Technologies of contraception and abortion

Soon to turn 60, the oral contraceptive pill still dominates histories of technology in the ‘sexual revolution’ and after. ‘The pill’ was revolutionary for many, though by no means all, women in the west, but there have always been alternatives, and looking globally yields a different picture. The condom, intrauterine device (IUD), surgical sterilization (male and female) and abortion were all transformed in the twentieth century, some more than once. Today, female sterilization (tubal ligation) and IUDs are the world's most commonly used technologies of contraception. The pill is in third place, followed closely by the condom. Long-acting hormonal injections are most frequently used in parts of Africa, male sterilization by vasectomy is unusually prevalent in Britain, and about one in five pregnancies worldwide ends in induced abortion. Though contraceptive use has generally increased in recent decades, the disparity between rich and poor countries is striking: the former tend to use condoms and pills, the latter sterilization and IUDs.

Contraception, a term dating from the late nineteenth century and since then often conflated with abortion, has existed in many forms, and techniques have changed and proliferated over time. Diverse local cultures have embraced new technologies while maintaining older practices. Focusing on Britain and the United States, with excursions to India, China and France, this chapter shows how the patterns observed today were established and stabilized, often despite persistent criticism and reform efforts. By examining past innovation, and the distribution and use of a variety of tools and techniques, it reconsiders some widely held assumptions about what counts as revolutionary and for whom. Analytically, it takes up and reflects on one of the main issues raised by feminists and social historians: the agency of users as patients and consumers faced with choice and coercion. By examining practices of contraception alongside those of abortion, it revisits the knotty question of technology in the sexual revolution and the related themes of medical, legal, religious and political forms of control.