When it comes to birth control, modern women are born privileged. After thousands of years of development, we now have relatively safe, reliable ways to prevent unwanted pregnancies. But before such of these modern birth control measures were developed, numerous contraceptive methods have been invented, tired out, developed or weeded out. The history of birth control started with the origin of human civilization. Our ancestors evolved: they stood up on their feet and handled tools, and gradually, they decided to interfere with the natural reproduction process.

In this first chapter we discuss how people controlled pregnancies before the invention of the pill and how this contraceptive game changer originated.

Contraception before the pill

Ancient times

Today's contraceptive methods consist of two types: physical barriers to block the sperm and hormonal methods to kill it. In ancient times, without the understanding of biology and chemistry, and with little technology development, neither proper barriers nor chemical production was available. When looking back at history, multiple untrustworthy or even horrifying-sounding methods were carried out by our ancestors. After figuring out the role of vaginal intercourse in the reproduction process, and after realizing that the presence of sperm is related to pregnancy, ancient Egyptian women applied honey and acacia leaves in their vagina. This form of birth control is the earliest documented physical barrier to avoid conceiving. Sounds nutritious and organic? There is something even more pure and natural. It appears that ancient Egyptians were also using reptile droppings - crocodile dung - as spermicidal material since the excretion is alkaline. Around 2000 BCE in China, women drank mercury in order to prevent pregnancies. It is not certain if they knew mercury can be deadly.

(Source: Paul J. Carrick, Medical Ethics in Ancient World, 2001; "A History of Birth Control Methods", Planned Parenthood Report, 2012.)

Ancient silver coin from Cyrene depicting a stalk of silphium

Bust of Hippocrates (engraving)

Solanum laciniatum Aiton Solanaceae

Ancient Greece and Rome

In ancient Greek and Roman times, they discovered that silphium, a plant usually used for seasoning purposes, had a contraceptive effect. However, how useful it actually was for anti-pregnancy, we cannot know. It was harvested to extinction since it was worth more than its weight in silver. After the disappearance of silphium, one of its relatives called asafoetida was used as a replacement. However, overdosing could be lethal. These examples are not the only ancient methods of birth control. It is documented that in other ancient societies stones or garlic was used to block the vaginal passage. Others chose to apply plugs of grass, cloth or sea sponges.

A little later, in the fourth century BCE, the father of medicine, Hippocrates, however great his legacy is, suggested that women could drink copper salt water to prevent pregnancy. Even though he claimed it was effective for a year, it was still toxic. Just when you thought you have heard the craziest birth control methods by now, there is more. The Greek physician and gynecologist Soranus declared in the second century CE that women should hold their breath during sex and sneeze afterwards to expel the semen. Next to that, he advised women to jump backwards seven times. Unreliable tricks, for instance ejaculation interruption, had been widely used throughout the world as less harmful but also less reliable than other methods.

However, because of the harms, difficulties, and fallibility of these ancient methods, men and women continued trying to find better solutions.

(Source: Paul J. Carrick, Medical Ethics in Ancient World, 2001; "A History of Birth Control Methods", Planned Parenthood Report, 2012.)

The condom & the IUD

Over time, new birth control methods were developed, and new features of existing measures were discovered. In the late fifteenth century, the first syphilis breakout hit Europe. That’s when people started realizing another effect of barrier contraception: stopping the transmission of sexually transmitted diseases. This discovery led to the development of the first condom in 1564, which was a linen sheath tied with a ribbon. Even though the popularity of this method increased, it was primarily used to protect men when they visited brothels. Women were left little choice whether they wanted to use this method or not, since it was necessary to protect the women's well-being. Later, in the early eighteenth century, condoms were sold for a high price in bars, barber shops, chemists and theaters in both Europe and the United States. Still, they continued to develop new versions of this barrier contraceptive method. In 1855 the first rubber condoms were used. The realization that vulcanizing rubber made them more elastic led to the start of the widespread production of condoms. This form of birth control became even more common when latex condoms were developed in the 1920s. This version could lie on the shelf for five years, while earlier versions could only be stored for three months.

Another form of birth control, that is still used today is the Intrauterine Device (IUD), which was developed in the 1920s by Ernst Gräfenberg, a German-Jewish physician. This contraceptive method was suppressed by the Nazi regime because they saw it as a threat to the Aryan race. In 1969, the addition of copper made IUDs over 95% effective. Later, also hormonal IUD's were invented. Both the copper and the hormonal IUD's changed the way sperm cells move, which prevented them from reaching an egg. This form of birth control has a long-term use, and nowadays they are reversible contraceptive implants.

(Source: Paul J. Carrick, Medical Ethics in Ancient World, 2001; "A History of Birth Control Methods", Planned Parenthood Report, 2012.)

Contraceptive sponge, United Kingdom (1901-1930)

Rubber vault cap, London, England (1915-1925)

Condom advertisement (1990-1999), issued by the Seattle-King County Department of Public Health

The cervical cap & the contraceptive sponge

Simultaneous to the invention of the condom, the cervical cap was developed. This object, also called a vault or diaphragm cap, was inserted into the vagina. The early twentieth century rubber cup with the word "Racial" on it, shown below, was modified by Dr. Marie Stopes, one of the pioneers of the contraceptive pill. It was her eugenic belief that selective breeding through the application of contraceptive methods could prevent 'undesirables' from being born. After the founding of Stopes' Mother's Clinic in 1921, sponges were supplied to the facility. The sponge usually contains a mix of liquids that were believed to have a spermicidal effect. It is a tool that was already known in ancient times: physical barriers and applying a mixture of materials that were believed to have spermicidal properties were two forms of birth control that were used since 1875 BCE. Like the cervical cap and the condom, this form of birth control has been reinvented to make it safer than the earlier versions. The sponge was widely used as contraceptive equipment in the early twentieth century. Next to that, the contraceptive tampon was also a popular method, which functioned in a similar way and was also supplied by Stopes' Clinic.

(Source: Paul J. Carrick, Medical Ethics in Ancient World, 2001; "A History of Birth Control Methods", Planned Parenthood Report, 2012.)

The birth control pill

Origin of the Pill

In the 1870s, the early feminist movement began to ague for 'voluntary motherhood', which indicated women’s right to enjoy sex independently from making the decision whether they want children or not. Even though birth control existed long before the twentieth century, as explained above, the term 'birth control' has only been popularized since 1916. It was pioneer figure Margaret Sanger who played an important role in that process. In the 1950s, it was Sanger who managed to push the research on the effects of progesterone at preventing ovulation together with pioneer Katharine Dexter McCormick and with the effort of physiologists and gynecologists like Gregory Pincus, Min Chueh Chang, and John Rock. They discovered that progestin is also effective, which led to the start of scientific experiments on combining progesterone and progestins as oral contraceptives later that decade. The first trial of Enovid began in April 1956. Four years later, it became the first birth control pill purchasable in the United States. Within a few years, millions of American women were 'on the pill'. The popularity of the pill created a new market for pharmaceutical companies. For the first time, healthy women would be taking medication for an extended period of time.

(Source: James Reed, The Birth Control Movement and American Society: From Private Vice to Public Virtue, 1984.)

Bottle of 'Enovid' contraceptive pills, United Kingdom (1960-1965), made by G D Searle and Company, prepared by G D Searle and Company Limited

Picture 1: Pill Dispenser Prototype (1962), made by David P. Wagner

Picture 2: DialPak Pill Dispenser (1963), made by Ortho Pharmaceutical Corporation

Original drawing of dispenser (1962), made by David P. Wagner

The Pill Dispenser

In 1960 the Food and Drug Administration approved the first oral contraceptive pill. In 1961, David and Doris Wagner were a middle-aged couple with four kids. They didn’t want more children, so they were thrilled to learn about the pill. Doris got a prescription, and the pills came in a big glass bottle. The instructions said to begin the pill on the fifth day of her period, to take one pill every day for twenty days followed by a five-day break for menstruation. If Doris lost track of her cycle, or if she forgot whether or not she had taken her pill that day, she was instructed to pour all the pills out of the bottle, count how many pills were left, subtract that by the original number of pills, and consult a calendar. If Doris missed a pill, she risked getting pregnant again which made both Doris and husband David very nervous.

David Wagner, an engineer, was used to solving mechanical problems. He figured he could create a packaging system that would make the dispensing process easier. First, he created a simple calendar on a piece of paper and placed each pill on the correct day. That worked pretty well, until the inevitable accident, when the pills were scattered and fell to the floor. What David Wagner came up with next is very similar to what is still used today as it also marked a considerable pivotal moment in the pharmaceutical industry. Before birth control came into existence, only old or sick people had to use of pharmaceutical drugs. The contraceptive pill was one of the first prescriptions intended to be taken by healthy citizens. Therefore, pharmaceutical companies required a packaging design that resembled an ordinary everyday object, and not a pharmaceutical medicine: this was Wagner’s disc, with bright colors and graphics. Not only did it constitute a 'memory aid' to assist women in tracking their daily pill regimen, but also allowed the pill to be placed in styled cases and to be discreetly carried in female bags and purses. Most American pharmaceutical companies that sold birth control pills adopted his idea.

(Source: "Wagner Pill Dispenser Patent Model", National Museum of American History; "On The Pill", National Museum of American History.)

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