The Washington PostDemocracy Dies in Darkness

With Roe gone, women could lose more than abortion rights

The freedom to choose contraception and childbirth methods may also be lost


With the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, abortion is now illegal in many states. The decision came at a moment when we were already witnessing momentum toward criminalizing abortion, political leaders hinting at banning contraception and misguided calls for women to breastfeed in response to an infant formula shortage. At the heart of this is an argument that medical interventions related to reproduction and birth are unnatural — perhaps even unethical. But women have long sought ways to intervene in their reproductive journeys to control when and how they have children.

Through the ages, women have chosen or been subjected to interventions in their reproductive lives. This includes the methods women have used to terminate pregnancies and induce labor, as well as women nursing babies birthed by others.

Historically, interventions into the reproductive process have happened across societies, and although techniques vary from one community to another, they are remarkably similar. Preindustrial societies used rituals and plant-based drugs to terminate pregnancies, induce full-term labor and ease the pains of labor and delivery. Indeed, as researchers have shown, there hasn’t been any community, in any area, that did not have knowledge and procedures to ease childbirth pain or speed up the process.

During antiquity in Europe, for instance, women used herbs such as pennyroyal to terminate pregnancies. Ancient Egyptians, Greeks and Romans limited their populations using herbs to make vaginal pessaries, or teas, from herbs such as Queen Anne’s lace. Societies off the eastern coast of Africa also used medicines to hasten labor and encourage a smooth delivery. Malekulan women drank a leafy tea to entice the baby out; doctors of the Omaha had bitter concoctions to use; and the Buka used herbs to stop bleeding during pregnancy and birth.

At the turn of the 20th century, as pharmaceuticals developed, male physicians stepped in — as midwives once did — to help birthing women with substances such as ergot, a fungus found on rye, that could be used to stimulate uterine contractions. Initially, it was used to help women experiencing postpartum hemorrhage, but its use shifted to stimulate contractions to speed up labor.

Still, doctors were unclear whether ergot was helpful in labor, so researchers sought something with more obvious effects. New understandings of the body’s glandular products made researchers believe that testosterone and estrogen were medicines that could be deemed “natural.” Another hormone, oxytocin, allowed researchers to turn to the challenge of saving women from suffering through long labors and even death.

Researchers discovered that oxytocin — found in all mammals, not only humans — could be extracted from cows and used to help women in labor. Bovine oxytocin was successful at helping the uterus contract, but as demand for it grew, animal extractions were no longer enough. The hormone was eventually created in labs. We now know this drug as Pitocin, and it is regularly used during labor and delivery.

Since the 1970s, induction and pain-management drugs have been celebrated by women and physicians as tools to improve reproductive health and empower women to have more control over the childbirth process. Induction drugs have helped people through difficult or slow labors, and they have been touted for allowing the choice of scheduling labor. Even as far back as the 1930s, magazines such as McCall’s and Reader’s Digest published articles about how childbirth had become faster and more convenient thanks to induction drugs. It seemed as if birth was no longer such an unpredictable event. Induction drugs allowed people to schedule care for their other children and to better ensure that their physicians would be available to offer them safe, quality care during labor and delivery.

This medical model of childbirth had benefits. By interfering with medications or surgeries, many women were, and continue to be, better protected from the risks of childbirth — some of them fatal.

Opposition to medical childbirth, however, emerged from doctors and patients alike. “Natural” birth, as a named practice, in contrast to medically driven birthing, did not enter the American vernacular until the 1940s, when the New York-based Maternity Center Association brought British obstetrician Grantly Dick-Read for a lecture tour to share his ideas about childbirth. Dick-Read, who had traditional ideas about women’s roles in the family, believed that childbirth was a rare moment of strength in what he said was an otherwise mundane homemaking life; women should labor and deliver without modern medicine, because the natural way was without help.

Dick-Read based his philosophy on the idea that women from preindustrial societies had an easier time giving birth than Western women who were stressed by the burdens of modern civilization. If Western (meaning White) women prepared themselves by learning about birth, then they would birth easier. Thus, he argued for modern women to reject “interventions.”

But Dick-Read was wrong. Women in preindustrial societies had long used interventions; in fact, interventions helped them have control in the process. As anthropologist Margaret Mead said: “Natural” birth required extensive training and human intervention.

By the 1960s and ’70s, feminists were pushing back against the arguments of men like Dick-Read. They pushed for the right for women to choose between “medical” and “natural” births, with an understanding of “natural” birthing as an empowering, woman-centered experience. The demands women made to regain control over the experience of pregnancy, labor and delivery helped support the reemergence of midwifery in the 1970s — a practice involving human intervention by trained experts that evolved to counter the technology-driven methods of the medical birthing industry.

Today, women have choices. They can, for instance, birth with physicians and fetal monitoring or have a planned surgical birth, an unmedicated birth or a midwife-attended birth in a hospital or at home.

But that may change. The loss of Roe v. Wade is, of course, a threat to the right to an abortion in the United States. But it is also a threat to women’s fundamental right to privacy in making the decisions they believe are best for their own reproductive health. (Justice Clarence Thomas indicated in his concurrence in Dobbs a desire to revisit Griswold v. Connecticut, which recognized that right and applied it to contraceptives.) Roe’s repeal, therefore, could have far-reaching implications. If the objections to abortion — or birth control — are about enforcing “natural” childbirth, then the right to choose how to, or if to, intervene in childbirth may be at risk, too. And that could put the lives of even more women at risk.