On June 7, 1965, the U.S. Supreme Court, in Griswold v. Connecticut, struck down state laws that had made the use of birth control by married couples illegal. The court's landmark decision coming five years after oral contraceptives became available to American women and 49 years after Margaret Sanger opened the first birth control clinic in the U.S. legalized the use of birth control and paved the way for the nearly unanimous acceptance of contraception that now exists in this country.
The court's recognition of individuals' right to privacy in deciding when and whether to have a child in Griswold became the basis for later reproductive rights decisions. In Eisenstadt v. Baird (1972), the court granted unmarried couples access to contraception, and in Roe v. Wade (1973), the court recognized a woman's right to choose abortion. While challenges remain in the struggle to provide universal access to birth control, the court's 1965 decision in Griswold granted constitutional protection to the life-enhancing work of Planned Parenthood and other advocates of reproductive freedom in the U.S.
In the 35 years since birth control for married couples was legalized in the U.S., profound and beneficial social changes occurred, in large part because of women's relatively new freedom to control their fertility maternal and infant health have improved dramatically, the infant death rate has plummeted, and women have been able to fulfill increasingly diverse educational, social, political, and professional aspirations.
The ability to plan and space pregnancies has contributed to improved maternal, infant, and family health.
Since 1965, there has been a dramatic decline in unwanted births, the result of pregnancies that women wanted neither at the time they were conceived nor at any future time. This decline is particularly welcome because unwanted births are associated with delayed access to prenatal care and increased child abuse and neglect (Piccinino, 1994; Committee on Unintended Pregnancy, 1995).
By enabling women to control their fertility, access to contraception broadens their ability to make other choices about their lives, including those related to education and employment.
Since 1965, the number of women in the U.S. labor force more than doubled, and women's income now constitutes a growing proportion of family income.
Publicly funded contraception programs have increased the ability of lower-income women to exercise the right to control their fertility.
The reduction in unwanted births since 1965 is largely a result of Americans' shift to the more effective contraceptive methods that have become available.
Investing in family planning is cost-effective.
One recent study that measured the cost of contraceptive methods compared to the cost of unintended pregnancies when no contraception was used found that the total savings to the health care system falls between $9,000 and $14,000 per woman over five years of contraceptive use (Trussell et al., 1995).
In the last 35 years it has become clear that making good reproductive decisions does not rest on the legalization of birth control alone in order to make responsible choices for themselves women and men need access to sexual and reproductive health information and services.
Despite the overall reduction in unwanted pregnancy during the last decades, American women still experience some 3 million unintended pregnancies each year 49 percent of all pregnancies.
More than half of unintended pregnancies that do not end in miscarriage or stillbirth are terminated by induced abortion (Henshaw, 1998).
Unintended pregnancy is associated with a number of serious public health consequences, including delayed access to prenatal care, increased likelihood of alcohol and tobacco use during pregnancy, low birth weight, and child abuse and neglect (Committee on Unintended Pregnancy, 1995).
Cost is a major barrier against access to contraception.
Even though birth control is basic to women's health care, many insurance plans do not cover the full range of contraceptive choices, and while funding for contraception for poor women is provided through Title X and Medicaid, funding has not kept up with demand.
Improved contraceptive use has contributed to the declining U.S. teenage pregnancy rate, though it remains the highest in the developed world.
Although the rate of teenage pregnancy in the United States has been declining, it remains the highest in the developed world. Approximately one million American teenagers about 97 per 1,000 women aged 15-19 become pregnant each year. The majority of these pregnancies 78 percent are unintended (AGI, 1999).
Studies have confirmed that the results of teenage parenting are often discouraging for both mother and child.
Teenage pregnancy poses a substantial financial burden to society, estimated at $7 billion annually in lost tax revenues, public assistance, child health care, foster care, and involvement with the criminal justice system (Annie E. Casey Foundation, 1998).
During the last 35 years, women in the U.S. have seen the number of available contraceptive options fall behind those that are available in other countries.
The two most popular methods of reversible contraception among married women in 1965 the Pill and the condom remain the two most popular reversible methods today (Piccinino & Mosher, 1998; Ryder & Westoff, 1971).
Two methods approved in the past decade are Norplantฎ, a subdermal contraceptive implant that lasts for up to five years, and Depo-Proveraฎ, an injectable contraceptive that lasts for 12 weeks. Yet when Norplant was approved by the FDA in 1990, it had already been in use in many countries for nearly a decade (Boonstra et al., 2000). Depo-Provera, which was approved for use in the U.S. in 1992, had already been used by more than 30 million women in 90 countries for over 30 years (Connell, 1994).
Emergency contraception, which can prevent pregnancy after unprotected intercourse, has been available to women for more than 25 years. However, it was not until 1998 that the first dedicated emergency contraceptive pill was approved by the U.S. Food and Drug Administration. Widespread use of emergency contraception could prevent an estimated 1.7 million unintended pregnancies and 800,000 abortions each year (Glasier & Baird, 1998; Van Look & Stewart, 1998).
The continuing lack of sufficient options for reversible contraception has led many women to rely on perm-anent methods. Sterilization is the contraceptive choice of more than one-third (39 percent) of all couples. Among women 30-34 years of age, sterilization is also used more than any other method of contraception. Even women 25-29 years of age 17 percent rely upon permanent methods (Piccinino & Mosher, 1998).
For many women and couples, sterilization is not the ideal method of contraception, but it may be the best option available to them. In fact, a 1988 study funded by the National Institutes of Health showed that 30 percent of the low-income women who intended to be sterilized did not understand that the procedure would make it impossible for them to have more children (Cushman et al., 1988). The development of further options for reversible methods of contraception would offer many people more desirable alternatives to permanent, surgical methods.
The Institute of Medicine's Committee on Contraceptive Research and Development recently recommended "that, to make a full range of contraceptive products accessible to consumers and to increase demand for contraceptive products to something closer to the level of unmet need, there should be continued and sufficient government support of contraceptive services. . . . The committee also recommends that third-party payers, who bear the costs and may reap the benefits of the health status of their covered populations, include contraception as a covered service. Ideally, family planning services and the management of sexual health would be integrated as components of comprehensive reproductive health services (Institute of Medicine, 1996)."
Women and men no longer need to abstain from sex for fear of having more children than they can afford or in terror of endangering a woman's health with a high-risk pregnancy. In 1965, 35 percent of married women in the U.S. used a safe and effective method of family planning. Only one out of 10 women in the developing world did so. Today more than 50 percent of couples worldwide rely on modern methods of birth control to maintain the health and well-being of their families (Ryder & Westoff, 1971; Robey, 1994).
We have come a long way - but we have a lot farther to go. Although great advances in contraceptive technology have been made in the last half of the 20th century, there is pressing need for a much wider range of birth control options. No single method can work for everybody - women and men's economic circumstances, health needs, lifestyles, and personal preferences are highly individual. To fill those individual needs, more safe and effective contraception options are needed.
Abma, Joyce C., et al. (1997). "Fertility, Family Planning, and Women's Health: New Data From the 1995 National Survey of Family Growth." Vital and Health Statistics, 23(19).
AGI - Alan Guttmacher Institute. (1994). Uneven and Unequal: Insurance Coverage of Reproductive Health Services. New York: Alan Guttmacher Institute.
_____. (1999, accessed 1999, October 5). Facts in Brief: Teen Sex and Pregnancy [Online]. http://www.agi-usa.org/pubs/fb_teen_sex.html.
Annie E. Casey Foundation. (1998). When Teens Have Sex: Issues and Trends. Baltimore, MD: Annie E. Casey Foundation.
Boonstra, Heather, et al. (2000). "The 'Boom and Bust Phenomenon': The Hopes, Dreams, and Broken Promises of the Contraceptive Revolution." Contraception, 61(January), 9-25.
Committee on Unintended Pregnancy. Institute of Medicine, National Academy of Sciences. (1995). The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC:, National Academy Press.
Connell, Elizabeth B. (1994). "Depot Medroxyprogesterone Acetate: Clinical Experience in the United States." The Female Patient, 19(10), 91-92+.
Cushman, Linda F., et al. (1988). "Beliefs about Contraceptive Sterilization Among Low-Income Urban Women." Family Planning Perspectives, 20(5), 218-221; 233.
Dailard, Cynthia. (1999). "Title X Family Planning Clinics Confront Escalating Costs, Increasing Needs." Guttmacher Report on Public Policy, 2(2), 1-2, 14.
_____. (1999a). "U.S. Policy Can Reduce Cost Barriers to Contraception."" Issues in Brief, 1999 series, no. 2.
Eisenstadt v. Baird. (1972). 405 U.S. 438.
Glasier, Anna & David Baird. (1998). "The Effects of Self-Administering Emergency Contraception." The New England Journal of Medicine, 339(1), 1-4.
Griswold v. Connecticut. (1965). 381 U.S. 479.
Henshaw, Stanley K. (1998). "Unintended Pregnancy in the United States." Family Planning Perspectives, 30(January/February), 24-29; 46.
_____. (1999, accessed August 20). Special Report: U.S. Teen Pregnancy Statistics: With Comparative Statistics for Women Aged 20-24 [Online]. http://www.agi-usa.org/pubs/teen_preg_sr_0699.html.
Institute of Medicine. (1996). Contraceptive Research and Development: Looking to the Future. Washington, DC: National Academy Press.
Lewin, Tamar. (1995, May 11). "Women Are Becoming Equal Providers."" The New York Times, p. A27.
Luker, Kristin. (1996). Dubious Conceptions: The Politics of Teenage Pregnancy. Cambridge, MA: Harvard University Press.
Mosher, William D. (1988). "Fertility and Family Planning in the United States: Insights from the National Survey of Family Growth." Family Planning Perspectives, 20(5), 207-217.
NCHS - National Center for Health Statistics. (1967). Vital Statistics of the United States,1965: Vol. II - Mortality, Part A. Washington, D.C.: U.S. Government Printing Office (GPO).
Piccinino, Linda J. (1994). "Unintended Pregnancy and Childbearing."" Pp 73-82 in From Data to Action: CDC's Public Health Surveillance for Women, Infants, and Children. Hyattsville, MD: CDC.
Piccinino, Linda J. & William D. Mosher. (1998). "Trends in Contraceptive Use In the United States: 1982-1995."" Family Planning Perspectives, 30(January/February), 4-10; 46.
PL 58, 106th Cong. 1st sess. (September 29, 1999). Treasury and General Government Appropriations Act, 2000.
Robey, Bryant. (1994). "Family Planning Lessons and Challenges: Making Programs Work."" Population Reports, Series J, No. 40. Baltimore, MD: Johns Hopkins School of Public Health, Population Information Program.
Roe v. Wade, 410 U.S. 113 (1973).
Ryder, Norman B. & Charles F. Westoff. (1971). Reproduction in the United States 1965. Princeton: Princeton University Press.
Saul, Rebekah. (1999). "Teen Pregnancy: Progress Meets Politics."" The Guttmacher Report on Public Policy, 2(3), 6-9.
Trussell, James, et al. (1995). "The Economic Value of Contraception: A Comparison of 15 Methods."" American Journal of Public Health, 85(4), 494-503.
U.S. Census Bureau. (1998). Measuring 50 Years of Economic Change Using the March Current Population Survey. (Current Population Reports, P60-203). Washington, DC: GPO.
U.S. Census Bureau. (1999). Statistical Abstract of the United States, 119th ed. Washington, DC: GPO.
U.S. Census Bureau. (1999a, accessed 2000, April 27). "Table F22. Married-Couple Families with Wives' Earnings Greater Than Husbands' Earnings: 1981 to 1998." Historical Income Tables - Families [Online]. http://www.census.gov/hhes/income/histinc/f022.htm.
Van Look, Paul F.A. & Felicia Stewart. (1998). "Emergency Contraception." Pp. 277-295 in Robert A. Hatcher et al., eds., Contraceptive Technology, 17th edition. New York: Ardent Media.
Washington, DC: 202/785-3351
Public Policy Contact
Washington, DC: 202/785-3351
Published by the Katharine Dexter McCormick Library
Planned Parenthood Federation of America
810 Seventh Avenue, New York, NY 10019
Current as of May 2000