The current series is Inventions That Changed Women’s Lives, and today’s episode comes with a warning. This podcast is not intended to be explicit, not now, not ever. But a discussion of the invention of birth control does require mention of certain body parts and certain reproductive actions. If that’s going to bother you, maybe give this one a miss. Check out the 190 posts in the back catalog instead.

In 1925, a woman in New Jersey wrote a letter and addressed it to Margaret Sanger, who was famous and infamous for promoting birth control. The letter said:

Dear Mrs. Sanger,

…I am 30 years old have been married 14 years and have 11 children the oldest 13 and the youngest one year. I have kidney and heart disease and every one of my children is defectived and we are very poor… I am so worried and I have cryed myself sick… My doctor said I will surely go insane if I keep this up but I cant help it and the doctor wont do anything for me. Oh Mrs. Sanger if I could tell you all the terrible things that I have been through with my babies and children you would know why I would rather die than have another one… Doctors are men and have not had a baby so they have no pity for a poor sick Mother. You are a Mother and you know so please pitty me and help me” (Asbell, xi).

It’s relatively rare for us to have such a forthright plea recorded by a woman. In world literature, we more often hear the words of the women who begged and pleaded for the privilege of having a child. And having a child is a beautiful experience.

But maybe not when you can’t feed the children you already have, and your body is run down by an endless cycle of pregnancy, and your husband will abandon you penniless if you tell him no. This mother was not the first to be desperate. For as long as women have been trying to get pregnant, other women have also been trying not to get pregnant. Abstinence was certainly recommended for unmarried women, but it was basically forbidden to married women. And married or unmarried, willing or unwilling, a woman could find herself in desperate need of an alternate solution.

Ancient Advice on Birth Control

The Papyrus Kahun, written in Egypt in about 1850 BCE, recommends that such women take crocodile excrement, mash it up with fermented dough and soak. Or sprinkle. Apparently there’s some damage to the papyrus or some disagreement about grammar, so I’m not 100% sure what you are soaking or sprinkling in croc poop, but I’m struggling to think of any option I’d be okay with myself (Jütte, 31; Kahun, column 3, 6).

The Hippocratic documents from 4ᵗʰ and 5^th century BCE in Greece recommend drinking water with copper ore and fava bean (Jütte, 32).

A hundred or so years later, Aristotle recommended that women rub cedar oil on their genitals to make it too smooth for the semen to take hold (Jütte 34; Aristotle, 583 a).

Pliny the Elder, writing in 1st century Rome, recommended an herb called silphium, which regrettably was pretty much extinct, even in his own time. It could be drunk with wine, but also used with soft wool as a pessary (Pliny, 22.49). A pessary is a generic term for a device inserted into the vagina for a variety of purposes, including to provide a barrier. In this case, the wool would theoretically block the semen from going any further in. The silphium was probably intended as a spermicide, for additional protection.

Elsewhere, Pliny also suggests women find a certain large, hairy spider, dissect it, remove two small worms from its head, place them on a deer skin, and wrap it around their bodies (Jütte, 34; Pliny 29.27).

Yeah.

The 2^nd century Greek doctor Soranus recommended that women hold their breath during intercourse, then stand up right away, then squat, then sneeze violently, then douche (meaning wash out) their genitals and vagina (Jütte, 43).

Hundreds of years later, the Islamic doctor Avicenna brought us full circle back to excrement, but not from a crocodile. This time from an elephant (Tone, 14).

This is just a small sampling of the many methods suggested in the ancient and medieval world.

Did It Work?

You may be wondering whether any of these methods actually worked.

That turns out to be a complicated question. In the modern era, we make mostly clear distinctions between contraception versus abortion. We definitely make a clear distinction between those two things and infanticide. But in historical records, the writers do not necessarily view these as different things. It was all family planning, and yes, some of the abortion methods were and are somewhat effective. Infanticide was downright easy.

As for contraception, some herbs suggested by ancient writers do have some spermicidal properties, like acacia, willow leaves, Queen Anne’s Lace, and juniper root (Jütte, 46-47; Riddle, 36, 58). We can hardly judge an extinct herb like silphium. It might have been great. I’m informed that elephant dung is more acidic than crocodile dung and so would have worked better as a spermicide (Tone, 14).

To further complicate the issue, modern expectations are that if we say a birth control works, that means it works pretty much 100% of the time. But prior to the mid-20ᵗʰ century, that just wasn’t reality. In a world where 100% protection was impossible, you might be very grateful for something that worked even some of the time.

The method that probably worked the best was the only one mentioned in the Bible, and it wasn’t mentioned in a positive light. It came to be known as coitus interruptus, which means that the man withdraws just before climaxing so that “his seed,” as the King James Bible calls it, falls on the ground. God was not a fan of this strategy, according to Genesis 38:10, so it was technically forbidden to Jewish and Christian couples. But that did not stop it from being a very popular method for millennia for the simple reason that it worked, as long as the man did it right.

Another well-known method with potential was the rhythm method, where you abstain from sex during the fertile period. The tricky part is knowing when the fertile period is. That’s hard enough in modern times with scientific knowledge about ovulation. The ancient writers just flatly contradicted each other on that subject (Jütte, 45). Some of them were describing the most fertile period, but calling it the least fertile period.

Which brings me to another important point, which is that the ancient writers were almost universally men. They are not the ones I’d expect to be most knowledgeable about contraception. Your average woman probably didn’t go to a male doctor for help on this issue. She went to the midwife or the wise woman or her mother or her friends. But these people didn’t write books, or if they did, they haven’t survived to the present day.

The books by men usually just make it clear that contraception and abortion were both possible, often without mentioning exact ways and means. Mostly they just say something like prostitutes are experts at this, and then they move on (Jütte, 74).

When medieval and early modern guides give details, they are mostly repeating the recipes given by Greek, Roman, and Arab authors (Jütte, 70). It’s not until the early modern period that there’s clear evidence of something new. The condom was invented in 16^th century Italy. It was made of linen or sheep’s gut (Jütte, 96). It’s always possible that condoms did exist before, but this is when we have written evidence of it.

19th Century Urgency on Birth Control

But the 19ᵗʰ century is where the details explode. Partly that’s because there was just a whole lot more written material and more of it has survived. But also it was because in 1798 Thomas Malthus published an essay that went viral, in a pre-Internet way. In the essay Malthus used a lot of math and science to show that the total number of humans was increasing much faster than the rate of food production. The result would soon be people starving on the streets, savage war over scarce resources, anarchy, and basically the end of civilization as we know it!

Malthus turned out to be wrong on several important points, but a lot of people were convinced. Birth control was one fairly obvious way to try to circumvent this doomsday scenario.

The basic methods remained the same as they had been in the ancient world: oral herbs, vaginal spermicides, physically block the sperm from getting in, immediately wash the sperm out if it did get in, and abstinence (at least during the fertile period, if you’re sure when that is, which they still weren’t).

What was different was that advances in chemistry meant that the spermicides and douche mixtures were stronger. The 1839 invention of vulcanized rubber meant both condoms and pessaries felt better and blocked more, assuming they were well-made, which is a big assumption. Many had holes.

Judging by the limited correspondence on this subject, women knew the methods were flawed. That’s why they used multiple methods at once. If you used the rhythm method and a pessary and a condom and douched with a spermicide, your total overall coverage might be pretty good, even though none of those methods was foolproof alone.

If you were German, you could pick up a bestselling manual which would give you detailed instructions on the various methods available. For example, Dr Anna Fischer-Dückelmann wrote The Wife as Family Doctor. She did not approve of coitus interruptus because the man’s early withdrawal denies the woman “the necessary fulfillment for her physical health”. And she didn’t like condoms because they interfere with sensation. Her preferred method was the cervical cap (Jütte, 119). It’s a form of pessary.

If you were a Dutch woman, you might visit the world’s first birth control advice center. Or at least the world’s first open, above-board-and-not-supposed-to-be-shady advice center. It was run by Dr. Aletta Jacobs. She favored a diaphragm pessary, but it had to be fitted by a doctor who knew what they were doing (Jütte, 171).

If you were a British woman, you might read a book published by Annie Besant. Besant did not write the book, but she was co-owner of the publishing house, and they ran afoul of the British obscenity laws. However, she was acquitted, and a trial is the best of all possible publicity. That book recommended chemical douching as the best method, but Besant followed it up with her own book, which recommended the vaginal sponge, another form of pessary (Jutte, 121).

The American Black Market

If you were an American woman, life was more complicated. In 1873, Congress was in a huge hurry to pass a lot of bills before the session ended and power transferred to another party. The Comstock Act slipped through with virtually no comment at the time, but it made it illegal to use the US postal service to distribute obscene or indecent materials, which specifically included anything to do with abortion. In practice, it included contraception too.

The Comstock Act was never enforced as much as Anthony Comstock hoped it would be. But even with lax enforcement, it meant that American women could not legally order a book by Annie Besant or Anna Fischer-Dückelmann because the postal system could not deliver it. No large company would market any contraceptive products because they could not ship them to other locales or place advertisements in the magazines. A doctor could not send out a circular announcing the availability of any services. Technically, even a letter between husband and wife discussing their own private use of such possibilities was illegal.

Demand had not gone down, no matter what Comstock wanted. So the void was filled by small black-market players who were willing to take a risk and mail things in falsely labeled packages (Tone, 48). There was obviously no regulation or guarantee of product safety. The other option was off-label use of things made by larger companies but marketed for things like menstrual regulation or a prolapsed uterus (Tone, 59).

Officially, the approved methods for preventing pregnancy were abstinence and more abstinence. If you were married, maybe the rhythm version of abstinence. Official guides were often still wrong about when the fertile period is.

This was the American situation when Margaret Sanger came onto the scene.

Margaret Sanger, Birth Control Advocate

Sanger was and is a polarizing figure. I first learned about her years ago, from a podcast that told me she advocated for birth control, but only for Black people because the real point was white supremacy. With more scrutiny, I’ll say that portrayal was a huge, huge overstatement, but she also doesn’t come out completely untarnished. Sanger was complicated.

She was born in 1879 to a mother who gave birth eleven times and also had seven miscarriages. It was exhausting. By the 1910s, Sanger was a qualified nurse, and married, and a mother of three, and a political radical on many issues.

The experience that really galvanized her came when she visited New York’s immigrant slums in her capacity as a nurse. She found desperately poor mothers who could not feed the children they already had, but nevertheless faced pregnancy after dangerous pregnancy. Sanger’s most famous story was that of Sadie Sachs, who went to a doctor for birth control. The doctor said to make her husband sleep on the roof. Sadie died of sepsis after attempting a self-induced abortion (Tone, 80).

It is possible to poke holes in this story. For example, if Sadie Sachs could afford to see a doctor, why couldn’t she afford a 25-cent reusable condom? You might assume Sadie didn’t know or refused to do something so illegal or immoral, but Sanger told other stories about poor woman lining up to see a 5-dollar quack abortionist. That means poor women did know how to find such a forbidden service and they could afford $5. Presumably, they could have found other black market service providers for the much cheaper prevention methods too (Tone, 80, 85). Sanger was not above sensationalizing her stories to make a point.

Sanger viewed this as a class issue. Middle class women like her had access to knowledge that was inaccessible to poor women. In fact, there’s plenty of evidence that many poor women did know about birth control and did make use of it. There’s also plenty of evidence that middle- and upper-class women sometimes didn’t know things they should have.

Even if Sanger over-interpreted this as a class issue, even if she exaggerated her stories, she was right that protection was spotty, unofficial, and too expensive. She was also right that the most effective methods depended on male cooperation: Not every woman had the option of abstinence or timing or condoms. It’s hard when you cannot earn enough to support yourself, your male partner will not prioritize your health, your male doctor won’t tell you anything, your male clergyman says birth control’s a sin, and your male law enforcement says it’s illegal. Women got desperate, even if they did know how birth control worked.

Sanger flagrantly violated the Comstock Laws by printing and mailing detailed instructions on available contraception with titles like What Every Mother Should Know and What Every Girl Should Know. To escape prosecution, she fled to Europe, which was an education. The laws there were not so draconian, and she could learn from people like Dr. Aletta Jacobs.

In Europe, Sanger realized that birth control would never be widely available to all women as long as it was a seedy thing discussed only in back alleys. It needed the respectability of medicine and science. Also, it needed to actually work.

The First American Clinics

Sanger came back to the US with new knowledge, boundless enthusiasm, and a total disregard for the Comstock Laws. She opened her first birth control clinic on October 16, 1916. It was not directed at African Americans, but it was directed at immigrant groups that white supremacists didn’t like much better. The advertising circulars were printed in English, Yiddish, and Italian (Tone 107-119).

The clinic ran for ten days before police shut it down, as Sanger knew they would. She was jailed and thrilled. Publicity was good. On her release, she kept right on talking about what she wanted to talk about. And public sentiment was changing, even if the laws weren’t yet.

A few years later, she opened a new birth control clinic on Fifth Avenue and had doctors provide patients with diaphragms and spermicidal jellies. At first the diaphragms were smuggled in from Europe. Later Sanger established her own company to produce them (Tone, 125-127). The smuggling was done by another rule-breaking woman named Katherine Dexter McCormick, and I have a brand-new supporters-only bonus episode on exactly how she fooled the US customs agents.

The Intellectual Supporters

By the 1920s, Sanger’s detractors found her hard to silence. She could now could bolster her arguments on women’s rights with those of two respected intellectual movements. They aren’t necessarily highly respected now, but they were at the time.

The first was Sigmund Freud and his followers. Whatever their purely scientific claims were, the message the general public heard was: sex is natural, sex is good, don’t repress it, don’t sacrifice your physical and mental wellbeing for the sake of outdated Victorian notions like abstinence or fidelity. That’s ridiculous and unhealthy.

Margaret Sanger was perfectly okay with free love. She certainly wasn’t faithful to her own husband. But obviously there would have to be some way of protecting women from the traditional consequences to such behavior. Hence, birth control. Freud’s fans were natural allies.

The second respected-at-the-time intellectual movement was eugenics. Eugenicists did not all agree with each other, but the basic idea was an outgrowth of Darwinism. If the humans are essentially no different from animals, and if we want the human race to be strong, beautiful, intelligent, and all good things, should we not breed for those positive traits, just like we do with animal stocks? From there it’s a very short mental leap to informing certain people they don’t have those positive traits, therefore they should not reproduce. Hence, birth control. The eugenicists were natural allies too.

But eugenicists did not want birth control for everyone. They argued that white, middle- and upper-class women should reproduce as much as possible. It would be selfish of such women not to make use of their superior genes for the benefit of humanity. It was lesser people who should use birth control.

To her credit, Sanger did not fully agree with the most extreme eugenic statements. She was in favor of all women having access to birth control. But she did agree that the “unfit” should not reproduce, and she was willing to ally with people who defined “unfit” along racial lines. (Quite honestly, defining “unfit” is going to be problematic even if you take race out of it. The other possible definitions are also offensive.)

In 1930, Sanger opened a birth control clinic in Harlem, which was a predominantly African-American neighborhood. It didn’t go down too well, but not for the same reasons as the one in 1916. Medically-provided birth control had acquired some respectability in the intervening fourteen years, even if the legalities were still murky. Sanger’s problem in Harlem was that she was white, her staff was white, and she designated this clinic as a training clinic.

Every modern woman knows that it takes a certain amount of guts to go see your gynecologist. Imagine what it was like to be a Black woman, not having done this before and not being too sure about birth control and whether it was legal, moral, safe, or anything else. You do know there’s a long sorry history of white people controlling black bodies for their own benefit, and then the doctor himself is a white man who has never done this before and a handful of other white trainees looking on. Is it any wonder that the Harlem community viewed this with suspicion? Especially when Sanger refused to allow the Harlem Advisory Council to have any control over it? (Tone, 146)

The Other Options

To be honest, there were a great many women, of all classes and social statuses, who were never going to discuss contraception with a male doctor of any color. They were just too embarrassed.

That’s why a great many women were still getting their contraceptives without any doctor involvement. Various washes and devices were available at commercial stores with the label “feminine hygiene”. There were even advertisements in the magazines. Their purpose was fuzzed with statements like “Lysol has the power to destroy the most active germ life, which other compounds fail to do in the presence of organic matter.”

Nothing Comstock could object to there, is there?

Advertisers also made it clear that women who didn’t buy their product were doomed. “No wonder many Wives fade quickly” is the headline on that Lysol ad. “The unhappy husband wonders helplessly what has happened to the blithe young woman he married,” it continues (Tone, 158). The implication is if a husband abandons his wife, it was definitely her fault for not buying a Lysol douche.

So contraception was very popular. The US had Margaret Sanger campaigning for it. The UK had Marie C. Stopes who advocated for birth control, but against chemical means like Lysol. Her mantra was “never put anything in your vagina that you wouldn’t put in your mouth” (Jütte, 165).

The truth was that even with greater acceptance and reluctant cooperation from the medical community, the contraceptive methods in the 1930s, 40s, and 50s remained confusing, defective, expensive, inconvenient, and uncomfortable. Most of them still required the active cooperation or approval of the man in the relationship. There was a great deal of angst that the world’s poor people were too ignorant and careless to follow a detailed regime of inserting a diaphragm and using a spermicidal jelly. This was totally classist: Not because poor people never messed it up, but because a  great many middle- and upper-class people also messed it up. Some of them did it right and got pregnant anyway because it wasn’t 100% effective.

An aging Margaret Sanger knew that the world had come a long way since her youth, but it still wasn’t good enough. Women needed something easier and more reliable and more under their own control. Something like an oral pill. Stay tuned next week for what Margaret Sanger did next.

Today I have a special thank you to Candice, who signed up as a supporter on Patreon. Fabulous people like Candice keep this show going. If you’re able to help as well, there are a variety of ways and potential benefits, including that new bonus episode on smuggling birth control. If a monthly payment is out of your budget. You can get it by individual purchase too.

Selected Sources

Angus Maclaren. A History of Contraception : From Antiquity to the Present Day. Oxford: Basil Blackwell Scientific Publications, 1994. https://archive.org/details/historyofcontrac0000mcla/page/28/mode/2up?q=silphium.

Aristotle. Historia Animalium. Translated by David M Balme and Allan Gotthelf. Oxford: Clarendon Press, 1908. https://archive.org/details/historiaanimaliu00aris_0/page/n323/mode/2up?q=cedar.

Asbell, Bernard. The Pill : A Biography of the Drug That Changed the World. New York: Random House, 1995.

Brazan, Madison. “Controlling Their Bodies: Ancient Roman Women and Contraceptives,” n.d. https://provost.utsa.edu/undergraduate-research/journal/files/vol4/JURSW.Brazan.COLFA.revised.pdf.

Eig, Jonathan. The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution. W. W. Norton & Company, 2014.

Jütte. Robert. Contraception : A History. Cambridge, Uk ; Malden, Ma: Polity, 2008.

Pliny the Elder. The Natural History. John Bostock, M.D., F.R.S. H.T. Riley, Esq., B.A. London. Taylor and Francis, Red Lion Court, Fleet Street. 1855. https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.02.0137%3Abook%3D29%3Achapter%3D27

Riddle, John M.. Contraception and Abortion from the Ancient World to the Renaissance. United Kingdom: Harvard University Press, 1992.

Sohn, Amy. “Charles Knowlton, the Father of American Birth Control.” JSTOR Daily, March 21, 2018. https://daily.jstor.org/charles-knowlton-the-father-of-american-birth-control/.

Tone, Andrea. Devices and Desires : A History of Contraceptives in America. New York: Hill And Wang, A Division Of Farrar, Straus And Giroux, 2002.

uscode.house.gov. “Comstock Act (18 USC 1461: Mailing Obscene or Crime-Inciting Matter),” 1873. https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title18-section1461&num=0&edition=prelim.

http://www.ucl.ac.uk. “Kahun Medical Papyrus.” Accessed September 1, 2025. https://www.ucl.ac.uk/museums-static/digitalegypt/med/birthpapyrus.html.