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Imagine a world without contraception A shortage of birth control could be embraced as an easy solution to shrinking populations

Condoms for sale. Credit: Dimas Ardian/Getty


July 23, 2020   6 mins

In my teens and twenties, I had a recurring nightmare about accidental pregnancy. The idea that even a casual encounter could have life-changing consequences was a lurking presence at the edge of my otherwise relatively carefree sex life.

Of course, women in the modern world have options. My GP was happy to prescribe me the Pill when I was a teenager. When I was in my twenties in 00’s London, sexual health clinics plied drop-in clients with great fistfuls of condoms packed in brown paper bags like party favours. My years of prime fertility unfolded in a culture where an active sex life is seen as normal and healthy, and contraception as a basic healthcare right.

We seem sometimes to have forgotten that birth control is at least as central to women’s participation in public life as universal suffrage. Today, it’s expected that women will join the workforce on reaching adulthood, and pursue careers on equal terms with their male colleagues. But that couldn’t happen without contraception.

Shorn of the ability to control our fertility, a woman might pay others (if she can afford it) to care for her children, give her babies away to be adopted, or avoid sex altogether to ensure she doesn’t have them in the first place. But as for ‘having it all’ (or ‘having it’ at all without getting pregnant), forget it.

A century or so before I reached my prime shagging years, Margaret Sanger was making this case in a very different world. “Enforced motherhood”, she wrote in 1914, “is the most complete denial of a woman’s right to life and liberty.”

Sanger is no less controversial today than she was a century ago, albeit for different reasons. Recently Planned Parenthood, the contraception and abortion charity she helped found, disavowed Sanger for her enthusiasm for eugenics, which was considered a progressive cause in Sanger’s time. But 100 years ago, Sanger faced threats and even arrest for campaigning to make contraception and contraceptive knowledge widely available.

In 1929, she published Motherhood in Bondage, a collection of excerpts from letters sent to her by women desperate for help with fertility. The book gives an inkling of what life looks like when you’re poor and your fertility is not within your control: a litany of exhausted, ground-down, ill and impoverished women, many on their seventh or eighth pregnancy in their mid-twenties, begging Sanger for information or help on “how to don’t have more children”, as one correspondent put it. One writes:

My smallest baby is three months old and I’m afraid I’ll get pregnant any time from now on. So please give me some kind of advice because I cannot support what I got and when they are four I don’t know what to do. I’m only twenty years of age.

Sanger was one of the first feminists to campaign for a woman’s right to be, as she put it, “the absolute mistress of her own body”. A century on, in the developed West, her goal has been largely reached. While accidental pregnancies still happen, the vast majority of women are able to access contraception, emergency contraception and — should they wish it — abortion services.

The grim condition of those impoverished early twentieth-century women, struggling to feed and clothe an ever-growing brood, is happily a thing of the past. But I wonder if we can take this for granted in perpetuity.

The story of contraceptive manufacturing is, broadly speaking, the story of manufacturing generally: offshored to Asia to reduce overheads, with only branding, administration and R&D still predominantly based in Europe. Durex, once the British Rubber Company, has based its entire condom manufacturing capacity in China, India and Thailand. The vast majority of oral contraceptives, as well as the component ingredients used in their creation, are manufactured in China and India. No one makes contraceptives in Britain.

This is just fine in a situation where relatively frictionless international trade is assumed as a permanent feature of the modern world. But this turns out to have some drawbacks when there’s a political, economic or biomedical shock to supply chains.

It doesn’t even take a pandemic. Last year, doctors were worrying about the impact of Brexit on contraceptive supplies. In February this year, the estimated 3.1 million British women who use the contraceptive pill faced severe shortages, for reasons that still remain unclear.

Then when Covid-19 hit in the spring, India banned the export of pharmaceuticals, including progesterone — one of the key ingredients in the Pill. The ban only lasted three weeks, but still caused shortages of oral contraceptives. According to the global development organisation Devex, the ripple effects of coronavirus-related disruption to manufacturing also triggered a condom shortage in Mozambique and import delays in IUDs to Iran.

An optimist might tell me that none of these incidents is likely to be more than a blip. And perhaps they’d be right. Provided, at least, that the global economy stays stable, China stays friendly (and doesn’t go to war with India), global commercial shipping is able to continue, and there are no more surprises in store that threaten the fabric of globalised trade. A year ago I’d have said that scenario looks a reasonably safe bet. Halfway through the madness of 2020, I’m not so confident.

Of course, new factories can be built closer to home, if they seem economically viable. Women’s contraceptive security, though, is threatened not just by de-globalisation but also environmental concerns.

The contraceptive pill is one of the most widely used pharmaceuticals on the planet. 3.1 million British women use it, making it our most common prescribed contraceptive. It works by mimicking the hormones released during pregnancy, and its main hormonal component is a synthetic estrogen known as 17α-ethinylestradiol — a compound that is disastrous for aquatic life. Its presence in rivers and groundwater disrupts the endocrine systems of a range of species, causing intersex conditions in frogs and fish and severely harming their ability to reproduce. It is also difficult and expensive to clean from waste water.

Environmentalists tend to be broadly liberal-feminist in their sympathies, which may help to explain why this issue generally gets soft-pedalled. No one who supports women’s reproductive autonomy will be enthusiastic about confronting the ecological harms done by synthetic estrogens. So the topic remains, to date, mostly a talking-point for the Weird Right.

But there’s a clear trade off between a woman’s desire to be “absolute mistress of her own body”, and our collective duty to ensure oryzia latipes (and all the other aquatic species turned intersex by 17α-ethinylestradiol) can remain even to a degree masters of theirs. Eventually, we will have to confront this issue.

Let’s hope that when we do, science prevails, and we come up with a better way of cleaning waste water. If we don’t, sooner or later the contraceptive pill will be banned.

Such a ban might be hastened by demographic fears. The BBC recently reported a “jaw-dropping” global crash in fertility rates. In the developed West, fertility has been below replacement for generations, but the report predicts that the global birth rate — currently around 2.4 — will on current trends plummet to 1.7 by 2100. Extrapolated long-term, this is an existential threat to humanity: as Professor Christopher Murray, one of the reports’ authors, puts it: “If you can’t [find a solution] then eventually the species disappears.”

I doubt we’ll remain so committed as a species to reproductive autonomy that we shrug our shoulders while the birth rate plummets toward human extinction. Far more likely is that we’ll see growing pressure on women to get gestating. Oryzia latipes may yet find itself championed by pro-natalists, keen to use the ecological downsides of the Pill as an argument for restricting women’s contraceptive choices.

Though not (yet) on ecological grounds, some countries are already restricting contraception as part of efforts to drive up the birth rate. Iran has ceased to offer birth control and vasectomies via state healthcare — a policy that explicitly targets the country’s slumping birth rate. In effect, for Iranian women, worry-free sex has become a bit like cashmere jumpers or safari holidays: nice, but only if you can afford it.

Should contraceptive manufacturing be expensively re-shored, in response to de-globalisation, we might face an analogous situation in Britain: birth control still available, but only as a luxury product.

None of these scenarios is inevitable. But those of us concerned for women’s welfare should take the question of contraceptive security seriously. We should also take seriously the question of why women don’t seem to want to have babies.

The Left tends to blame this on sexism and the immiserating effects of capitalism (see for example Laurie Penny here), arguing that these factors make child-rearing arduous and unaffordable. The reactionary Right, on the other hand, tends to blame the baby strike on the pernicious effects of feminism. They’re both partly correct.

As that “jaw-dropping” BBC article puts it, falling birth rates are partly a result of “more women in education and work, as well as greater access to contraception”. In other words, they’re a consequence of the increase in women’s choices and as such are — in the article’s words — a feminist “success story”.

But recent research from the US-based Institute for Family Studies also shows that, worldwide, women are having fewer children than they’d like to. This implies that the supposedly ‘free’ choice to have fewer children is indeed, as Laurie Penny suggests, constrained by structural factors.

It ought to be possible for public policy to recognise that unwanted pregnancies are a nightmarish prospect for women — especially given today’s uncertain economic outlook — while also acknowledging that many women wish they could have more babies. Hungary’s birth rate has increased by 5.5% following Viktor Orbán’s introduction of subsidies aimed at encouraging larger families; this implies that state intervention can indeed tip the balance for would-be mothers, without coercive measures such as taking birth control away.

Those Right-wingers who are indifferent to women’s interests, safety or subjectivity might be tempted to leap on the prospect of contraceptive shortages as a straightforward solution to shrinking populations. But this would mean returning women to forms of bondage that Margaret Sanger fought to end a century ago. If we’re to stabilise the birth rate without embracing this kind of anti-women approach, the Right will need to learn from Hungary and embrace an activist, pro-family state.

Meanwhile, the Left will need to get over its obsession with abolishing the family. Both these perspectives, in different ways, treat human reproduction as a matter solely of individual choice. But bringing new generations into the world is the responsibility not just of individuals and families, nor just of women. Rather, it’s on all of us: a shared duty to our collective human future.


Mary Harrington is a contributing editor at UnHerd.

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chrisjwmartin
chrisjwmartin
4 years ago

“If you can’t [find a solution] then eventually the species disappears.”

I often wonder at the short-termist thinking of those who say things like this: as Mary rightly points out, it wouldn’t stay that way for long.

In particular, birth rates always fall as a society approaches its carrying capacity. For agrarian societies this was almost entirely a function of how much grain the land could produce. Modern societies have other limits, including living space and living standards, but the principle remains the same.

Despite the undoubtedly sincere worrying of feminists, families have always found ways to control their reproduction when necessary. That happened in agrarian societies, it happens today, and it will happen in the future, whatever it may look like.

Besides all which, a significant fall in the human population would be no bad thing. Throughout human history population falls have been a natural and necessary way for living standards to improve. We have not escaped the cycle of history, and we should look to the coming population adjustment with equanimity.

jim payne
jim payne
4 years ago
Reply to  chrisjwmartin

Is the fact that birthrates are only falling in developed countries?
It would seem in some less developed countries, births continue as before and as the “12 Century” impoverished women, can have little help to slow down their rate of pregnancies.

chrisjwmartin
chrisjwmartin
4 years ago
Reply to  jim payne

No, birth rates have fallen starkly in nearly all of the developing world too. Not as much as the developed world, but still a big fall.

Steve Gwynne
Steve Gwynne
4 years ago
Reply to  chrisjwmartin

https://www.bbc.co.uk/news/

What about Africa?
The population of sub-Saharan Africa is expected to treble in size to more than three billion people by 2100.

And the study says Nigeria will become the world’s second biggest country, with a population of 791 million.

As such, we can expect to see diminishing national populations supplemented by mass migrations from Africa.

Brian Dorsley
Brian Dorsley
4 years ago

Most Western left-wing politics is designed to reduce population growth: abortion, LGBQT lifestyles, feminism etc. My wife and I have considered having children, but are put off by the costs, the ‘need’ to have a job, and simply the hard work of it all.

Many of my friends have children but seem to regard them as a ‘mini-me’ or a lifestyle accessory. Occasionally I indulgently wonder if I’m missing out on some wonderful experience until the moment I hear the shrill ear-splitting shriek of a two-year old in the grocery store.

Anton Nadal
Anton Nadal
3 years ago
Reply to  Brian Dorsley

Left-wing politics are not designed to reduce population growth. They are designed to give individuals the right of choice over their lifestyles. The birth rate in the West is not declining as a result of lrft wing politics (if only because there are but few left wing governments around). Heterosexual families are the norm. Try looking in the precariousness that forty years of neoliberalism has imposed in the lives of the people who depend on jobs for subsistence, you’ll find a more logical explanation there. I’m not discounting other cultural factors that may shape young people’s expectations.

Matthew Powell
Matthew Powell
4 years ago

Rapidly falling birth rates may not be an existential threat but they certainly are a financial one.

Our savings only make up part of our pensions, the rest is made up of from the continued economic growth of the next generation and as such pensions are reliant on keeping the dependant to worker ratio low enough to be able to afford them. Increase this ratio too quickly and pensions will become unaffordable, which is exactly what happens when the birth rate declines rapidly, as it is now.

Immigration can mitigate this but it is effectively a ponzi scheme. You will need more migration tomorrow than you did today to sustain the same dependant to worker ratio, so migration would have to increase infinitely to sustain the ratio you started with.

Whilst the choice to have children is up to the individual, there becomes a communal aspect when you realise that in a population with a low birth rate, those who bore the costs of raising children are effectively having their children pay for their pensions, and the pensions those who didn’t have children.

Of course I don’t suggest we punish the childless but it would certainly help if society and the government was more supportive of families and recognise that children and families are a necessity, not a life style choice.

unconcurrentinconnu
unconcurrentinconnu
4 years ago
Reply to  Matthew Powell

A little bit of truth and a little bit of exaggeration there. We don’t need large families, nor population growth. In fact, a smaller population would have many benefits in terms of space, pollution, congestion, wildlife, and even house prices. It would just be an adjustment process in moving to a policy of population decline – and we are all used to adjusting in the face of never ending change.

Matthew Powell
Matthew Powell
4 years ago

What your omitting is that modern pensions have been structured in a way that require high levels of continued economic growth to afford them and that population growth has been used as a short cut to easy economic growth, to make up for the short fall in productivity growth.

Therefore I’m not advocating population growth but pointing out that the beneficial dependant to worker ratio, which modern pensions rely on to be affordable, will be lost when we transition from a growing to a static or declining population.

This change is inevitable but has continuously been postponed by our government by using immigration to drive population growth to sustain the ratio.

When we do transition however, we will be hit by a multi billion pound pension deficit, unless in the near future economic growth increases significantly to offset this. This will likely dwarf the economic benefits of population decline in the short to medium term.

If economic growth doesn’t occur, then the next best thing is to transition more gradually to a static or declining population, as the faster the transition, the less favourable the ratio of dependants to workers will be and the bigger the economic shock from the pensions black hole we’re amassing.

From this perspective, a fertility rate on or just below replacement rate would be required to mitigate the damage but at present we’re not meeting this target, which increases the magnitude of the pensions shortfall.

If you think the youth of today are angry, just wait a few more years when they are told they have to work longer, pay more tax and receive less back in return, to pay for the pensions of the generation which preceded them.

Anton Nadal
Anton Nadal
3 years ago
Reply to  Matthew Powell

“Immigration can mitigate this but it is effectively a ponzi scheme. You will need more migration tomorrow than you did today to sustain the same dependant to worker ratio, so migration would have to increase infinitely to sustain the ratio you started with.” As with immigration so with having children, wouldn’t you think?

Matthew Powell
Matthew Powell
3 years ago
Reply to  Anton Nadal

I cover the need for a static or declining population. It’s the speed of decline which is the issue.

alisonwren3
alisonwren3
4 years ago

No one seems to have mentioned so far that it takes heterosexual vaginal intercourse to make a baby ( unless technology is used). In the pre Pill days we made sure we didn’t get pregnant with a series of very pleasurable and non penetrative sexual behaviours. If women knew they wanted to avoid pregnancy, and men accepted they don’t have a right of access to women’s bodies, maybe we wouldn’t need to interfere with nature by introducing artificial hormones into women’s bodies and the wider ecosystems. And natural family planning has an extremely low failure rate when practiced correctly.

H N
H N
4 years ago
Reply to  alisonwren3

LOL. That wouldn’t work. These men would demand a**l. Nobody wants to acknowledge the fact that many men (and increasingly women) are addicted to internet pornography. It’s now to the point where many young men have erectile dysfunction. It’s impossible to consider having a family with a man who spends all his spare moments staring at a screen, looking for his next sexual fix. Many young women with children are experiencing exactly that– they are stuck with all of the childcare and domestic duties while their partners spend hours upon hours surfing internet porn and video gaming. Those who have one children don’t want any more. Those who witness their friends suffer carrying all the burden of keeping the family in tact while daddy chases his next cam girl fantasies say “no thanks– I’ll stay single and childless”.

The ridiculous cost of basic necessities today make having children a sure-fire one way street to profound poverty unless you are well connected and have an excellent STEM job.

I regret having a child prior to earning six figures. He will always always suffer and have limited opportunities because his parents weren’t wealthy, and he already knows it despite barely being a teenager.

carolstaines8
carolstaines8
3 years ago
Reply to  alisonwren3

I can’t accept the phrase “accidental pregnancy”. As you point out, there are many ways of avoiding pregnancy and have been practiced for aeons. Is the term “accidental pregnancy” used as a cover for not understanding what sex can result in conception? Most pregnancies are caused by indulging in consensual acts, often with fingers crossed and lack of forethought.

Stuart Bennett
Stuart Bennett
3 years ago
Reply to  alisonwren3

In defence of decent men everywhere, and there any many. I don’t know anyone who believes they have “a right of access”.

Dougie Undersub
Dougie Undersub
4 years ago

Another typically thoughtful and thought provoking article from Mary on a topic that should be, but isn’t, widely discussed.
Our birth rate may be below replacement level yet the population of the UK keeps increasing. Any ideas? Whatever the reason, extinction of the human race isn’t an immediate problem on our little island.
Indeed, extinction of the human race isn’t a problem at all. As environmentalists keep telling us, we’re just another species, with no greater right to exist than bonoboes, lizards or slugs. It’s not as if it’s going to happen overnight. If the human beings of the 31st century are worried about extinction, I’m sure they’ll be able to clone a few billion extra people as necessary.
No, the only real problem is the one you opened with, the ecological damage caused by pharmaceuticals – it’s not just the pill. Environmentalist feminists are going to have to grab this bull – cow? – by the horns.
Over to you, Dr Lucas.

Stuart Bennett
Stuart Bennett
3 years ago

I’m no eco warrior by any measure but I can find no sensible argument against reducing the global population given the still accelerating consumption of finite resources, human caused species extinction, pollution & the A.I. / Robotics revolution that’s surely coming and will affect job prospects for the poorest most of all. There are several billions too many of us already. It’s madness to suggest that more humans is a good idea and as I understand it the only proven way to reduce population without harm is the education and empowerment of women. It goes without saying we should be fighting for this on a global scale in all countries (even without the benefit of not clogging up the planet with more consumers, obviously).

johnjweyland
johnjweyland
4 years ago

who in their right mind does not want population to shrink?

Andrew Fisher
Andrew Fisher
3 years ago

The whole article though interesting has a slightly odd flavour in that environmental concerns about overpopulation (whether well-founded or not) are not even mentioned. Clearly if population growth is going to flatten and then go into reverse then populations will inevitably age and the proportion of young people decline. An oft mentioned ‘solution’ to this is to increase immigration from poorer and younger countries, but as we know this also has its political, social, economic and cultural issues. And with a replacement fertility rate already having I believe fallen to about 2.5 worldwide, this will eventually itself become less and less feasible, at least without huge harm to the ‘people donor’ countries themselves.

However surely it should not be beyond our competence to reconfigure social care, tax and pension systems need to adjust to the new population realities. Although what extent voters want to retire later and work longer is of course another issue.

We seem to be addicted to doom-mongering scenarios whichever way we face; the population is too big, then it it is becoming too small….

Anton Nadal
Anton Nadal
3 years ago

The left has an obsession with abolishing the family?! First time I’ve heard.

Meghan Kathleen Jamieson
Meghan Kathleen Jamieson
3 years ago

Given that we are quickly depleting the ability of the planet to sustain the human population we have, this article is bizarre. The spectre of underpopulation is really the spectre of consumption that doesn’t meet the increasing demands of capitalism.

What’s really very interesting, in terms of the availability of artificial contraception, is that feminism, or women’s liberation, or equality of the sexes, is so very dependent on this technological intervention to make it possible – as if it is only by making women less female that we can see them as equal, or shape society to give them equally good lives, dignity and respect. Without access to these products, our vision of ourselves as enlightened about women and their role will fall apart very quickly.

In a way artificial contraception is a perfect mirror to unrestrained capitalism, severing the connection between action and result, creating the illusion that by consumption is a right and that the consequences of that consumption are an imposition, and allowing us to think we can and should be able to construct a good society where we care for others without the necessity for personal self-restraint.

John Alyson
John Alyson
4 years ago

The idea that even a casual encounter could have life-changing consequences was a lurking presence at the edge of my otherwise relatively carefree sex life.

And there we find the elephant in the room. The inherent point of sex is to produce life-changing consequences. Using contraception to gut a fundamental aspect of biology of its purpose is always going to be awkward and, from a classical philosophical point of view, be immoral.

Miriam UĂ­
Miriam UĂ­
4 years ago

Maybe we could start enjoying our families again?

Muscleguy
Muscleguy
4 years ago

Here in Scotland ScotGov funds an increasing number of free childcare hours. Up to 35 hours a week now. Both to encourage women’s participation in the workforce and to try and increase the birth rate by supporting families. We need more people up here.

Pete Marsh
Pete Marsh
3 years ago

I saw a UN report that predicts the population of Africa will increase from 1.3 billion now to 4 billion by 2100. So an extra 2,700 million people. I don’t think we’re going to run out of people anytime soon…

frances.edwards.fe
frances.edwards.fe
4 years ago

Stop abortion and then they’d be enough people.

Paddy Taylor
Paddy Taylor
4 years ago

Frances,

Be careful what you wish for:

https://journalistsresource.org/studies/economics/abortion-crime-research-donohue-levitt/

H N
H N
4 years ago

You’d have a lot more crime, and more poverty.