Book Review

Contraception and Abortion in 19th-Century America

N Engl J Med 1994; 331:1595December 8, 1994

Article

Contraception and Abortion in 19th-Century America
By Janet Farrell Brodie. 373 pp. Ithaca, N.Y., Cornell University Press, 1994. $33.95. ISBN: 0-8014-2849-1

Regardless of official political or religious policy, attempts to control fertility have been made since antiquity. Women have usually initiated limitations on fertility, a subject that in many societies has been, and still is, considered unsuitable for open discussion. Information has been passed on orally or by means of ephemera such as pamphlets, periodicals, and package instructions. These items, which are usually discarded or recycled, challenge the historian.

From these and other sources, Brodie has constructed a history of changes in fertility control among women living in the United States during the 19th century. She introduces the subject with her study of one middle-class woman's life, as recorded in a remarkable series of diaries. This woman, married to a loving and cooperative husband, had nine pregnancies and delivered seven children. Despite the use of lactation, douching, and possibly other methods, she recorded increasing worry and despair about her own health and her inability to prevent pregnancy. The diaries provide a rare glimpse of one woman's feelings in an era when contraception was not considered an appropriate subject of medical attention.

During the 19th century, barrier methods, withdrawal, douching, and periodic abstinence were popularized. There were technical advances in barrier methods, particularly as experience with rubber manufacture increased, but lack of knowledge about the menstrual cycle caused inaccurate advice to be given about periodic abstinence. Information was disseminated by several routes. Public lectures and tours became more frequent with urbanization, and the mail provided an opportunity to order books and supplies discreetly. Brodie's intensive search through periodicals, advertisements, catalogues, and contemporary books has yielded a fascinating gallery of characters. Some authors and lecturers, whether physicians or entrepreneurs, promoted a single method of contraception, whereas others attempted to include information on all that were available. Many had a substantial financial interest in selling their method of choice, whether condoms, pessaries, syringes, or spermicides. This practice was not unusual at a time when many physicians earned much of their income from selling medications.

Descriptions of the popularization of these contraceptive methods occupy most of the book. A series of fascinating vignettes for anyone with an interest in history, they remind us that much of the world still depends on methods, however imperfect, that were available in the United States over a century ago.

The much shorter and more awkward discussion of abortion practice consists of descriptions of several practitioners. The final chapter, “Criminalizing Reproductive Control,” is the weakest and least satisfying in the book. It lacks the organization of the previous chapters and is repetitious. This deficiency is unfortunate. The history of the criminalization of methods to control reproduction, with a cast of ambitious politicians, variously apathetic and contradictory physicians, and minority political voices, has relevance to the ethical and political debates of today.

Despite the limitations of the final chapter, anyone interested in the social or medical history of the last century will enjoy Contraception and Abortion in 19th-Century America.

Lynn Borgatta, M.D., M.P.H.
Planned Parenthood, White Plains, NY 10607-1616