feodor Vassilyev (her first name does not appear in the records), a peasant from the village of Shula, 150 miles east of Moscow. She had thirty-seven pregnancies: ten individual births, sixteen pairs of twins, seven sets of triplets, and four sets of quadruplets, all born between 1725 and 1765, and almost all of them survived beyond the first year. Although we can wonder about the historical accuracy of such reports, we know that the leading mother of the twentieth century, Leontina Espinossa Albina (b. 1925) of San Antonio, Chile, in 1981 gave birth to the last of her fifty-five children, forty of whom were still alive in the 1990s. Most natural pregnancies, that is, before fertility drugs, result in only one baby. At least three women in the twentieth century have been reported as having given birth in one pregnancy to ten infants, all of whom were stillborn. An equal number of women gave birth to nine, none of whom survived beyond a few days.

Although few women beyond their mid-forties, without fertility drugs, give birth, many have become pregnant at later ages. There are several claims of women having given birth at age seventy or older but historians have been reluctant to accept such cases because when investigation has been possible it turned out to be an instance of a mother or grandmother claiming as her own the illegitimate child of a daughter or granddaughter. The best documented incident of an older woman giving birth was the case of Ruth Alice Taylor Shephard Kistler (1899—1982), whose daughter Suzan was born in Glendale, California, on October 18, 1956, when Kistler was 57 years and 129 days old. It is also possible for pregnancies to occur at very young ages, and births have been reported to girls under ten, and one to a girl perhaps as young as five, all the result of incest.

If the female reproductive potential is limited to offspring numbering in the double digits, that of the male can number into four digits. The man who is recorded as having fathered the most children is the polygamous Moulay Ismail (1672—1727), the last Sharfan emperor of Morocco. He was reported as having had 525 sons and 341 daughters by 1703, and in 1721 he recorded the birth of his seven hundredth son. Apparently by then he no longer recorded the number of his daughters. The European holder of the title is probably Augustus the Strong (1670—1733), king of Poland and elector of Saxony, who recognized 365 individuals as his children, only one of whom was legitimate. The record holders are the exception, but it is clear that few peoples and societies ever reached the theoretical maximum.

Statisticians talk of a total maternity ratio, defined as the average number of previous live births per women age forty-five or over, regardless of whether a particular woman has children. Obviously, not all women can or do have children, and maternity ratio excludes abortions, whether induced or spontaneous. Though several societies have at different times registered as high as seven or eight, the highest rate recorded is among the Hutterites, 10.6 per woman in the first part of the twentieth century. The Hut-terites are a communal religious group dating from the sixteenth century that settled in South Dakota between 1874 and 1877. They now live in more than a hundred different religious colonies in the Dakotas, Montana, and Washington in the United States and in Alberta, Saskatchewan, and Manitoba in Canada. Interestingly, their maternity ratio declined somewhat in the last part of the twentieth century. Having children, however, did not necessarily mean having a large family of adult children, and, as Thomas Malthus pointed out at the end of the eighteenth century, one result of unchecked birthrates was misery, wars, and suffering.

Although infant mortality figures of the past are notoriously difficult to determine accurately, our best estimates are that somewhere between 25 and 40 percent of the infants born before the nineteenth century did not live beyond their first birthday. One of the best sources of evidence we have about infant and child mortality is in the progeny of European royalty, where a high rate of infant mortality can be documented. Infant mortality rates began to decline in the nineteenth century, but at the beginning of the twentieth they were still between 15 and 17 percent of live births in countries such as the United States and Great Britain.

Though infant mortality is not a form of birth control, there is considerable evidence that the high mortality rate of newborns and infants in many societies has not necessarily been a result of natural causes, but rather has resulted from actions that either intentionally or unintentionally would lead to a higher death rate. In few societies would infants be deliberately murdered, although the father in many societies had the right to accept or reject an infant’s membership in the family, and rejection meant abandonment of the infant. This practice allowed the individuals involved to rationalize that the possible death of a child was up to the gods because whether the child lived (by being found and raised by someone else) or died was out of their hands. Such practices have often been continued today.

I had a personal experience in Egypt with an abandoned newborn that was found by a police-man.When he tried to turn it over to the hospital, he was told that he had found it so it was his responsibility and I remember the man mumbling that it was not his and what should he do. As I talked to him later, he implied that he would just ignore the next case he saw. In short, few of the societal institutions were willing to take responsibility for an infant’s survival and the chance of one surviving were highly problematic. Even if the infant ended up in a foundling home, as they often did in medieval Europe and later, mortality statistics were extremely high in such places because contagious diseases, neglect, and infection killed most of the infants early on. The problem of nursing infants in such institutions was a serious one. Again, in Egypt when I lived there, infants in such institutions were nursed by wet nurses who were paid monthly to be wet nurses. Some of the wet nurses had very little milk but the need was so desperate that almost any woman was accepted, even older women beyond childbearing age. When the wet nurses came in for the monthly checkup, they brought the infants or corpses of the infants with them. Many of the infants had died weeks before but the wet nurses waited until the end of the month in order to get maximum pay. Again, it was claimed it was God’s will whether the infant lived or died.

Many upper income residents of eighteenth-and nineteenth-century Paris turned to wet nurses until the infant reached the age when it could take solid foods. Undoubtedly infant mortality in the city (and in fact most major cities) was high because of poor sanitation, likelihood of contagious diseases, and other difficulties of city living, but dependence on country wet nurses probably increased rather than decreased infant mortality. This is because wet nurses by definition usually had infants of their own to feed, and milk production was not always enough to support more than one, although it might have been the child of the wet nurse who died because she might have neglected her own for the money available for the other. Some estimate that the total mortality rate of wet-nursed babies sent out from Paris was more than 40 percent.

Fertility was also curtailed by many societies, whether consciously or unconsciously, by providing for periods of abstinence during some seasons of the year such as Lent or by prohibiting intercourse with women during certain periods of their lives, as when they were lactating or menstruating. Because fertility among men is highest when they are between sixteen and twenty, another way of controlling population growth is to delay the age of marriage for both sexes and make the age higher for men. Ireland, for example, discouraged early marriages for much of the twentieth century. Such a delay is based on the assumption that women will remain abstinent until marriage. Such assumptions are not usually made about men, who remain free to visit prostitutes or engage in temporary liaisons. Such practices work most effectively in cutting down the total maternity ratio in countries with a high tolerance for a double standard of sexual conduct or where government or religious control and interference in the private lives of its citizens is very great.

Another factor in keeping the maternity ratio down was sexually transmitted diseases. Gonorrhea in women—transmitted, it was usually claimed, by an errant husband—could cause infertility, as could other sexually transmitted diseases that were finally diagnosed only in the twentieth century. Fertility is controlled also by the health of the mother. Women on protein-and iron-poor diets are more likely to be anemic than are women on diets with adequate protein and iron, and those with anemia are less likely to become pregnant and, if pregnant, less able to carry the baby to term. They also tend to die younger. Maternal mortality has usually been very high in the past, and inadequate diet has been a major factor along with too many pregnancies too close together or difficulties in child birth. Most women are not believed to have lived long enough to reach the menopause, particularly if they had very many children.

Another societal custom that could limit the total maternity ratio is polygamy. It has the effect of cutting the young men who are the most fertile out of the marriage market because the polygamists are the older and more politically powerful men. If the number of wives or concubines is very large, in spite of the example of Moulay Ismail, it is difficult for an aging man to keep them pregnant. Because on a random basis of active sexual activity, without any understanding of the fertility period, a woman is likely to become pregnant about one out of every thirty-three times she has intercourse, the women in a harem would not always be pregnant. Even if there were only three or four wives, the pregnancy rate would decline, especially if there was discrepancy in age between the husband and his wives.

Whether any of these customs were deliberately adopted as a means of birth control is unclear, but it seems clear that throughout history various methods have been tried to space births, prevent pregnancy, or induce an abortion if pregnancy occurred. Contemporary peoples who live in tribal of nomadic groups, for example, are known to use douches and drugs believed to prevent or cure pregnancy, to practice withdrawal (coitus interruptus), and to insert vaginal suppositories of one kind or another as well as use magic and herbs. Some of the methods were probably effective. For example, the suppositories might have had resins that blocked the entrance to the cervix or oils that reduced the motility of the sperm. Subincision was also practiced in some groups. It involves an operation that creates a hole in the male urethra at the base of the penis near the scrotum so that during ejaculation semen dribbles over the scrotum instead of entering the vagina. Urine also dribbles out but if a finger is placed over the hole it acts as a plug, allowing both the urine and semen to come out in the normal way. Whether subincision was done originally for ritualistic reasons or contraceptive purposes is not clear. Although some semen when the hole is unplugged might spill out onto the labia of the woman and some semen and sperm might spill into the vagina, it certainly lessened the likelihood of pregnancy. We also know that many peoples engaged in what can be called nonfertile intercourse: anal, oral, or with a partner of the same sex. Certainly such behavior was not rare and was even common in classical antiquity, as indicated in vase paintings and in literary works.

The oldest birth control prescription we have dates from the second millennium (between 2000 and 1000 B.C.E.). One of the difficulties with the written record, however, is that it was mostly written by men, and it is believed by most historians, including me, that women in the past were far more involved than men in trying to establish some kind of family planning, if only for their own welfare. This so-called folk medicine passed orally by women has occasionally been preserved.

Usually it involves the use of various plants or minerals, many of which have been found to have some effect on lowering the total maternity ratio. Unfortunately much of this oral tradition has not survived. Still, many of these traditional recipes made their way into the medical works. And we can now test to see how effective they were. Some have been found to be rather effective as abortifacients and some might well have acted to lessen the potentiality of becoming pregnant. These recipes are examined in detail in this topic under herbal remedies.

We know that effective birth control is based on a mindset that allows a person to believe that it is possible to control or limit birth, and probably for long stretches of history that mindset was held by only a few. Others simply acted in desperation. Part of the difficulty was that people knew little about the process of reproduction, although they knew it was dependent on sexual intercourse. Semen was visible but sperm and ova were not. Sperm was first seen at the end of the seventeenth century, and although there was speculation by the beginning of the nineteenth century that women had something like an egg, the process of fertilization was first observed in the starfish in 1877. Not until the discovery of hormones in the 1920s and 1930s was the process of menstruation and fertilization fully understood. This understanding ultimately led to the various hormonal methods of birth control and to a more accurate definition of a safe period.

There was, however, a recognition even in ancient Egypt of the need to slow the motility of the sperm and block off the cervix, the entrance to the uterus. In the nineteenth century a concentrated effort was made to make such methods more effective, although many of them were very similar to devices used centuries earlier. It was not enough, however, to find more effective means of contraception or to bring about an abortion; it was also necessary to convince the public, especially women, that they could control the use of their bodies. It was Sigmund Freud who said biology was destiny, implying that there was little that women could do to avoid their mission in life to be wives and mothers. Convincing women that they could control their own bodies, knowing that many wanted to do so, has been the mission of birth control advocates, both women and men, throughout the twentieth century and into the beginning of the twenty-first.

All of this is by way of introduction to this topic, which is a historical-sociological study of birth control throughout history. Although the general history of birth control worldwide is covered, the concentration here is on the political efforts in the United Kingdom and the United States that made modern birth control possible.Each country had its own leaders and advocates, although the general leadership of the movement worldwide was basically American and British. Space limitations and the difficulties of covering all of the people who could be potentially included have led to a decision to somewhat narrow the focus.It is designed for the average reader, but the specialist, I believe, will also find it helpful, and everyone will find it interesting.

Next post:

Previous post: