These effective and convenient methods resulted in widespread changes in birth control (16). In 1960, the era of modern contraception began when both the birth control pill and intrauterine device (IUD) became available.
Nevertheless, by 1933, the average family size had declined to 2.3 children.įamily size increased from 1940 until 1957 ( Figure 1), when the average number of children per family peaked at 3.7 (14,15 CDC, unpublished data, 1999). In 1928, the timing of ovulation was established medically, but the safe interval for intercourse was mistakenly understood to include half the menstrual period (13). Other reported methods included infrequent sexual intercourse (8%), intermittent abstinence (6%), and contraceptive sterilization (4%).*** Using abstinence to prevent pregnancy was limited by uncertainty about the timing of a woman's ovulation. Among a national probability sample** of 1049 ever-married white women born during 1901-1910 and interviewed in 1978, 71% reported having practiced contraception common techniques used were the condom (54%), contraceptive douche (47%), withdrawal (45%), rhythm (24%), and the cervical diaphragm (17%) (12). By the 1930s, a few state health departments (e.g., North Carolina) and public hospitals had begun to provide family planning services.ĭuring the first part of the 20th century, family planning focused on the need of married couples to space children and limit family size. As a result, physicians gained the right to counsel patients and to prescribe contraceptive methods (10,11).
During the 1920s and 1930s, Sanger continued to promote family planning by opening more clinics and challenging legal restrictions. The police closed her clinic, but the court challenges that followed established a legal precedent that allowed physicians to provide advice on contraception for health reasons. In 1916, Sanger challenged the laws that suppressed the distribution of birth control information by opening in Brooklyn, New York, the first family planning clinic. Margaret Sanger ( see box), a public health nurse concerned about the adverse health effects of frequent childbirth, miscarriages, and abortion, initiated efforts to circulate information about and provide access to contraception (9). In 1912, the modern birth-control movement began. In 1900, six to nine of every 1000 women died in childbirth, and one in five children died during the first 5 years of life.* Distributing information and counseling patients about contraception and contraceptive devices was illegal under federal and state laws (8,9) the timing of ovulation, the length of the fertile period, and other reproductive facts were unknown. This report reviews the history of family planning during the past century summarizes social, legal, and technologic developments and the impact of family planning services and discusses the need to ensure continued technologic improvements and access to care.įamily size declined between 18 from 7.0 to 3.5 children (4). Publicly supported family planning services prevent an estimated 1.3 million unintended pregnancies annually (5). Modern contraception and reproductive health-care systems that became available later in the century further improved couples' ability to plan their families. Despite high failure rates, traditional methods of fertility control contributed to the decline in family size (4). Smaller families and longer birth intervals have contributed to the better health of infants, children, and women, and have improved the social and economic role of women (2,3).
Fertility decreased as couples chose to have fewer children concurrently, child mortality declined, people moved from farms to cities, and the age at marriage increased (1). Achievements in Public Health, 1900-1999: Family Planningĭuring the 20th century, the hallmark of family planning in the United States has been the ability to achieve desired birth spacing and family size ( Figure 1). For assistance, please send e-mail to: Type 508 Accommodation and the title of the report in the subject line of e-mail. Persons using assistive technology might not be able to fully access information in this file.
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