The Washington PostDemocracy Dies in Darkness

A century ago, women fought for access to contraception. The Trump administration threatens to undo their work.

Affordable birth control is essential to women's health.

As women protest to defend federal funding for contraception, they join a fight that has been taking place for nearly a century. (Chip Somodevilla/Getty Images)
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Trump administration officials vow that they are going to take care of the health of moms and babies. But their pledge to cut funding to Planned Parenthood promises to do the opposite. The proposed cuts have focused not just on the procedure of legal abortion (which is, of course, another column), but also on eliminating access to contraceptives.

These proposals ignore a fundamental truth: Access to birth control is central to women’s health. In fact, it always has been.

Over the past century, the ability to plan pregnancies has been shown to improve women’s health and lower the rate of abortions. The federal government’s support for contraception is essential for maintaining the health of all American women. Cuts to family planning funds will revert public health standards and women’s health policy to conditions similar to the early 1920s — a threat not only to maternal and infant health, but to women’s broader rights to privacy and self-determination.

In 1921, progressive reform advocates achieved a major victory with the passage of the Sheppard-Towner Act, formally known as the Promotion of the Welfare and Hygiene of Maternity and Infancy Act. Signed by President Warren Harding, the act provided government aid over a five-year period to enact prenatal- and newborn-care programs throughout the United States.

While this program contributed to a significant decline in the infant mortality rate by the late 1920s, its effect was limited. Why? Because women were still unable to plan their families with certainty. Birth control — both its use and distribution — remained illegal under the guise of “obscenity” as mandated by the 1873 Comstock Act. Women died by the thousands from illegal abortions and added millions of unwanted children to families already struggling mightily in the uncertain economy of the early 20th century.

Reformers such as Mary Ware Dennett and Margaret Sanger, who ran the two largest birth-control advocacy organizations in the country at the time, argued that contraception was an essential component of general prenatal care and castigated the Sheppard-Towner Act for not including it. Both women recognized that any effective federal program for women’s health needed to include comprehensive access to birth-control services to advance women’s rights to make choices about their lives.

They also pointed out that without federal funding for birth control, economically vulnerable women suffered the most. Contraception and abortion had always been (and continue to be) accessible to middle- and upper-class women, despite legal restrictions.

Poor and working-class women, however, didn’t have the financial means to pay for physician care or to buy the tinctures, suppositories, pessaries or other methods that were commonly known to cause abortion or prevent pregnancy. Mortality rates for children born to poor and working-class women were also the highest, often the result of poor living conditions, infection and sanitation problems. Although efforts through federal organizations such as the Children’s Bureau encouraged family planning and instituted relatively successful prenatal- and postnatal-care programs, their efforts were incomplete in addressing all aspects of maternal and female health.

Dennett called on her fellow female reformers to recognize their hypocrisy in supporting the Sheppard-Towner Act, while rejecting the legalization of birth control. “It is obvious that practically [all of you] believe in family limitation,” she wrote, “for [you] have achieved it long ago, despite the laws which prohibit the knowledge as ‘obscenity.’ ”

In arguing for legalizing contraception, Dennett and Sanger resorted to the common class- and eugenics-based arguments of the period, ones that urged the reduction in births of “unfit” children. Nonetheless, both reformers were also deeply sympathetic to the suffering and misery of women desperately seeking information on how to prevent the births of children they couldn’t afford. Sanger’s Birth Control Review magazine received thousands of letters every month that begged her to “please write me soon and tell me some way I can keep from having any more children.” One woman wrote, “I want to do what is right, but if I cannot find a contraceptive, I will practice abortion if it kills me.”

Dennett and Sanger’s records reveal the misery these women experienced, their poor health outcomes and the contribution that the lack of widespread contraception access made to the high rate of maternal and infant mortality in this era. The deluge of pleas also explains why access to birth control and family planning policy were at the core of women’s activism for equal rights over the past century.

The medical community and advocates for women’s rights emphasized the important role that contraception played in the broader management of every woman’s health over her lifetime, and the Supreme Court enshrined this belief in the law by ruling contraception legal for both married couples and single people.

Yet the growing power of the religious right illustrated the precarious nature of these gains. Beginning in the late 1970s, powerful evangelical voting blocs mobilized the Republican Party to begin targeting these reforms as key platform issues. Over the past few decades, they have collaborated to chip steadily away at women’s health-care rights on the state and federal level, both through increasingly restrictive abortion laws and campaigns to defund Planned Parenthood, as well as their open scorn for the idea of free birth control.

These efforts have coalesced in the Trump administration, and the nearly century-old pleas from women to Dennett and Sanger have new resonance. Women’s health has become a partisan issue rather than a policy issue, politicized by Republicans who question the place of contraception in federal programming.

Key figures appointed by President Trump to oversee Americans’ public health needs, including Secretary of Health and Human Services Tom Price and Deputy Assistant Secretary for Population Affairs Teresa Manning, make it clear that they do not support federal funding for contraception and argue that women do not need their employers or the federal government to ensure broad access to it.

Republican alternatives, however, simply don’t work. Leaving the question of family-planning funding up to the states or new federally funded “community health centers” or instituting federally mandated abstinence-only sex education policies won’t solve the problem. According to the Guttmacher Institute, 6.2 million American women obtained contraception through public funding in 2015, including Title X and Medicaid. This effort prevented 1.9 million unintended pregnancies and 628,600 abortions. Cutting this aid will return us to a time that both Dennett and Sanger worked so hard to end.

In 2017, full contraceptive access should be an uncontested standard in federal policies on women’s health. But as the machinations of Trump and the Republicans show, attitudes about our collective responsibility for providing low-cost and readily available birth control for all citizens of reproductive age have changed little since the early 20th century.