Barbara Seaman, once called "The Ralph Nader of the Birth Control Pill," is author of The Doctor's Case Against the Pill (Hunter House) and is co-founder of the National Women's Health Network.
Once in a while you come across a book that is so original, so persuasive, so meticulously researched and documented that it overrides some of your most taken-for-granted assumptions and beliefs. Devices and Desires is such a work. The author, Andrea Tone, associate professor of history at Georgia Tech, belongs to a small band of new historians who are reassessing the lives of nineteenth-century women through attention to their personal (and I do mean very personal) health aids. An earlier example would be Rachel Maines's The Technology of Orgasm, published by Johns Hopkins in 1999, which describes and illustrates the 1880s-style vibrators that doctors freely used in their offices--and women in their homes--for relief of pelvic congestion and the female "hysteria" associated with it.
Devices and Desires opens in 1873 when, through the machinations of Anthony Comstock--star agent for the New York Society for the Suppression of Vice (NYSSV)--Congress unexpectedly voted to make contraceptives illegal. Many Americans disapproved, and when the news reached Ireland, George Bernard Shaw coined the word "Comstockery," which, he predicted, would become "the world's standing joke at the expense of the United States."
It may be that talk of the new law made contraception known to some folks who had never heard of it before. It may be that, as with Eve's forbidden fruit, the ban made pregnancy prevention seem more alluring or naughty--or more fun. Then too, the "bootleg" business environment that ensued was relatively welcoming to entrepreneurial immigrants, smart single mothers with families to support and other ambitious "outsiders." "As with condoms," Tone observes, "creating diaphragms was easy and inexpensive, an ideal venture for those with little money and a penchant for risk." In any case the business of contraception flourished in the Comstock era, embracing scores of diverse devices and spermicides for women and men. Hundreds if not thousands of small entrepreneurs and distributors profited, as did as an impressive handful of industrial giants, including the arch-hypocrite Samuel Colgate, millionaire heir to the New Jersey-based soap firm, who served as president of Comstock's NYSSV while openly promoting Vaseline to "destroy spermatozoa, without injury to the uterus or vagina."
Other well-established companies that made, distributed and freely advertised contraceptives--ranging from intrauterine devices (IUDs) to vaginal pessaries (appliances intended to support the uterus that could also prevent the passage of sperm), and from douching syringes, suppositories and foaming tablets to sponges and male caps--included some still familiar names: B.F. Goodrich, Sears, Roebuck & Co. and Goodyear. "The B.F. Goodrich Company," notes Tone, "manufactured three soft-rubber IUDs--one pear- and two donut-shaped, each available in five sizes--and twelve hard-rubber models. Two of the latter models were one-size-fits-all rings." Physicians were leading players in the commercialization of mass-produced IUDs--constructed from rubber, metal, ivory and even wood--although some models were promoted for do-it-yourself insertion.
Tone's exhaustive research led her--like an ace detective or shoe-leather crime reporter--through an eight-year coast-to-coast investigation of Post Office Department records, Federal Trade Commission transcripts (some with decaying diaphragms and condoms glued to the pages), American Medical Association (AMA) Health Fraud Archives, records of the NYSSV, credit reports from nineteenth-century Dun and Co. collections, patents, love letters, arrest records, trial records, advertisements and trade catalogues--as well as "entrapment" letters, some drafted by Comstock himself. (He or another agent would pose as being in desperate need of birth control, get the goods and make the arrest.) Established companies, Tone discovered, run by "honest, brave men" who supported Comstock and NYSSV, were never targets for such treatment, which was reserved for smaller entrepreneurs--especially immigrants ("sly" Jews) and women ("old she villains").
Even so, many of those arrested were let off or punished lightly, while the entrapping agents and prosecutors ran the risk of being scolded and humiliated by judges and juries who doubted the advisability, and constitutionality, of such far-reaching Congressional interference into personal matters. Over time, what Tone calls a "zone of tolerance" was created to buffer the flourishing contraceptives trade and its practitioners. In fact, Shaw's prediction that Comstockery would become a "standing joke" was soon realized here in the United States, even, it would seem, in Congress itself.
The hugely ambitious Comstock Act, however, was hardly about contraceptives alone. It stated:
No obscene, lewd or lascivious book, pamphlet, picture, paper, print or other publication of an indecent character, or any article or thing designed to be intended for the prevention of conception or the inducing of abortion, nor any article or thing intended or adapted for any indecent or immoral use or nature, nor any written or printed card, circular, book, pamphlet, advertisement or notice of any kind giving information, directly or indirectly, where, or how, or of whom, or by what means either of the things mentioned may be obtained or made...shall be carried in the mail.
You do the math. A small army of Post Office inspectors (known as special agents) were required to enforce such an effort. But Congress refused to drum up a serious budget for the measure when Comstock went into effect and made light of the ambitious national program by raising the number of inspectors--nationwide--from fifty-nine to only sixty-three. Looking at the postal arrest figures from May 1875 through April 1876, Tone counted a total of 410 apprehensions, of which only twenty-seven were for violations of the Comstock law.
Nonetheless, in later generations we took it for granted that from passage of the Comstock Act until the post-World War I rise of Margaret Sanger, the average American had little or no access to what we now call "family planning" (a term, Tone informs us, suggested in the 1960s by Malcolm X--"because Negroes [are] more willing to plan than to be controlled"). And while it's true that some of the contraceptives available at the time were ineffective, dangerous or both, others, including condoms, cervical caps (apt to be euphemistically advertised as pessaries in the Comstock era), diaphragms, sponges and some spermicides were often pretty good and relatively inexpensive. Tone notes that in this sea of alternatives many determined wives and husbands doubled, tripled or quadrupled on protection. Given this environment, it's not surprising that after 1880 the national fertility rates for both white and black women declined rapidly, reaching an all-time low in 1940--twenty years before Enovid, the first birth-control pill, came to market and only three years after the AMA's 1937 resolution to "endorse" contraception and recommend it for inclusion in the standard medical school curriculum.
Between 1880 and 1940 the average fertility rate of whites dropped from 4.4 children per woman to 2.1. For blacks it dropped from 7.5 children to 3. Given these incontrovertible facts--a flourishing contraceptives industry paired with a steady decline in births--how could we have come to believe otherwise, that our great and great-great grandmothers were, so to speak, up the fertility creek without a paddle?
Some of the historical distortion must be attributed to the work of Margaret Sanger, who originally dreamed of female empowerment through woman-oriented contraceptive technologies. She viewed birth control as a woman's right and responsibility, and wrote in 1922 that "the question of bearing and rearing children is the concern of the mother and potential mother.... No woman can call herself free who does not own and control her own body." Condoms "compromised this objective by placing women's procreative destiny in men's hands." Until her death in 1966 Sanger promoted the manufacture first of diaphragms and later the pill, never quite answering objections from other feminists--in the 1920s and again in the 1960s--that this transferred power over women's bodies to doctors who were overwhelmingly (in the case of gynecologists, 97 percent) male. Sanger came to believe so strongly in medically controlled contraception that in a 1952 letter she stated that her greatest achievement had been "to keep the movement strictly and sanely under medical auspices."
This was an about-face from her earlier position. In her extraordinary 1915 pamphlet, Family Limitation, a home guide to contraception, Sanger, as Tone explains, "envisioned a world of grassroots birth control where women from all walks of life could use contraceptives without reliance on doctors, a populist approach she would soon abandon." Family Limitation discussed douches, condoms and cervical caps. (The essential difference between a pessary or cap and a diaphragm is that the generally thimble-shaped caps fit over the cervix by suction and are less likely to be displaced. The diaphragm, however, more or less divides the vagina vertically into two compartments, protecting the cervix from the arena where sperm is deposited. Both methods can benefit from outside help with fitting and correct technique, but the cap has a better record of over-the-counter success, and was long distributed by this means in France, England and the United States.) Sanger ultimately recommended caps, which she felt could be most easily and discreetly used and controlled by women. She distributed 100,000 copies of her pamphlet, imploring women to learn how to insert caps into their own bodies and then to "teach each other" how to as well.
When Sanger and her sister Ethel opened their first clinic in 1916 they instructed women, eight at a time, on how to use over-the-counter (OTC) contraceptives, including condoms, suppositories and rubber pessaries. When police, inevitably, raided the clinic, they found boxes of Mizpah pessaries. An effective OTC contraceptive, this flexible rubber cap was sold by druggists and mail-order vendors for the alleged purpose of treating such medical conditions as a displaced (or prolapsed) uterus. But as Tone writes: "Family Limitation got Sanger into more trouble. In 1915, she found herself back in Europe dodging American law while continuing her contraceptive education.... The trip across the Atlantic was risky. War had broken out." Back home, her husband, William Sanger, had his own problems. And as fate would have it, so did Anthony Comstock. William Sanger had been arrested by Comstock for distributing Family Limitation. And Comstock, who caught a cold in the courtroom during the trial, died soon after of pneumonia.
After her divorce from William, Margaret admitted she was looking for "a widower with money." James Noah Henry Slee, twenty years her senior, was "a well-heeled member of Manhattan's business elite...part of the same establishment Sanger had vilified in her younger, more radical years." They married in 1922 and with his backing, Tone explains,
Sanger embarked on a new chapter of her career, one that distanced the birth control movement from its radical origins and placed it on a more conservative path.... She recognized...that medical science enjoyed increasing prestige and political clout...she sought birth control allies through an ideology that trumpeted women's health over their civil liberties and cast doctors, not patients, as agents of contraceptive choice.
Sanger switched her preference to the diaphragm, particularly the Holland-Rantos brand, which sold exclusively to doctors. (This company, established in 1925, was funded by none other than Mr. Margaret Sanger, James Noah Henry Slee.) Sanger next prevailed on her besotted bridegroom to hire a distinguished, high-salaried doctor to promote their new company:
1925 is to be the big year for the break in birth control...the medical profession will take up the work...I shall feel that I have made my contribution to the cause and...I can withdraw from full-time activity.... If I am able to accomplish this victory...I shall bless my adorable husband, JNH Slee, and retire with him to the garden of love.
Sanger did not retire. In the following years she worked ceaselessly toward her goal of getting the AMA to endorse birth control. Her "signature" story, often bringing audiences to tears, concerned Sadie Sachs, a young immigrant mother of three, married to Jake, a truck driver. When Sadie begged a doctor to give her birth control he cruelly retorted, "Tell Jake to sleep on the roof." Sadie later died of septicemia following a self-induced abortion. Sanger was now in the business of helping the public forget that some of the widely available OTC methods worked very well for many people. As Tone points out, if Sadie could afford a physician visit, she could surely afford the far lower price of a contraceptive.
In addition to the move toward medicalization, our collective memory may have been dealt a brainwashing by panic-driven "eugenicists." As Sanger moved up socially she supported birth control for some elitist reasons, such as "the facilitation of the process of weeding out the unfit [and] of preventing the birth of defectives." But this was mild compared with the phobic reasoning of some of our greatest national leaders, who also feared the newcomers from Europe. Falling birthrates among our native born and the widespread immigration of foreigners from southern and eastern Europe (over 23 million people arrived on America's shores between 1880 and 1920) led Teddy Roosevelt to warn in 1912 that if middle-class American women used fertility control it "means racial death." In 1927 Supreme Court Justice Oliver Wendell Holmes, our great champion of civil liberties, stunned many of his admirers when, in Buck v. Bell, he agreed to uphold a Virginia eugenics statute legalizing the coerced sterilization of "socially inadequate persons." Carrie Buck, the plaintiff, was young, single and white, the "daughter of an imbecile," the mother of an "illegitimate feeble minded child." Holmes agreed to the cutting of Buck's fallopian tubes, proclaiming, "Three generations of imbeciles are enough." Tone adds that during the Nuremberg trials following World War II, accused Nazi war criminals cited Buck v. Bell to justify the forced sterilization of some 2 million Germans.
Here in the United States, the eugenics and population control movements promoted--and continue to promote--the need to develop contraceptives that take prescription (and often removal) out of the woman's hands. For example, in interviews with 686 low-income users of Norplant--a hormonal contraceptive, intended to last for five years, that consists of six matchstick-sized capsules implanted in a woman's arm--researchers at Columbia University's Center for Population and Family Health learned that 40 percent anticipated or experienced "cost barriers" that could impede the removal of Norplant. They urge that family-planning clinics "follow a policy of Norplant removal on demand, regardless of the patient's ability to pay." Some feminists charge that the effectiveness of OTC methods (carefully used) is still downplayed in quasi-official figures, a dangerous public health mistake in this age of galloping STDs.
Meanwhile, the effectiveness of doctor-controlled methods has been exaggerated, as the FDA has acknowledged. Previously, it gave out "ideal" figures for oral-contraceptive effectiveness, in contrast to discouraging clinic "use" figures for barrier methods. In the new round of product labeling this has been partially corrected; actual-use figures for the Pill are placed in a truthful range of 92-95 percent, not at the falsely optimistic 99 percent-plus.
Devices and Desires is replete with riveting histories of women and men who labored--legally and illegally--in the ever-challenging arena of conception control, from the Comstock era through today, and includes portraits of the men who developed Enovid, the first pill, as well as those behind the notorious IUD, the Dalkon shield. Those who read this fascinating book will have a far keener and more credible sense of what has happened and where we are now. Most women are still unsatisfied with their contraceptive choices, and as Tone concludes,
It is ironic that in a post-Roe v. Wade world that celebrates reproductive choice, the most frequently used contraceptive in the country--by a wide-margin--is female sterilization. In a very real sense Americans are still waiting for the heralded "second contraceptive revolution" to arrive.... In the absence of universal health care or prescription drug coverage, one way out of the contraceptive conundrum may be the development of more affordable over-the-counter methods, which would increase men's and women's options without tethering contraceptives to the medical marketplace from which millions are excluded.... Today to meet the needs of women and men who lack sufficient resources, we must supplement reliable medical methods with inexpensive over-the-counter options.
In the 1960s, the introduction of the Pill, revival of the ever-treacherous IUD and "stealth sterilization" of welfare moms--whose tubes were tied, without permission, after giving birth--placed contraception still more firmly in doctors' hands. In the parlance of that decade the "greasy kid stuff," including condoms, was left in the dust. Because of overpopulation fears, the new technologies enjoyed a diplomatic immunity--at women's expense. At an annual meeting of medical school deans, Nobel laureate Dr. Frederick Robbins declared, "The dangers of overpopulation are so great that we may have to use certain techniques of conception control that may entail considerable risk to the individual woman." Original Pills contained 150 micrograms of estrogen; today we know that 20 suffices. Millions of women served as guinea pigs for high-dose pills and IUDs, and thousands died. In 1970, at Senate hearings, Dr. Louis Hellman, chairman of the FDA advisory committee that twice declared the Pill safe, admitted that in his equation of benefit versus risk he "put population first, before benefits to the individual woman's health."
As women demanded to "take our bodies back" from deceitful doctors, the spirit of Comstock rose up again. In 1973 Our Bodies, Ourselves, Ellen Frankfort's Vaginal Politics and my book Free and Female were banned in Cleveland and Washington, DC. In 1979 shipments of cervical caps that independent women's self-help clinics imported from England were seized by FDA agents. Senator Ted Kennedy helped to get the caps released, but the FDA restricted their use to "investigational device" (ludicrous--the same caps had been in continuous use in England for a century), thus subverting the grassroots revival of the cap. Who can say who put the FDA up to this, but perhaps some future Andrea Tone-type women's history sleuth will get to the bottom of it.
Meanwhile, one of my hopes for Tone's extraordinary book is that it might encourage many people--men as well as women--to reconsider the barrier methods, respect them more and possibly learn to enjoy them, as some say they do. In contrast to the steady decline of teenage pregnancy, the epidemic of sexually transmitted diseases in young adults is increasing at a truly alarming rate. For example, estimates are that 46 percent of female college students are now infected with human papilloma virus (HPV), which can cause both genital warts and cervical cancer. Are student health services reliably advising their clients of this? My informants say no.