There are few things in America as universal as contraception. More than 99% of reproductive age women—and by extension, their partners—have used it at some point in their lives, to prevent pregnancy and for a whole range of other health reasons. This is true across religion, geography, age, and sexual orientation or gender identity. If measured by our behavior, contraception is something that we as a country have long agreed is an important and routine part of how we live our lives.

As a social scientist who has spent the past two decades studying how and why people use contraception, my work has been defined by a distinct tension. Slowly and methodically, more contraceptives—designed for more people with various needs and preferences—have become available. But as access to new methods has expanded, so too have the attacks on contraception and related health care. While these attacks are longstanding, today they feel more overt: I’m concerned that contraceptive access in the United States is on a precarious path.

Given the ubiquity with which Americans use contraception, these attacks seem paradoxical. But they are part of a much broader political strategy to limit bodily autonomy.

One consistent theme in my research is that federal and state restrictions that ostensibly target abortion have impacts far beyond abortion access. You cannot seek to restrict or regulate one aspect of sexual and reproductive health without tightening other types of care and people’s overarching reproductive freedoms. This reflects the realities of how people live their lives: It is impossible to silo one aspect of our health from our overall well-being.

The most popular methods of contraception in the U.S. among reproductive-aged women are permanent sterilization (“getting your tubes tied”), the birth control pill, condoms, and intrauterine devices, or IUDs. (While data collection often focuses on contraceptive users who identify as women—including most of the studies referred to in this piece—many users who are not women also rely on contraception.) At the same time, about one-fourth of current and prospective contraceptive users say they would rather be using another (or any) method of contraception. In other words, we know there is often a gap between the contraceptive methods people are using and the methods they wish they could be using. Abortion restrictions, and their numerous ripple effects, may be widening that gap.

When the Supreme Court overturned Roe v. Wade in the Dobbs v. Jackson Women’s Health Organization decision in 2022, there was a direct and immediate impact on abortion access.

Two years later, there’s a growing body of evidence documenting Dobbs’ far-reaching consequences on the delivery of other types of sexual and reproductive health care as well. Patients report lower quality contraceptive care following the decision, meaning their conversations with providers are less likely to specifically address their needs. They’re also having trouble accessing the methods that they want to use, due to insufficient clinic availability and cost, among other barriers. Meanwhile, providers in states with and without abortion bans report increases in patients seeking contraceptive care, and there are documented increases in people receiving long-acting reversible contraceptives, like IUDs and implants, as well as permanent methods of contraception, including vasectomies and tubal ligation. What we still don’t know is whether these changes reflect people’s true preferences or whether they represent constrained choices being made in an environment in which people recognize that their reproductive freedoms are threatened. 

The strategy behind those threats is one we’ve seen before; it mirrors the strategy used by the anti-abortion movement, which chipped away at abortion access piece by piece. These are both part of a campaign targeting bodily autonomy more generally, which includes access to gender affirming and infertility care.

Following the anti-abortion playbook, the campaign against contraception is intentionally aimed at restricting access for certain communities and methods. At the beginning of the summer, there were eight bills proposed in six states that would have limited young people’s access to contraception through requirements around parental consent; while most didn’t make it out of legislatures this year, in Texas and Tennessee, such laws are now in place. Some states are already reducing coverage for contraceptives through public programs like Medicaid, which provide insurance to many people with low incomes. And in states including Oklahoma and Indiana, bills reflect language falsely claiming methods like emergency contraception and IUDs facilitate abortions, despite clear scientific evidence that these methods prevent pregnancy, rather than terminate it. Lawmakers in these and other states are leveraging language in ongoing abortion bans to attempt to restrict these contraceptives.

Each of these individual attacks perpetuates and exacerbates longstanding inequities in who can access their desired contraception and whose reproduction—and health—American society values. In a recent study, we found that young people, sexual and gender minorities, people born outside the U.S., and lower income people were less likely to be using their preferred method of contraception post-Dobbs as compared to their less marginalized counterparts.

We also know that the way people are accessing sexual and reproductive health care is changing dramatically, from clicking through an app on their phones to select their contraception via telehealth to being able to purchase the first-ever over-the-counter birth control pill. But research tracking these changes—which delves into the most intimate aspects of people’s lives—is becoming increasingly challenging to conduct. People understandably worry about how their information is used and who has access to it, concerned that data related to pregnancy and menstruation could be used against them. This could be a harbinger of poorer quality data that, at best, capture only a narrow slice of the population, and, at worst, inaccurately represent people’s lived experiences.

There is no one best method of birth control or one best avenue for getting it. The more options we have and the more ways people have to access them, the closer we’ll get to closing the gap between the contraceptives people are using and those they want to be using. Systems-level solutions—like making sure that all forms of contraception are covered via public and private insurance plans and increasing funding to sexual and reproductive health care programs that center patients’ needs and perspectives—must be a key focus of efforts to close that gap.

Those efforts must also recognize that a threat to one aspect of sexual and reproductive health care is a threat to our entire ability to have autonomy over our bodies and to live the lives that we each desire. As a country, we’ve long shown that using contraception is routine, important, and ubiquitous. But it’s not enough for contraceptive use to be nearly universal. Contraceptive access—to whatever method desired—should be, too.

The post Is Birth Control Under Attack? appeared first on Zócalo Public Square.

I was a virgin on my wedding night. This is neither a confession nor a brag, simply a statement of fact. It was expected. The year was 1950. Horror stories of how giving birth “out of wedlock” would ruin one’s life were common. They were told by mothers, grandmothers, and aunts to keep you on the straight and narrow.

No one in my home talked about contraception; I’m sure I wouldn’t have known what the word meant if I had heard it. That is, until I told my parents I was getting married. My boyfriend and I were juniors in college when we decided it’d be a great idea to marry during Christmas break (even though we both had term papers to write). My parents were not pleased. To be more accurate, they were terrified. Their first question: “What if you get pregnant?”

That had not entered my mind. While my parents spent the rest of the evening bombarding my future husband and me with practical questions about money, housing, and school, the last question was the same as the first: “What if you get pregnant?”

We were all emotionally drained by then, and the evening ended with nothing resolved. We reiterated that we didn’t need my parents’ permission to get married, but we wanted their blessing. Mother went to bed in tears.

The next day my mother decided the two of us needed to have a serious conversation about my plans to finish school. Naturally, I would finish; my boyfriend and I both planned to finish our B.A.s, I would start teaching, and he would go on to graduate school for his M.F.A and Ph.D. That’s when she brought up the word “pregnant” again. She asked how I was going to avoid it.

I became extremely uncomfortable. We had never really talked about sex before. She told me there were three available ways of avoiding pregnancy: abstinence, condoms for men, and diaphragms for women. The only foolproof choice was abstinence, and if I was getting married, that was no longer an option. Mother made an appointment for me with her doctor to talk about getting a diaphragm.

On the day of my doctor’s visit, my boyfriend made a scene. I didn’t understand why he was so upset until he spelled it out for me. (Once again, I remind the reader that the year was 1950. My future husband was as much a product of the time as I was.) He didn’t want the doctor to be the first to penetrate my vagina. As it turned out, the doctor told me he couldn’t fit me with a diaphragm until I had been married for about six months, because I was so small. For the first time in my life I worried about getting pregnant. The doctor recommended a spermicidal lubricant and said it was the best he could do before I was married. He recommended condoms for my boyfriend.

My husband nixed the idea of condom use. He had been issued condoms while in the army during World War II (as were all military personnel), and he found his limited experience with them unsatisfactory. So, five months after I was married, I went back to the doctor (not pregnant) and got my diaphragm. It was a cervical barrier made of soft latex or silicone, shaped into a dome with a spring molded into the rim. The spring was meant to create a seal against the walls of the vagina. The doctor explained that the diaphragm was invented in 1916 in Europe. Margaret Sanger, an American birth control advocate, discovered diaphragms in the Netherlands and illegally imported them into the U.S. By 1940, after diaphragms became legal, one-third of married women were using the device. But it was–and is–not a 100-percent-reliable anti-pregnancy tool, and it can cause urinary tract infections.

By the 1960s the intrauterine device (IUD) and the oral contraceptive pill were in use, and, by the 1970s, the diaphragm was obsolete. It hadn’t been convenient for me, and I did occasionally have painful urinary tract infections, but it worked. I never became pregnant. I was grateful it was available during the lean years we went through.

I was a high school teacher and principal from the 1960s to the 1990s and saw attitudes concerning sex change a lot among the young. In many ways, I was glad to see this. I wish I hadn’t been a virgin on my wedding night. I don’t think the lack of experience and choice that I came of age with was a good thing. But even as the young saw more and more about sex all over–on TV commercials, in everyday conversation–they also seemed to place less and less importance on it.

Also, to my amazement, many of my students, despite being sexually active, knew almost as little as I did in 1950. One former student showed up at school to show us her new baby. She’d married another former student who was now in the service. I told her I thought they were planning to wait several years before having children. “I don’t know what happened,” she said. “I wouldn’t let him near me when I was having my period.” Another student came to my office to tell me she was pregnant and that she and her boyfriend wanted to keep the baby. I asked if they were planning to get married. “Oh no,” she said. “I’m not old enough to get married!” Part of the problem has been a kind of manufactured ignorance: no one wants to be labeled a slut or a dude who just wants to brag about numbers. If you don’t have a steady boyfriend and you’re on the pill, what does that make you? If you’re a guy who carries condoms around all the time, what does that tell a “nice” girl about you? Drug and alcohol use also contributes to the problem.

When I was in charge of the teen mothers program for the school district, we always had dozens of pregnant teens enrolled. Even in this time of contraceptive choices, they kept showing up. Condoms can rip, withdrawal before ejaculation may not be quick enough, a girl can forget to take her pill, a friend with a cute baby may be getting a lot of attention, or mama may miss having a baby around the house. Many of the girls also admitted that they just wanted to please their boyfriends.

But the good news is that the teen mothers program no longer exists in the school district. In 2010, teenage pregnancy rates dropped to an all-time low: there were fewer teenage mothers in 2010 than in any year since 1946, around when I was finishing high school. Our teenagers are getting better at taking care of themselves, and (provided some politicians don’t take us back 50 years) they’re using contraception properly. Women of all ages have gained a kind of independence since 1950. We’re finally figuring out how to use it.

The post How I Had Sex in 1950 appeared first on Zócalo Public Square.