Author: Desiree Ingram
Texas Women’s Healthcare Coalition
From Pill to Policy: The History of Birth Control Access
Imagine being told that you could not choose if or when to have a child. For many Americans just a few generations ago, that was reality. The history of birth control is a story of science, courage, and people fighting for the right to make private decisions for themselves and their families. Tracing this history, we see when birth control access started, how it expanded over time, and why it remains essential today.
The Comstock Act of 1873
In 1873, Congress passed the Comstock Act, a federal law that labeled birth control and information about it as “obscene.” The law made it illegal to mail, sell, or share contraceptives or any information about preventing pregnancy across state lines. Many states passed similar laws, creating nationwide restrictions that lasted for decades.
The law banned physical products such as condoms, diaphragms, spermicides, and cervical caps. It also banned written materials, including pamphlets, letters, advertisements, and medical textbooks that explained how pregnancy could be prevented.
Enforcement was strict. Doctors could be arrested for giving patients birth control advice. Anthony Comstock, a moral reformer, was given broad authority to enforce the law and aggressively prosecuted people for sharing reproductive health information.
As a result, birth control became difficult or impossible to access. Drugstores stopped selling contraceptives, publishers censored books, and newspapers removed ads related to birth control or abortion. The law effectively criminalized reproductive knowledge and limited people’s ability to make informed decisions about their bodies.
Life Before Legal Birth Control
Because of the Comstock laws, women were denied safe medical care and reliable information. Many were forced to use dangerous or ineffective methods to prevent pregnancy.
Dangerous and Misleading Products
Women often turned to so-called “female medicines,” such as Dr. Peter’s French Renovating Pills or pennyroyal oil. These products were legally sold but often contained toxic substances like mercury, arsenic, or lead. Many women suffered poisoning, organ damage, or death. Others used homemade devices or chemical-soaked sponges, which frequently caused infections and injuries.
Dr. Martel’s French Female Pills advertising booklet, ca 1905, New-York Historical Society Library, Bella C. Landauer Collection.
Douching and False Medical Advice
Douching was widely promoted as birth control, even though it did not work and was harmful. Women were encouraged to use vinegar, disinfectants, or Lysol. Lysol douching products were marketed as “feminine hygiene.” These ads used coded language to avoid legal trouble and played on women’s insecurities, implying that using Lysol would keep them attractive and preserve their marriages. Early formulas contained toxic chemicals that caused burns, infections, poisoning, and even death. By 1911, doctors recorded 193 cases of Lysol poisonings and 5 deaths, though the real number was likely much higher.
Limited Options and Serious Consequences
With accurate information suppressed, many women relied on withdrawal or fertility timing, which often failed. Abstinence was promoted as the only moral option, even though many women could not refuse sex within marriage. When pregnancy occurred, some women sought illegal abortions, which often led to severe bleeding, infection, infertility, or death.
Slow Legal Change and Unequal Access
Doctors who tried to help women access birth control risked arrest. Wealthier women sometimes found private doctors willing to help, but most women had no options.
In 1936, United States v. One Package of Japanese Pessaries allowed doctors to import birth control for medical use, mainly diaphragms. However, public access was still illegal. By the 1950s, laws varied by state. Some states, like Connecticut, banned birth control entirely, even for married couples.
Without reliable birth control, families often grew larger than they could afford, and repeated pregnancies put women’s lives at risk.
The Pill: A Scientific Turning Point
A major shift began in the 1950s. Scientists Gregory Pincus, Min Chueh Chang, and John Rock worked to create a reliable birth control pill. Earlier methods depended on timing or correct use and failed often. The pill was different because it used hormones to prevent ovulation, making it much more effective when taken correctly.
Because birth control was still illegal in many states, researchers used medical loopholes. Hormones could be studied for menstrual regulation or infertility treatment. Activists Margaret Sanger and Katharine Dexter McCormick played key roles, with McCormick funding much of the research.
Around the same time, chemist Russell Marker discovered that a Mexican plant called the barbasco root could be used to create synthetic progesterone. This made large-scale production of the pill possible.
Large clinical trials were conducted in Puerto Rico, where birth control laws were less restrictive. These trials were crucial to development.
In 1957, the FDA approved the pill to treat menstrual disorders, listing pregnancy prevention as a side effect. In 1960, the FDA officially approved the pill for birth control. By 1962, about 1.2 million American women were on the pill. The pill did more than prevent pregnancy, it gave women greater control over their education, careers, and futures. It also paved the way for many modern birth control methods.
Court Decisions and the Right to Privacy
As the pill grew in popularity, the courts began to take on cases and rule in favor of privacy rights, including that personal decisions about preventing pregnancy were a matter of privacy.
- 1965 – Griswold v. Connecticut
At the time, some states still banned married couples from using birth control. The Supreme Court ruled that married couples have a constitutional right to privacy in their personal decisions, including whether to prevent pregnancy. This ruling established the idea of a “right to marital privacy,” which later shaped several important court decisions.
- 1972 – Eisenstadt v. Baird
The Supreme Court extended this right to unmarried adults. The Court ruled that it was unfair to give married people access to birth control but deny it to others. This expanded privacy rights to all individuals, regardless of marital status.
Prior to 1972, many states restricted legal access of birth control to married couples, leaving unmarried individuals with limited and inconsistent options. Some could obtain birth control through private doctors or family planning clinics; however, access depended heavily on location and provider discretion. The inequality ended with this supreme court case.
Federal Support and Broader Access
In 1970, Congress created Title X, the nation’s only federal program specifically designed to provide affordable reproductive healthcare. Title X clinics offer birth control, testing for sexually transmitted infections and treatment, cancer screenings, preconception counseling and more. These clinics remain an important resource for people without insurance and families with low incomes.
In 1977, Carey v. Population Services International ruled that states could not restrict the sale or advertisement of contraceptives. By the mid-1970s, condoms were legal nationwide.
New Birth Control Options
From the 1980s onward, medical advances expanded birth control options and safety:
- 1980s–1990s: Lower-dose birth control pills
- 1991: Norplant, the first long-acting reversible contraceptive (LARC)
- 1992: FDA approval of the birth control shot (Depo-Provera)
- 1997: Prescription emergency contraception approved
- 2000s: FDA approval of patches, rings, implants, and modern IUDs
- 2006–2013: Emergency contraception (Plan B) became fully over-the-counter for adults 18 and older, later fully over-the-counter without age restriction in late 2013.
Insurance Coverage and the Affordable Care Act
In late 2000, the Equal Employment Opportunity Commission ruled that excluding birth control methods from employer-provided health plans violated the Civil Rights Act, laying groundwork for later insurance coverage debates. Several states required birth control coverage in private insurance, but access and cost-sharing varied.
In 2010, the Affordable Care Act (ACA) required most private insurance plans to cover FDA-approved birth control with no out-of-pocket cost. This removed a major financial barrier for millions of women.
Some employers qualify for religious exemptions, which means not all insurance plans provide the same coverage. Still, the ACA greatly expanded birth control access nationwide.
Recent Concerns and State Protections
In 2022, the Supreme Court issued the Dobbs v Jackson Women’s Health Organization decision. This ruling overturned Roe v Wade and ended the federal right to abortion. While this case focused on abortion, one justice wrote a separate opinion suggesting the Court should also reconsider earlier decisions, including Griswold v Connecticut. The other justices did not join that view, but the statement raised concerns that privacy rights could be at risk in the future.
In response, some federal lawmakers introduced the Right to Contraception Act, a bill aiming to protect nationwide access. However, it has not moved, leaving birth control laws to the states.
State Level Policies
As of November 2025, fourteen states and Washington, D.C. have passed strong protections for birth control access: California, Colorado, Florida, Illinois, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Ohio, Oregon, Rhode Island, Vermont, Washington.
Some of these states, including Michigan, Ohio, and Vermont, have gone a step further by amending their state constitutions to protect the right to birth control. Constitutional protections make it harder for future lawmakers to weaken access.
States provide access or protections in different ways, including:
- Requiring insurance companies to cover birth control
- Allowing pharmacists to prescribe certain birth control
- Mandating that health insurance plans provide extended prescription supplies
Lessons from the History of Birth Control
Access to birth control in the United States has changed over time due to scientific advances, court decisions, and public policy. What began as strict legal bans gradually shifted toward broader access, shaped by research, activism, and legal rulings about privacy and equality.
These shifts show that birth control access is not fixed. Laws and policies continue to vary by state, and court decisions can influence who has access and under what conditions. Understanding this context helps explain why birth control remains an important topic in health and public policy discussions today.
Birth control supports health, independence, education, and financial stability for women and families. Both history and today’s evidence show that limiting access to birth control increases health risks and reduces opportunities for women. Ensuring birth control access is essential for the wellbeing of women and our communities.
What’s Next in the Birth Control Blog Series?
In our next post, we’ll take a closer look at birth control itself. We’ll share science-based facts, debunk common myths, and include a video featuring a healthcare professional explaining what you should know about birth control. Stay tuned!
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