Our sentimentalizing of pregnancy, combined with our faith in modern medicine, have contributed to a backlash against birth control, encouraging us to see pregnancy as low risk and to lose sight of its dangers and perils. Contraceptives — and legal access to them — continue to be a source of controversy, political wrangling, and ideological posturing because the political and cultural discussion surrounding them focuses on issues of personal choice and sexual mores rather than questions of health. The recent Supreme Court decision regarding Hobby Lobby reflects this view of birth control as a matter of religious conviction and personal choice rather than reproductive health. If pregnancy is so natural, so low risk for women, then preventing pregnancy is not a medical issue, but rather a personal decision. Even efforts to argue that women use birth control for other health reasons, such as treating PMS or endometriosis, miss the point that limiting, preventing, and spacing pregnancies are medical reasons to use birth control. The backlash against contraceptives stems, in part, from our current misguided view of pregnancy as a low risk medical event for women. The problem with this view is that pregnancy is dangerous, and medical science has a long history of revealing its risks and perils for women.
In fact, women’s ability to control their reproductive rates, directly resulting from access to modern birth control, was a significant victory for women’s health. As our own Jacqueline Antonovich has argued, “Prior to the legalization of birth control and the invention of oral contraceptives, women, especially those of the working class, found themselves perpetually pregnant or nursing, with many dying from the physical hardships of reproduction.” The phrase “perpetually pregnant” aptly describes the reproductive reality of women in a world without access to modern birth control. It describes the world of women for much of human history.
And this world of perpetual pregnancy is not a pretty place. Pregnancy, to put it mildly, is tough on a woman’s body. As Suzanne Sadedin illustrates wonderfully in her recent piece “War in the Womb,” the “ferocious biological struggle between mother and baby belies any sentimental ideas we might have about pregnancy.” Despite these sentimental ideas, she argues, pregnancy actually is a battle for women, with their bodies often unable to withstand this biological war waged by the invader in the womb. Sadedin describes an experiment where mouse embryos were implanted outside of the uterus in mice and the result – “placental cells rampaged through surrounding tissues, slaughtering everything in their path as they hunted for arteries to sate their thirst for nutrients” – reads more like slasher horror than biological science.
Further, this view of pregnancy as physically difficult for women is not new. As Sadedin points out, as far back as the early twentieth century, researchers used terms like “fighting line,” “invading,” “conflict,” and other war-related language to describe the relationship between the female uterus and the developing embryo. But this view of the hostile nature of pregnancy goes back even further. Nineteenth century doctors and researchers presented a view of pregnancy as an unhealthy, and even dangerous, state for women’s bodies. Partly, this was a result of the medical community’s focus on women’s overall health as rooted in her reproductive health. Victorian medical texts viewed the ovaries as “the workshop of generation.” Doctors even viewed female reproductive organs as “the seat of her diseases.” In one particularly revealing statement, Dr. Frederick Hollick, a nineteenth century physician, thought that an enlarged clitoris could “degenerate into gangrene, fungus, or cancer.” Nineteenth century doctors clearly saw reproductive processes as exerting a negative influence on women’s overall health, and if women’s overall health was subject to their reproductive health, then a threat to their reproductive system was viewed as particularly grave.
What’s more, the medical uncertainty in the nineteenth century about the line between abortion and miscarriage raised further questions about the dangers of pregnancy for women. For these physicians, the threat of “blockage,” a malfunctioning of the female reproductive system due to a blockage of the uterine system, loomed over women’s reproductive lives and posed grave health risks. As Simone Caron explains, “Many women and their doctors assumed the abeyance of the menstrual cycle could result from a blockage as much as from pregnancy.” As one physician put it, “the health of the woman depended on the secretion of the womb,” and these blockages “should be corrected whenever any derangement as to quantity or quality may occur.” The logic of this sentiment indicates that any absence of menses could be viewed as a malfunctioning of the female system that necessitated treatment. In other words, doctors viewed pregnancy itself as potentially a threat to the healthful functioning of the female body.
Several historians (most recently in this piece at Slate) have pointed out the coded language of contraceptive advertisements in the nineteenth and twentieth centuries and attributed the use of this code to the desire to avoid prosecution for selling products that at best operated in a legal gray area and at worst were outright illegal. The coded language, then, allowed them to avoid stating explicitly the actual intended use of their products. When that code, though, is deciphered using the medical language of the time, it becomes clear that there is more to this story.
By the 1860’s, advertisements for over twenty-five different chemical abortifacients could be found in newspapers, periodicals, and pharmacies. These products — advertised as “cures” for “obstructed menses” or “interrupted menstruation” — operated rhetorically within the space between abnormal functioning of the female system due to disease, which necessitated medical intervention, usually in the form of a medically-induced miscarriage, and the normal absence of menstruation due to pregnancy. Indeed the popular periodicals of the time featured ads that offered to cure “suppressed menses,” “suppression, irregularity, or retention of the menses,” and “the irregularities, suppressions and obstructions of Nature.” These advertisements helped create a view of pregnancy as an unhealthy and dangerous state for the female body.
Two particular examples come to mind. Dr. Geissner’s Menstrual Pills, for example, illustrated the way that the ads’ focus on “obstructions of Nature” participated in a view of reproductive obstructions as harmful for women, while also promising to “act like a charm … never failing to afford relief, and always successful as a preventative.” In effect, the product claimed to both remove and prevent menstrual obstructions, or to either induce miscarriage or prevent pregnancy in the first place. The Compound Vegetable Systematic Pills also were advertised as “strong cathartic or purgative pills” that acted as a “deobstruent” agent for the female reproductive system. Again, the ads promised to remove these “obstructions of customary evacuations,” of course referencing the evacuation that does occur during a woman’s normal menstrual cycle but does not occur when the female system is obstructed by pregnancy. These ads, and many more like them, made it clear that these “customary evacuations” were a necessary part of the normal, healthy functioning of the female system and that any obstruction posed potential health risks for women. The ads’ coded language allowed women to separate the regulating of the health of their “system” from the regulating of sexual reproduction by relying on a medical view of pregnancy as potentially unhealthy and dangerous for women.
“Maternal deaths remain the second largest killer of women of childbearing age, 99% of which occur in developing countries without reliable access to modern birth control.”
The scientific community, in fact, has not disproved the view of pregnancy as risky for the female body — just the opposite. Reproductive science continues to reveal just how dangerous pregnancy is for women’s bodies, despite the advances that modern medicine has made. According to the CDC, severe maternal morbidity, or severe, life-threatening complications during pregnancy, affects 50,000 women in the United States every year and that rate is actually rising, not falling. In fact, according to some estimates by the CDC, the maternal death rate in the United States has doubled since the 1980s, largely due to factors like an aging population of women undergoing pregnancy, increasing preexisting conditions such as obesity and diabetes, and the increase in cesarian delivery. And while pregnancy certainly is much safer today in developed countries than it was before the introduction of antibiotics and other methods to control infection in the twentieth century, our sense that pregnancy is not a health risk for women, it seems, is misguided. Indeed, maternal deaths remain the second largest killer of women of childbearing age, 99% of which occur in developing countries without reliable access to modern birth control.
As these numbers show, avoiding the physical drain and risks of “perpetual pregnancy” is a health issue. Being able to space pregnancies and decide when to take on these risks is a health issue. Access to birth control is a health issue. Perhaps a return to a medical and cultural focus on the dangers, risks, and complications inherent in pregnancy and a rejection of the cultural sentimentalizing of it as a safe, idyllic period of mother/fetus bonding would help turn the rising tide of political posturing that limits women’s access to birth control. Perhaps more focus on the risks of pregnancy would allow us to see contraceptives for what they are — life-saving medical products for women. Perhaps the creators of those advertisements in the nineteenth century were onto something.
 Matus, Jill L. Unstable Bodies: Victorian Representations of Sexuality and Maternity. Manchester: Manchester University Press, 1995, 32.
 Smith-Rosenberg, Carroll. Disorderly Conduct: Visions of Gender in Victorian America. 1st ed. New York: A.A. Knopf, 1985, 184.
 Hollick, Frederick. Diseases of Woman. New York: Excelsior Publishing House, 1876, 604.
 Caron, Simone M. Who Chooses?: American Reproductive History since 1830. Gainesville: University Press of Florida, 2008, 16.
 Gaston, J.M., “Treatment of Menorrhagia,” The New Hampshire Journal of Medicine 7.8 (1857): 228.
Feature image: “Revisión,” taken on March 11, 2010. Licensed CC BY 2.0 by Daniel Lobo.