3.7.9: Margaret Sanger, Title X, Abortion, and Birth Control

Margaret Sanger was one of 11 children born to her parents in 1879. Her mother was frail due having experienced 18 pregnancies in total - which she believed contributed to her mother’s death from tuberculosis at the age of 50. This galvanized Sanger’s mission to become a nurse and provide women access to birth control. In 1921 she founded the American Birth Control League, which would eventually become the Planned Parenthood Federation. At the time, there were only two barrier methods of birth control - the rubber condom and the diaphragm - and neither were widely used. By the 1950s, Sanger turned her focus toward promoting research and development of a contraceptive pill. Funded by her friend, Katherine McCormick - who had inherited a fortune from the International Harvester company - Sanger supported research conducted by two doctors: Gregory Pincus in developing the pill, and John Rock in testing it. The researchers used progesterone derived from certain wild yams which had been traditionally used by the Aztecs for birth control and menstrual cramping. The pill went through clinical trials with women in Puerto Rico as subjects (since it would not have gotten approval in other states) and was approved by the FDA in 1960. Since then, it has been discovered that much lower doses of estrogen and progesterone are just as effective at preventing pregnancy and cause much fewer side effects (Planned Parenthood Federation of America, Inc., 2015).

The importance of sexual and reproductive health as a public health service was recognized in the next decade. Title X was signed into law by President Nixon in 1970, and provided funding for family planning clinics. These clinics could provide contraceptives and reproductive health services to people who could not afford them. Screening services for sexually transmitted infections, reproductive cancers could also be provided, as well as education on preventing HIV and other STDs - but importantly, funding by Title X is prohibited from being used to provide abortion services. Further regulations subsequently added to Title X during conservative presidencies made it difficult for healthcare providers to even discuss abortion as an option for reproductive healthcare (Seabert et al., 2021).

Two key court cases solidified access to both contraceptives and abortions for women in the 60’s and 70’s. Griswold v. Connecticut in 1965 prevented states from banning contraceptives, citing the right to privacy derived from several constitutional amendments but most notably the 14th amendment (LII, n.d.). In 1973, Roe v, Wade struck down a Texas law which criminalized helping a woman get an abortion, again citing the right to privacy. This effectively legalized abortion federally, but only up to the age of fetal viability (the age at which the fetus could possibly survive outside the uterus), with exceptions beyond if there is risk to the mother’s health. It is important to note that the age of fetal viability is influenced by a variety of factors including sex, weight, availability of medical support, etc. and the current consensus places fetal viability between 23-25 weeks of pregnancy (The American College of Obstetrics and Gynecologists, 2023). In 2022, the Roe v. Wade ruling was overturned in Dobbs v. Jackson, allowing the conservative legislature in many states to enact abortion bans between 6 and 15 weeks of pregnancy (Contributors to Wikimedia projects, Griswold v. Connecticut, 2023b). Within the same year, the ripple effects of these laws was apparent - exemplified by a lawsuit against the state of Texas where several women testified that they were denied abortions for pregnancies risking their health, and nonviable pregnancies (including fatal fetal growth complications) - resulting in traumatic illness and birth experiences (Varney, 2023). Fears around lawsuits and navigating obstetric care have also been cited as reasons for some hospitals to close their maternity wards (Kekatos, 2023). This is a contemporary example of how legislative decisions can have immediate effects on medical care.