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Birth control is a fundamental human need, and historical evidence agrees.

Modern forms of birth control — latex condoms, IUDs, birth control pills — are still very new, in the context of overall human history. Records of ancient Greek and Egyptian birth control methods suggest that control over reproduction has been a concern for, well, pretty much as long as humans have been reproducing.

Early birth control methods from around the world included:

  • condoms (external and internal) made of animal bladders, linen, silk, or plants
  • spermicides made of acacia, honey, rock salt, or crocodile dung
  • sponges made of moss, grass, or bamboo
  • vaginal douches or sponges soaked in oil, vinegar, lemon juice, or cedar oil — substances believed to slow or weaken sperm
  • oral contraceptives, including Queen Anne’s lace seeds, lead and other toxic metals, pomegranate seeds, silphium, unripe papaya, and blue cohosh

And, of course, withdrawal — or pulling out — has long been a popular approach to birth control. “Coitus interruptus,” or withdrawal followed by ejaculation, dates back to the Bible (though the spilling of seed was considered a sin rather than a method of birth control).

Some of these methods were successful. Others came with dangerous side effects, including infection and poisoning. Similarities between Queen Anne’s lace and toxic plants, like hemlock, for example, likely led to many accidental deaths.

Fortunately, plenty of options for safe and effective birth control exist today. (Good crocodile dung is so hard to come by, after all.) Here’s a look at how those methods evolved in the United States.

Long before any European settlers arrived, Indigenous Americans used various herbs for contraceptives, including:

  • black cohosh
  • blue cohosh
  • thistles
  • stoneseed
  • false hellebore
  • Indian paintbrush

Some records also suggest many Indigenous nations practiced extended nursing to reduce the chances of pregnancy.

Many Indigenous Americans also had enough awareness of their own fertility cycles that they could often tell, based on the appearance of vaginal discharge, when they were most and least likely to become pregnant.

They shared contraceptive methods with the settlers, broadening their knowledge of family planning and making it easier to prevent unwanted pregnancies.

Herbal contraceptives, and other types of birth control, were widely banned in Europe. So European contraceptive knowledge was, in many cases, limited to the use of charms and amulets, along with practices, like outercourse and bundling.

What’s bundling?

Couples in the early 18th century often had to travel quite a distance to spend time together.

It wasn’t always possible to visit your beloved and make it back home in a single day. So, at bedtime, you might be “bundled” together — put to bed fully clothed, separated by a board, or even sewn into a sack.

Needless to say, this wasn’t the most effective method of birth control. Plenty of determined young adults unbundled themselves into a more intimate embrace, and religious leaders eventually discouraged bundling entirely.

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For early settlers, contraceptives didn’t just offer the benefit of controlling family size — though this was absolutely an important concern, since a large family could easily strain limited resources and lead to poverty.

Becoming pregnant on a yearly basis was fairly common, and the exhaustion of back-to-back pregnancies had serious health complications for many. What’s more, maternal death was such an accepted outcome of childbirth that many people greatly feared becoming pregnant.

Enslaved people also brought a wealth of herbal knowledge to America, including remedies to prevent and terminate pregnancy.

Research suggests enslaved people in the American South used contraceptives, like cotton root and alum water, for two key reasons:

  • to deny those who enslaved them the chance to profit off their children
  • to avoid the grief and pain of having a child that their enslavers could later sell to other enslavers

Existing records of folk medicine traditions suggest enslaved women likely shared contraceptive information with the wives and daughters of enslavers. Eventually, African herbal lore was combined with the knowledge gained from Indigenous peoples to create a more comprehensive approach to birth control.

Some birth control methods used today, like condoms and diaphragms, were developed and used widely (though somewhat secretly) before the 1900s. Latex condoms, however, weren’t introduced until the 1920s.

Margaret Sanger, who founded the first American birth control clinic in 1916, propelled the research that led to the creation of the pill, one of the most popular modern contraceptives.

The progestin needed for the pills came from another source, however. In the 1940s, chemistry professor Russell Marker realized Mexican women had used the wild yam cabeza de negro to prevent pregnancy for generations.

Extracting plant-based progesterone from the yams allowed Marker to create the synthetic version, progestin, which made production of the pill possible.

The success of oral contraceptives eventually led to the development of other modern hormonal birth control methods.

Here’s a brief timeline:

  • Mid-1950s: Clinical trials on the pill begin. Researchers conclude the pill successfully prevents ovulation.
  • 1957: The U.S. Food and Drug Administration (FDA) approves Enovid, the first birth control pill, with a catch — it’s only approved to treat severe or painful periods. The label warns that taking the pill will have a contraceptive effect. Unsurprisingly, more and more women begin to report menstruation problems and request a prescription for the pill.
  • 1960: The FDA approves the pill for the purposes of birth control.
  • 1964: The Lippes Loop enters the market as the first IUD available in the United States.
  • 1967: Worldwide, almost 13 million people used the pill by this point, according to Planned Parenthood. Multiple brands begin to enter the market. The Depo-Provera shot becomes available, but the FDA denies approval.
  • 1970s: The introduction of fiberoptic technology allows for safer medical procedures and shorter recovery times, prompting many to consider tubal ligation as a permanent form of birth control.
  • 1988: ParaGard, the copper IUD, becomes available in the United States.
  • 1991: The FDA approves Norplant, the birth control implant, for U.S. use. (The World Health Organization approved it in 1984). Unlike Nexplanon, the single implant you’d likely receive today, the first long-term contraceptive consisted of six small silicone capsules.
  • 1992: The FDA approves Depo-Provera for U.S. use.
  • 1998: The FDA approves Preven, the first emergency contraception widely available in the United States.
  • 1999: The FDA approves Plan B for emergency contraception.
  • 2000: Mirena, the first hormonal IUD, becomes available in the United States.
  • 2001: NuvaRing, a ring-shaped contraceptive placed in the vagina, receives FDA approval.
  • 2002: The FDA approves Ortho Evra, the first birth control patch.
  • 2006: The FDA approves Implanon, a birth control implant.
  • 2010: The FDA approves a new type of emergency contraceptive, ulipristal acetate. It’s now sold as ella in the United States.
  • 2010: Nexplanon replaces Implanon as the single-rod implant prescribed in the United States.

Federal and state restrictions have long complicated access to contraceptive knowledge in the United States.

The Comstock Act, an anti-obscenity law, prevented both the sale of contraceptives and all sharing of contraceptive information until 1936.

Sanger’s first birth control clinic was shut down almost immediately after she opened it in 1916, and it wasn’t until 1923 when she was able to open a clinic legally. Even then, she agreed to only distribute contraceptives for medical reasons.

Well into the 1900s, abstinence was considered the only true method of birth control. Yet some couldn’t even safely choose abstinence, as marital rape wasn’t recognized as a crime in every state until 1993.

Once the pill was introduced, plenty of opposition surfaced. Some criticism focused on the potential for side effects, a legitimate concern since the first pill contained high doses of hormones. (While many people taking birth control pills today experience some mild side effects, the pill is widely considered safe for general use.)

But much of the opposition related to the pill’s true purpose: preventing pregnancy.

Religious leaders, including Pope Paul VI, criticized and condemned the artificial manipulation of conception, along with female sexuality.

Many people still believed women should stay home and raise children. The pill, however, allowed them to subvert this biological “destiny” and take charge of their futures for themselves — while still enjoying a healthy sex life.

The turning point

Birth control remained illegal in many states until the second half of the 20th century. Two key Supreme Court cases helped change that:

  • In 1965, the landmark case Griswold v. Connecticut recognized a married couple’s right to privacy. Consequently, state laws banning contraceptive use by married couples became unconstitutional.
  • In 1972, this ruling was extended in Eisenstadt v. Baird, granting single people that same right to privacy.
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Continued challenges to birth control

Though birth control is entirely legal and widely available in the United States today, barriers to access — including the need for a prescription — still remain.

The Affordable Care Act, passed in 2010 by the Obama administration, required health insurance companies to include birth control coverage at no cost, as a form of preventive healthcare.

The Trump administration, however, passed legislation allowing employers to deny birth control coverage on religious or moral grounds. Consequently, anyone who couldn’t pay out-of-pocket costs could lose access to birth control.

As of May 2021, 29 states and the District of Columbia require insurers to cover prescriptions for birth control. Only 8 of these states, however, prevent employers and insurers from refusing to cover birth control. The others allow some exceptions.

In other words, insurance-covered access to birth control is only guaranteed in 8 states.

Insurance plans don’t always cover emergency contraception, either. This puts after-the-fact contraception out of reach if you can’t afford to purchase it yourself.

Even if your insurance does cover emergency contraception, you usually have to get a prescription from a healthcare professional. Of course, since you need to take emergency contraception as soon as possible after sex without birth control, it’s not always possible to get an appointment in time.

What’s more, some schools across the country continue to teach abstinence-only sex education, preventing students from learning about birth control options.

If you’re able to become pregnant, you probably value birth control as a voluntary approach to managing your reproductive health and choosing pregnancy on your own terms.

Birth control does offer this freedom, true. Yet there’s also a darker side to modern birth control that not everyone recognizes.

Birth control and eugenics

Sanger’s connection to the eugenics movement can’t be denied.

Historians disagree on whether Sanger allied with eugenicists simply to further her own goals of advancing birth control or because she truly wanted to lower birth rates among Black families and others deemed “unfit” to procreate.

Some experts believe she simply wanted to reduce the number of babies born into poverty or to parents who didn’t want children. Still, the fact remains that she did ally with eugenicists, who believed, among other things, that only white, financially stable people should be allowed to have children.

In the late 1960s, the National Association for the Advancement of Colored People (NAACP) pointed out that the number of Planned Parenthood clinics in lower income and Black neighborhoods had a sinister purpose: lowering the number of Black children born.

These concerns stemmed from a long history of exploiting the reproductive rights of Black women:

  • Many enslaved Black women were forced to undergo experimental medical procedures, including reproductive surgeries.
  • Eugenics programs sterilized many Black women, often without their knowledge or consent, into the 1970s. When doctors did inform them of the nature of the procedure, they often threatened to withhold benefits, such as healthcare or public assistance, unless they agreed to sterilization.
  • Teaching hospitals often exploited Black women by allowing medical students to perform unneeded and unwanted hysterectomies for “practice.”
  • Even today, healthcare professionals are more likely to encourage Black women, especially those with lower incomes, to have fewer children or use long-term contraceptives, such as IUDs.

Norplant coercion

The American Civil Liberties Union (NCLU) also reports attempts to require women to use Norplant, the contraceptive implant:

  • after being convicted of certain offenses, such as substance use while pregnant
  • if they receive public assistance benefits

By and large, these policies target women of color and families with lower incomes.

Forced sterilization of Indigenous women

In another example of the abuse of birth control, many Indigenous women were subject to forced sterilization.

In the ’60s and ’70s, the Indian Health Service sterilized as many as 1 in 4 Indigenous women without their consent. By 1976, up to half of all Indigenous women in the United States had potentially been sterilized.

Many of them weren’t told about the procedure. Instead, they believed they were receiving appendectomies, tonsillectomies, or another necessary medical treatment. Those who received some information were often told they could eventually reverse the procedure.

Forced sterilization today

You might feel somewhat comforted to think these atrocities lie in the past. Forced sterilization doesn’t happen today, right?

Wrong. As recently as 2020, a nurse at an ICE detention center reported that several women detained there had received hysterectomies and other medically unnecessary procedures.

Not only were they misled or misinformed about the type of surgery they were having, but many were also told that, if they didn’t agree to the procedure, they wouldn’t receive medical care in the future.

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Birth control allows you to protect your bodily autonomy and your choice to have sex without the possibility of pregnancy. Present-day options for birth control are both safe and widely available, but not everyone has the access they deserve.

Becoming a parent earlier than planned, or having more children than intended, can create life challenges and strain financial resources. Pregnancy itself can involve any number of health complications, including death.

Continued, affordable access to contraception is essential for lifelong health and wellness.

Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.