The struggle for birth control

In the light of a recently published book that gives a glimpse of the social mores of Victorian England regarding birth control and women’s sexuality, ELEANOR DONNE looks at the historical struggle for contraception and, in particular, the role of working-class women within that struggle.

A Dirty, Filthy Book: Sex, Scandal, and One Woman’s Fight in the Victorian Trial of the Century

By Michael Meyer

Published by WH Allen, 2024, £25

A Dirty Filthy Book tells the story of the trial of Annie Besant and Charles Bradlaugh – free thinking, radical publishers based in London – who in 1877 were prosecuted under censorship laws for printing and selling a pamphlet called The Fruits of Philosophy, written by an American doctor, Charles Knowlton. The pamphlet contained information about the ‘mechanics’ of sex, genitalia, methods of contraception, and menstruation. Knowlton had printed it in restricted numbers in a very small, ‘discreet’ format for his young married patients. But Besant and Bradlaugh abandoned ‘discretion’ and openly challenged censorship laws, even telling police and local magistrates where and when they would be selling the pamphlet.

Although dealing with a limited event, Meyer’s book nonetheless gives a glimpse of the sexist and class-based social mores of Britain in that period. The law was used to police morals. The ruling class promoted the idea that the mass of the people had to be protected by the state from their own base instincts and that women were more easily led into immoral behaviour. The Obscene Publications Act of 1852 was used to ‘clamp down’ on pornography but also to criminalise the distribution or sale of information about birth control. These social norms were to form the backdrop of the struggle that was waged for women’s control over their fertility in the period after Besant and Bradlaugh’s trial.

Patriarchal family

Of course, birth control is not new. Throughout history people have found ways to limit numbers of children through abstaining from sex, using spermicides or abortion via various herbs and substances. These didn’t necessarily work for every individual, but on a societal level kept populations lower when times were hard. Communities even resorted to infanticide at times of crisis.

With the division of societies into classes, private ownership of property and the importance of inheritance to consolidate wealth, property and power – a process that began thousands of years ago when hunter-gatherer societies discovered how to domesticate animals and cultivate crops –  women lost rights, and their sexuality and fertility became tightly controlled through the patriarchal family in order to ensure a legitimate heir. Over time, male control over women within the patriarchal family and women’s second-class status became reinforced, legitimised and reproduced through institutions like the church, the legal system, education etc.

Marriage and the institution of the family were vital for the rich to obtain more land and pass on property rights in the feudal system. With the development of capitalism, especially industrial manufacturing, the family played a more complex role. Heredity was still important for the rich, but the working-class family, and women’s unpaid caring and domestic labour within it, also played an important economic role. In the capitalist economy of the nineteenth century that generated super-profits for the rich there was no state support for children. As well as working-class women being responsible for bringing up the next generation of workers and caring for the needs of their husbands and family members unable to work, individual men were expected to provide economically for their families.

This was impossible on the poverty wages that most working-class men got, and many working-class women and children worked in order to survive. In Victorian Britain frequent pregnancies and childbirth could lead to long-term health issues for women of all classes. But for working-class women with no access to ante-natal care, a poor diet, and overcrowded and damp living conditions, this was especially true. In addition, being unable to work and having another mouth to feed could mean destitution and the workhouse. So, in working-class communities, terminations using lead or other harmful chemicals, especially in early pregnancy, were fairly common, in spite of being illegal and unsafe.

The family, with the man as the undisputed head of the household, was also important in upholding the patriarchal ‘values’ of society – a place where women and men could be socialised into the binary gender roles that benefited capitalism. Women’s sexuality, where it was acknowledged, was still tightly controlled. Girls were often kept in ignorance about periods, their bodies, and especially sex, before and after marriage. Men were forbidden by law from having sex with men, which was punishable by life imprisonment, but straight men had more sexual freedom via a thriving sex industry. Large numbers of working-class women relied on sex work at times to avoid destitution, risking not only sexually transmitted infections and unwanted pregnancies, but society’s hypocritical condemnation.

The real crime of Annie Besant and Charles Bradlaugh in the eyes of the church and the establishment was to sell their book at sixpence – putting it within reach of working-class people. Many wealthy women could already get contraceptive devices and information and even surgical abortions through private doctors. Chemists also sold a variety of douching devices, diaphragms, vaginal sponges with spermicide, and condoms. How effective they were may be debatable, but they were beyond the means of most working-class women, who continued to rely on illegal and unsafe abortions to limit their family size.

The ‘Knowlton Trial’ was headline news for weeks and put the issue of birth control into the public domain. The press found it especially ‘scandalous’ that it was a woman in the dock. Sales of the offending pamphlet rocketed and whilst on bail Besant spoke at large public meetings and helped to establish the Malthusian League to campaign for birth control. In the end, neither Bradlaugh nor Annie Besant went to prison.  But Besant paid a high personal price for her stand when, based on the trial, a Family Court found her to be an unsuitable mother and awarded custody of her daughter to her estranged husband.

Working-class women

In the fight for access to contraception, the role of working-class women is unfortunately often overlooked in favour of well-known, middle-class individuals. Another of these is Marie Stopes, who established the first birth control clinic in London in 1921. Less known is the story of the tens of thousands in the Labour Party women’s sections and the Women’s Labour League who were active in the 1920s and 1930s. Many of these activists campaigned for local councils to fund maternity clinics and provide contraception advice and devices.

They faced opposition, including within the labour movement, from those who said it was against their religious faith to promote contraception or insisted that family planning was a ‘private’ not a public matter. Others in the Labour Party had understandable concerns about the ideology of the main organisation promoting birth control at that time, the Malthusian League, with its philosophy (after Thomas Malthus) that poverty was caused not by capitalism and its inherent economic crises and exploitation of the working class, but by overpopulation. Propaganda about uncontrolled population growth and an ‘overcrowded planet’ was again used widely in the 1960s and 1970s, particularly in the colonised or recently independent countries of the ‘Global South’, where investment in population control programmes was considered by the World Bank to be a cheaper alternative to economic growth.

Unfortunately, eugenics – the reactionary idea that some people were less ‘fit’ to breed then others – was also embedded in the birth control movement from the outset. Marie Stopes actually advocated in her 1920 book Radiant Motherhood for the compulsory sterilisation of those ‘totally unfit for parenthood’. She was a horrendous snob who worried that the ‘wrong kind’ of people were having children, and this was a key motivation for her opening a clinic in a poor part of London.

Nevertheless, hundreds of working-class women came to open air meetings organised by the Malthusian League in Bermondsey in the 1920s and queued up to attend Stopes’ free clinic, desperate to find ways to prevent pregnancy. Middle-class families had started having fewer children from the start of 20th century. With technological advances such as the invention of latex and automated production, the quality of condoms and cervical caps improved and prices dropped. Using the cap with spermicide gave women much more direct control over their own fertility. Some advertisements even used this to sell the product, stating ambiguously that ‘your husband will not even know it is there’.

But most working-class women still could not afford them. Only one in twenty working-class couples used barrier methods of contraception up to the 1920s. Most relied on withdrawal and even periods of abstinence, but this obviously required co-operation from their partner. Given that a husband’s expectations of ‘conjugal rights’ were recognised in law, and the overall level of authority that men held within the family, this was not a reliable option for many. Abortion, although illegal, was also still widely practised. In 1937 there were an estimated 150,000 illegal abortions and 411 related deaths. Large families were ‘the norm’ in most working-class areas in the 1920s and 1930s. Stella Browne, a socialist and active campaigner for birth control, who later set up the Abortion Law Reform Association, references one woman’s experience: “twelve live births, four children dead, eight surviving. Three bad miscarriages. Motherhood in all its sacredness”.

Labour in government

In 1924 the first Labour government was elected. The health secretary, John Wheatley, representing a Glasgow seat, had a history as a left winger who had opposed the first world war and whose Housing Act brought about an important expansion of municipal housing. But he was also a Catholic, personally opposed to birth control, and refused to allow Ministry of Health institutions to give contraceptive advice to any mother under any circumstances. The Labour Women’s Conference unanimously voted to support birth control shortly after and established the Workers’ Birth control Group (WBCG) to campaign for public funding for birth control as a vital public health measure.

The Labour Party leadership continued to oppose birth control or regard it as a ‘non-party-political matter’ and a Private Members’ Bill in favour was defeated, with 44 Labour MPs voting against. It was not until Labour was back in office in 1929 – five years of unwanted pregnancies and unsafe abortions later – that it passed the Local Government Act 1930 giving councils the power (not a duty) to fund contraception and advice at child welfare clinics. This was limited to married women whose health would be harmed by having another child.

By the 1940s over 40% of married women were estimated to be using contraceptive devices some of the time. The 1945 Labour government established the NHS, which was to be hugely beneficial to women’s health in pregnancy and beyond. However, a Royal Commission on Population recommending that the health service should provide birth control widely to married people, not just to those who needed it for health reasons, was not implemented for another twenty years or so.

In the 1960s and early 1970s a collection of relatively progressive laws passed under Labour governments, partially legalising homosexuality, outlawing direct race and sex discrimination, introducing ‘no fault’ divorce and equal pay as well as reproductive rights, including the right to abortion. This was a time of economic boom when women had been drawn into the workforce in ever larger numbers. This in turn led to big changes in social attitudes. Coming out of isolation in the home, getting organised into trade unions and struggling collectively on pay and rights at work, women had also begun to challenge their wider gender oppression and demand rights, including reproductive rights. At the same time, it suited capitalism, during a labour shortage, to have women in work and for them to have smaller families to accommodate this.

Hormone-based oral contraception had been in basic development in the US since at least the 1950s, but birth control was illegal in many US states and a taboo subject generally. Manufacturers saw a ‘market’ for the contraceptive pill amongst working women in the US and the NHS in the UK, but had to wait for social attitudes to ‘catch up’ with the science and for it to become politically acceptable for pharmaceutical companies to place such a pill on the market. This happened in the USA from 1960 and ‘the Pill’ was approved by the British Family Planning Association in 1961. Although initially limited to those who were married or ‘engaged’ it became increasingly accessible to single women via family planning services.

The Pill gave women direct control over their fertility. It was significantly more reliable than existing barrier methods in preventing pregnancy, so all but removed the constant fear of pregnancy which had hung over previous generations. It required less direct forward planning, allowing for more spontaneity, and, potentially, more sexual freedom. For all these reasons it is sometimes described as starting the ‘sexual revolution’ of the 1960s. Young people in particular challenged entrenched sexist attitudes, homophobia and hypocritical ‘moral standards’ that shamed women for ‘sleeping around’. But sometimes ‘free love’ was interpreted by men as ‘the right to sex’. Of course, the freedom to say no to sex is essential to a genuine sexual revolution.

Profits before safety

‘Light touch regulation’ from the US Food and Drug Administration meant that in the 1960s the Pill was licensed after only 132 case studies for side effects – some of which were done in Puerto Rico, where women had fewer options to get redress for any harm. High oestrogen pills were withdrawn in the 1980s after links to thromboembolic disease. The Dalkon Shield, the largest selling IUD (coil) in the world in the 1970s, was found to cause pelvic inflammation which could lead to sterility and even death. It was withdrawn in the UK in 1975. But manufacturers waited until 1980 to alert GPs about safety regarding devices already fitted, and a further five years before trying to alert other women to have them removed.

Whilst it may not be possible to eliminate all side effects or health risks from various methods of contraception, there has been a chronic lack of consistent investment in new potential methods, including the ‘male pill’. Pharmaceutical companies producing contraceptives only spend 2% of their budget on research and development, compared to the general figure of 20%. In Davina McCall’s 2023 TV documentary, The Pill Revolution, she points out that the current most common contraceptives were developed around thirty years ago and asks why is there a “gaping black hole where research into women’s health should be?”. Answer – capitalism! Companies producing contraceptives have made huge profits for their shareholders at the expense of the NHS. In the book, Whose Choice, published in 1990 by Militant, the predecessor of the Socialist Party, Vivien Seal describes the hormonal contraceptive pill as “the classic golden egg of the drug business – a pill to be taken not by the sick but by the healthy, and by millions of women almost every day throughout their child-bearing lives”. No wonder there is little incentive to research other suitable alternatives when huge profits are potentially at stake.

A socialist government would take companies that produce contraceptives into public ownership, under democratic control, and integrate them into the health system. Removing the profit motive would allow genuine, consistent and collaborative research into developing a range of contraceptives that are safer for the user’s health as well as effective in preventing pregnancy. It would also enable research into better techniques to aid fertility and for research into environmental and other causes of infertility.

Cuts threaten access to contraception

Today cuts to funding and the ‘internal market’ centred on commissioning services in the NHS have badly affected timely access to suitable contraception. GPs often don’t have the time or the in-depth current knowledge to discuss all contraceptive options fully, but they are the default provider because specialist sexual health and family planning services have been reduced. According to the UK Women’s Health Ambassador, the demand for IUDs has increased over the last ten years but not enough people are trained to fit them. Waiting times for a fitting range from one month to several months and has been up to a year in parts of Devon and Northern Ireland.

Lack of access to suitable contraception is one factor that has led to an increase in unplanned pregnancies. Faculty of Sexual and Reproductive Health research shows that 45% pregnancies in England are unplanned and one in four pregnancies end in terminations. In a British Pregnancy Advisory Service (BPAS) survey from May 2024, of 1,300 people who had ended their pregnancies 57% gave financial factors as the main or partial reason and 36% had been unable to get the contraception they wanted or faced delays.

Oral contraception has now been made available from participating pharmacies without prescription. This could be a positive step if it is properly resourced and clinically safe. But we need to fight for an urgent and significant injection of funding into family planning/contraceptive and sexual health clinics, plus longer-term investment including staff training so that more staff intensive options such as IUDs are not denied by default.

McCall’s documentary draws attention to a reduction in numbers using the Pill. She highlights a survey of 4,000 women and people assigned female at birth: 77% experienced side effects and 33% stopped taking it because of them. She also points to an increase in non-medical methods of avoiding pregnancy, using fertility apps which rely on temperature readings and menstrual cycle information input to work out when you are least fertile. This method is statistically less reliable for preventing pregnancy than some other contraceptives but may indicate that a new generation are not as willing to put up with side effects from hormonal methods and are searching online for alternatives.

There is, unfortunately, a lot of misinformation about contraception on unregulated social media platforms, where ‘wellness industry’ advocates and others play on health concerns in order to monetise their platforms. Cancer risks from the pill have been hugely overstated on some of the sites, and some other claims are frankly bizarre. Whilst the NHS website provides basic information and some other sites have NHS registered nurses and doctors responding to questions as well as contraceptive users’ own reviews and experiences, this should not be a substitute for in-person discussion about options.

The decision by the last Tory government to make all secondary schools, including Academies, provide relationship, health and sex education (RHSE) could potentially have been a positive one. The Statutory Guidance includes, for example, teaching ‘the facts about the full range of contraceptive choices, efficacy and options available’, as well as about consent and sexual health. But teachers need access to training and resources to deliver RSHE lessons effectively. In addition, there should be democratic control over what is taught, involving teachers, students and parents, together with relevant social organisations.

In addition, the subject has become a weapon in the ‘culture wars’ that the Tory government and right-wing media have used to try to divide communities and distract from their failures. In a disturbing echo of the Thatcherite Section 28 laws of the late 1980s banning local authorities from ‘promoting homosexuality’ (only repealed in 2003) the new guidance for schools is ‘Do not teach about gender ID. Teach the facts about biological sex. If asked about gender identity do not say that gender is a spectrum’. There have also been attempts by some parents and social media to imply that children are being ‘sexualised’ with accusations that ‘age-inappropriate material’ was being taught in some schools. In some cases, this may stem from the mistaken view that ignorance about sex is a protection from abuse, when the opposite is the case. 

We need socialist change

A genuine choice about when or whether to have children has to also include the right to end pregnancy. Any demands should include the decriminalisation of abortion, removing the need for two doctors to ‘sign it off’, as well as facilities for abortion to be fully funded and provided by the NHS. We also need the proper resources to bring children up free from poverty and hardship. An immediate first step would be to remove the current two-child limit on Universal Credit and the benefit cap, but we also need liveable benefits and a £15-an-hour minimum wage, major investment in schools, social housing and publicly funded, good quality childcare facilities.

However, the Labour government has chosen to work within the ‘fiscal rules’ of a crisis-ridden capitalist economy. The working class needs a political voice – a new mass working-class party that can fight austerity, for a programme that meets the reproductive and other needs of women and all working-class people, and for a fundamental change in society.

Access to contraception and abortion has changed many women’s lives, allowing us to participate more fully not just in the workforce but in wider society. Women now make up the majority of trade union members so are a vital part of the organised working class. But the important gains in reproductive rights we have made historically are not permanent under capitalism, as we have seen in the US where constitutional abortion rights were abolished overnight by the Supreme Court.

We need a socialist planned economy based on democratic ownership of the major companies and financial institutions, including pharmaceutical companies, so that we can allocate resources genuinely based on all our needs for safe, effective contraception, fertility treatment and reproductive health. A socialist society, based on cooperation rather than exploitation and hierarchy, would, over time, change social attitudes and how people related to each other. Decisions such as those about contraception, fertility treatment, adoption, and the choice of being child free via sterilisation would no longer be constrained by the ideology of ‘suitable’ family models and gender norms.