Once seen as a tool of sexual liberation, the Pill is now often spoken of as a pharmaceutical menace, wreaking havoc with female moods and increasing the risk of cancer. It was first rolled out on the NHS in 1961 — for married women, of course. And though still the most popular method of birth-control, its use is plummeting — data published in June last year showed that community pharmacies dispensed 7.2 million items of progestogen and combined contraceptives in 2022-3. In 2014/15, the number was 8.5 million.

A world away from the groans associated with the Pill, there is an enticing optimism to the chatter around the contraception app of the moment, Natural Cycles. To look at testimonies online is to find yourself in the lexical world of the farmers market — words like “harmony” and “rhythms” crop up just as a wrinkling of the nose, an eye roll, follow any mention of the Pill. How good might it be, I think between big rips of a vape, to be free of chemicals?

There are currently three million users, or “Cyclers”. And the Swedish developers claim a 93% effectiveness rate — similar to the Pill — when used correctly. But the app’s effectiveness is in fact disputed, with many women reporting unwanted pregnancies. The NHS says of fertility awareness methods: “If you do not follow the instructions exactly, it is only 76% effective. This means 24 in 100 women will get pregnant when tracking their fertility for a year.” Aside from this, you have to pay for it. I was quoted £69.99/year to use Natural Cycles, or £9.99/month; the Pill is free for us and costs the NHS £11-18 per year. “It takes a bit of privilege to be able to afford to do all this lifestyle stuff,” remarked one friend. “It’s kind of like being vegan.” 

One Cycler friend talks me through the appeal. “The reason I did it was because the alternatives were just shite. I had used condoms for a while and then I was seeing someone who was an absolute arsehole, who refused to use a condom.” The app requires you to take your temperature every day; some looking for more data insights also take a luteinising hormone test — a strip dipped in urine — which indicates when you are about to ovulate.

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The theory goes that your temperature rises in line with ovulation — but it’s far from an exact science. “I’ve been using it for two months and my temperature has not gone up when I’ve ovulated,” says my friend. “Another problem is the temperature is declared void if you’re hungover or if you’ve slept differently (three hours more or less than usual) which for me is quite often.” But, she adds, there is a “huge positive”: “This girl I know has the sweetest boyfriend, and they have both downloaded the app, so he can see her cycle days. I think that’s a really sweet aspect of it.”

The app’s effectiveness seems secondary to the lifestyle it implies: one of responsible, communicative relationships, control and modernity. Thinking about my past relationships, I’m not sure I’d want someone to be able to cross-reference my bouts of irritation or friskiness with charts on their phone. But might the dividend, a feeling of purity, be worth it? One hormone-free friend tells me: “I love being in touch with my body and knowing when my period is coming. Obviously if I get pregnant, I’ll probably feel differently but so far it’s been working really well for me, and I love how it feels more natural.”

I can understand this desire. Like most women I know, I’ve been through the ringer. The day after I lost my virginity, a woman in Boots told me with full confidence that I was almost definitely pregnant and had to take the morning-after pill. I fainted from the shock and found myself lying in a side room with my legs in the air, with my best friend trying not to laugh. Then I was put on the combined pill Rigevidon, the architect of so many teen crises. I would cry hysterically, rage at my poor boyfriend, break out in a rash of chin spots. A year on, I got the progesterone-only arm implant. But when I wanted it removed, three years later, muscle had grown so tightly around it that the lady in the UCL sexual health clinic had to spend a good five minutes trying to jimmy it out with a scalpel, blood streaming down the left side of my body. When my hormones went back to normal, I couldn’t cope. I was so used to synthetic interventions that I couldn’t hack being without them. So I came full circle, returning to the chemical embrace of the good old combined Pill.

And the funny thing is, my experiences are very much at the less dramatic end. Almost every straight woman my age is walking around with about 10 years of contraceptive crises behind them — pregnancy scares, alien discharge, battered sex drives, fizzing rage. 

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One explanation for Gen Z’s particular aversion to the Pill might be its much-touted sexlessness. Much has been made of “puriteens” — who are now entering their monastic mid-twenties. Over the weekend, I asked one pal why on earth she wasn’t using any contraception. “Because I don’t have sex,” she said. “It’s like a solstice,” she conceded. “Bi-annual.” She has high standards, she added. “And men are disgusting” — an afterthought.

The poisonous dating scene may be all the contraceptive we need. It also dampens hopes of a male Pill — if there even was one, would women trust them to take it? Probing further, the common refrains emerge. “I’ve never met a penis that’s worth the risk.”

Most women I speak to also cite cancer concerns. I can pinpoint the exact moment my circles started fretting about this — the publication of an Oxford study in March last year, which showed progestogen-only contraception raised the risk of breast cancer by up to 30%, an effect which disappears a year or so after you stop taking it. The extra cases of breast cancer amounted to eight in 100,000 for those in their late teens, and 265 in their late 30s. In other words, there will be just 0.008-0.265% more cases of breast cancer because of the Pill. The only new information in the study was that the risks of progestogen-only contraception were similar to those of the combined Pill — stats which had been known about for decades. But the ripples of panic among women I knew (and myself, before I looked into it more) were completely out of proportion. 

It cannot escape us that a generation so accepting of the considerably greater risks of gender-affirming hormones is so worried about those of the Pill. This tells you, I believe, how ideological the use of oral contraceptives actually is: in a cishet context, synthetic hormones are symbolic of the lack of parity between the sexes (“I feel slightly hard done-by as a woman that we’re expected to take drugs that could potentially harm us when men get off scot-free,” says one friend); for a gender-dysphoric teenager, they are framed as a revolutionary tool.

The final nail in the coffin may, I believe, be the mood changes associated with the Pill. “Instantly when I took it my libido was just zero,” said a friend. “I came off the patch by accident when I was travelling and once I got back I noticed I was a lot less anxious — despite being at quite a stressful point in life,” said another. Another tells me: “I was on all sorts of hormonal contraception for over 10 years and I’ve been doing the pull-out method for a year now. When I first came off the patch this weird dark cloud lifted off me that I didn’t realise was there and had been for years. Like I was basically a little bit depressed all the time without knowing.” I am well aware of the rollercoaster of synthetic hormones — by turns euphoric, terrifying, nauseating, lurching. I have three sisters, and suspect that the stratospheric teenaged dramas in our house at least partly originated in some pharmaceutical lab.

Politically, the Pill has always been grist to any mill going — a cypher for social malaise. Its liberating potential is a big topic in the manosphere — it variously frees men from the apparently oppressive strictures of monogamy or allows women, formerly wiping baby-sick from chins at home as they should, to sail through workplace hierarchies and tread on men’s prospects. In feminist circles, its emancipating qualities have been linked to a casual sex culture which ultimately disadvantages women. While I know this to be true, I think what gives men the desire and ability to pick up and cast aside partners has to do with more than just pharmaceuticals. 

What will really sink the Pill, though, is not its cancer risk, mental health impacts or effectiveness — but its susceptibility to the swirl of ideologies that swamps modern women. It has become synonymous with self-fashioning; do you identify as a feminist, are you sex-positive, are you a health nut? Are you a Catholic, are you a witch, are you a femcel? Any one of these labels has a corresponding stance on the Pill. What was once a question of being liberated or not has been swept up in the thousand atomised tribes of modern identity politics. We have forgotten how hard-won reproductive rights are, and look with disdain on many of the women who fought for and secured us those rights in the Fifties and Sixties, and whose views we now deem outmoded. Fragmentary feminism is at risk of forgetting where it came from.  

It matters greatly if the Pill falls out of fashion, because in a world where abortion rights are ever more precarious, we need to be on our guard about contraceptive trends — fuelled by exaggeration, misinformation and purity fantasies, they may in fact land any one of us with an unwanted pregnancy. In the sweep of history, having sex without having a baby has only recently become an option — and it may not be forever.

It’s not exactly subtle. And it’s not exactly misguided, either: in the Fifties, when Dr Gregory Pincus began testing an early prototype for the pill, his test cases were incarcerated, institutionalised, and impoverished women. In other words, women whose incapacitation and economic despair made them easy to take advantage of. It was a deplorable measure, in a desperate time: funding for birth-control research was banned by the US government until 1959, so Pincus’s work was supported by private donors, whose advocacy was directly downstream from an unsavoury enthusiasm for eugenics. For those funding the research, the pill represented a way to keep the wrong people from procreating. For the doctors who created it, the pill was an exciting scientific challenge.

That it would eventually emerge as a vehicle of female sexual liberation, one of the most socially important breakthroughs in medical history, was something neither party anticipated. While women’s bodies and biology were central to the science of the birth control pill, women themselves — not only the ones who served as guinea pigs, but also the ones who would eventually choose to take the pill — were treated as something of an afterthought. Pincus rather infamously wrote off his patients’ self-reported side effects — that same litany of problems featured on McCall’s wild spinning wheel — as the “psychogenic” products of an overactive imagination.

In short, McCall is right to suggest that the ubiquity of the birth control pill has come at the expense of women’s ability to express their concerns about it. And with Pill Revolution, she seems poised to usher in a new age of pill-related controversy: one centred on health concerns.

In this, she is unlike early critics of the pill, who were, of course, far more concerned with sexual morality than women’s wellbeing. Hormonal contraception has long been a source of consternation amongst conservatives, particularly the religious variety, who see it as a facilitator of consequence-free sexual intercourse. That loathing has little to do with the pill specifically — and more to do with a categorically antagonistic relationship toward non-procreative sex of all kinds — but it proved markedly influential in the public conversation about birth control.

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For me, that influence was most clearly visible in the form of abstinence-focused sex education programmes, which were ubiquitous in American public schools in the Nineties — including the one I attended. Among other things, these classes were an exercise in institutionalised slut-shaming. Often, a piece of lint-covered Scotch tape would be brought out as a visual representation of how premarital sex ruined a woman’s ability to bond with her eventual husband. And with the primary goal of discouraging teens from doing it, the instruction we received in reproductive science verged on intentional disinformation. Girls, it was understood, were so wildly and indiscriminately fertile that just looking at an erect penis from across the room might result in pregnancy.

Birth control, meanwhile, was described as unreliable at best. Often, these programmes would tout inflated failure rates for various contraceptive methods — without ever mentioning that these numbers included pregnancies which resulted when a couple had birth control available but hadn’t actually bothered to use it. The pill, we were warned, was less than 90% effective — and that was assuming you could get past the stigma of being the kind of trollop who needed to take it in the first place.

The point, of course, was not education, but intimidation: to scare you away from sex until you were married and ready to procreate, at which point you would not be bothering with birth control. The conservative hostility to the pill rumbled along in the form of abstinence programmes and purity culture for years before reaching its contemporary apotheosis in 2012. After the US government moved to provide birth control to all women free of charge, Rush Limbaugh infamously suggested that women who supported this measure were akin to prostitutes demanding other people’s money so they could have sex.

But Limbaugh’s outburst was a swansong for the Right-wing war on contraception. And the new backlash against the pill, as embodied by programmes such as McCall’s, is fuelled less by conservative pearl-clutching about hook-up culture, and more by renewed concerns over its side effects — a full-circle return to the issues that plagued the pill in its infancy.

Among women who believe that the birth control pill has had a deleterious effect on their physical or mental health, there’s a palpable sense that the medical establishment has behaved irresponsibly, foisting powerful pharmaceuticals on them while dismissing their doubts as nonsense. “As young women, we’re just chucked on the pill and expected to get on with it — but when we go back with concerns, you don’t feel like you’re being heard,” McCall says, echoing a sentiment that comes up repeatedly throughout Pill Revolution. A few years ago, Sarah E. Hill’s book about How the Pill Changes Everything made a splash with similar points.

Whether you agree with their broader points or not, the women making this case are responding to decades of gaslighting by the medical establishment. McCall explains during her program that the weeklong break many women have from their birth control cycle each month is not medically necessary, but rather a product of the Fifties-era desire of scientists to create a contraceptive product that would not raise the hackles of the Catholic church. What she doesn’t mention is that it was also meant to quell the doubts of women themselves: when Pincus realised that the progesterone in his prototype pill would cause the complete cessation of the body’s normal menstrual cycle, he suspected women would find this alarming. His prescribed regimen — three weeks of hormonal contraceptives followed by one week’s worth of placebos — was designed to cause a monthly drop in hormone levels, resulting in the shedding of the uterine lining. It’s not a real period, but it looks and feels like one, creating the illusion that the body’s natural processes remain unaltered. If this mollified the Catholic church, it also sold women a bill of goods about the true impact of the pill on their bodies.

Two things are true. First: hormonal contraception has been unequivocally a tool of female empowerment. It gives women an unprecedented and invaluable level of control over their fertility, and, by extension, their lives. Second: the utility of the pill for women in general does not mean that it is right for every woman individually. And in the mad rush to celebrate hormonal contraception for the world-changing invention it is, some women have been silenced, and side-lined.

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If the pill has been absurdly demonised by its detractors as the purview of “sluts” and “prostitutes”, its most avid proponents seem to view it with a reverence bordering on the deific. Pill Revolution began to raise alarms within the medical community well in advance of its airing. In the Daily Mail last week, Dr Philippa Kaye wrote that while “I welcome any initiative to promote or improve women’s wellbeing”, she “was left with concerns that women may be alarmed” by the suggestion that the pill might have mood-related side effects. Where the trad movement sees the popularity of the pill as a symbol of society in decline, the progressives among us warn that its disuse would be nothing less than catastrophic.

In an interesting example of the phenomenon the French describe as “les extrêmes se touchent“, people on both sides of this issue seem to take a rather dim view of women themselves — of our ability to manage our lives, our bodies, our reproductive health. The anti-pill contingent, represented by old-school conservatives and tradfluencers alike, suggest that women are so seduced by the illusory freedom of artificially-induced infertility that they become like hedonistic children, squandering their fertile years on meaningless hook-ups and breakneck career advancement at the expense of society at large. Even more progressive sceptics — including the growing TikTok movement of self-described hormone coaches who advocate for #naturalbirthcontrol — seem to believe that women are so hopelessly manipulated by Big Pharma, and addled by contraceptive hormones, that they’ve lost all connection with their bodies.

And yet, the pro-pill side isn’t much better when it wrings its hands over the notion that women might choose not to take the pill and, hence, get pregnant. As if pregnancy is something that happens to women out of nowhere, without their knowledge or consent. As if they couldn’t possibly be trusted to weigh the costs and benefits of hormonal birth control and decide accordingly if they wish to use it.

Much is made in these conversations of the fact that so many pregnancies are unplanned — 45% in America, up to 30% in the UK — in a way that reminds me, oddly, of the way my high school sex ed programme used statistics to persuade us that birth control was futile and untrustworthy. These numbers raise the terrifying spectre of a world in which millions of women are giving birth to children against their will, eliding the fact that unplanned and unwanted are not necessarily the same thing. It’s hard not to notice that the tone of these debates — especially when they dovetail with the bigger, hairier question of women’s reproductive rights in general — has a way of crossing the line between staunchly feminist and outright anti-natalist.

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As a woman still of an age to be at least ostensibly concerned about birth control, I personally still find the anti-pill folks more off-putting, whether they’re purity-obsessed religious scolds who want to scare and shame women away from having non-procreative sex, or the contemporary “RETVRN TO TRADITION” ones with a fetishistic fixation on women’s fertility.

And yet, I’m not convinced that certain pro-pill types — the ones whose vision of liberated womanhood seems to begin and end with free birth control and company-subsidised egg freezing, the better to avoid the pesky workplace interruption of a ticking biological clock — are the heroes we need, either. The loudest voices in this conversation leave little room for a middle way, one that empowers women to avoid pregnancy if they want to, but also supports them if they wish to become mothers.

No doubt the people who want to keep women puttering away in cubicles during their peak childbearing years believe that they’re offering a better, more feminist vision than the ones who want to keep them barefoot and pregnant. But both groups are ultimately seeking the same end: to exert control over women’s fertility, and by extension, over their destinies. On this front, at least, Davina McCall’s Pill Revolution is a welcome entry into the debate: a call for more research, more education, and better options for women than the one-size-fits-all contraceptive regimen favoured by medicine and society alike.

The topic of birth control has never not been fraught, but it has also long been dominated by men, whether they’re scoffing at women who complain of side effects or screaming at them for being sluts. Perhaps this new controversy — one that originates with women themselves and prioritises their concerns — represents something more than another skirmish in the contraceptive wars; perhaps it’s a way forward.

Today, little has changed. The NHS’s looming vaccine mandate — requiring that employees are vaccinated against Covid before April — has inspired grim warnings about the debilitating impact of an exodus of staff: the effect on waiting times, on overworked doctors and on vulnerable patients. But what’s been ignored is the disproportionate number of women it could affect.

At its heart, of course, this is simply business as usual: women are no strangers to coercion in healthcare, and the NHS’s relationship with its predominantly female workforce has long been problematic. While women make up 76.7% of the NHS’s 1.3 million employees, only 45% of doctors are female; despite recruitment drives, fewer than 30% of surgeons are women, while two-thirds of consultants are male. No doubt that goes some way to explaining why male doctors earn 20% more than their female counterparts. Figures show that, out of 212 NHS trusts, 198 have a gender pay gap and in 125 the gap is worsening.

But this isn’t simply a money issue: the NHS also has a dismal record on employment rights, discrimination and abuse of its staff. In just one year, nearly 1 in 10 of Unison’s NHS members reported rape, sexual abuse or harassment at work, with 1 in 3 describing such incidents as a “frequent” or “regular” occurrence. Only 15% felt their case was dealt with adequately.

Nor is it just female employees who are affected by the sexism of the NHS. Female patients regularly face discrimination, with their concerns often dismissed as “women’s problems”. For instance, studies have shown how healthcare staff routinely underestimate and undertreat the pain reported by female patients, largely thanks to institutionalised stereotypes about women being oversensitive or over dramatic. Only last year, a Health Minister was forced to admit that “women are not listened to” by the NHS.

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Yet in light of multiple reports of systematic failings in maternity care, including harrowing descriptions of how thousands of women have been subjected to “birth rape” — doctors performing vaginal examinations on women without their consent — it’s hard not to conclude that the problem runs deeper than women simply not “being listened to”. In fact, as we’ve seen during lockdown, the medical establishment seems to have all but forgotten that women exist. At the start of the pandemic, a UN report warned that Covid lockdowns could have “serious consequences to women’s health”, including disruption to reproductive and sexual health services, as well as services to combat gender-based violence. But even its authors couldn’t have foreseen the horror of women being forced to miscarry and give birth on their own, while their partners waited in car parks.

Similarly cruel scenarios played out in the realm of contraceptive rights. For the past two years, many providers of contraception have refused to meet women face to face, even if it meant a woman was unable to remove her interuterine devices (IUDs). As with all battles over reproductive choice, this only pushed the problem underground: this time in the form of grim TikTok videos teaching women how to pull IUDs from their uterus at home.

But such sexism was present in almost every aspect of Covid response, up to and including the manufacturing of vaccines. Male bodies are assumed to be the “default” during clinical trials; even on the rare occasions, such as the Covid vaccine trials, when women are included, questions tend not to be asked about specifically female concerns, such as changes in menstruation.

It was hardly surprising, then, that reports of menstrual irregularities following the jabs were downplayed for months, despite tens of thousands of women reporting changes. Rather than being listed as a side effect or investigated promptly, such concerns were often belittled and diminished. For many women, the only available information they had on the menstrual side effects was via social media — hardly a comforting (or reliable) source of information.

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It is only now, more than a year after the vaccine rollout began, that researchers have begun looking at the extent and cause of the link. It is likely that the changes to menstrual cycles are benign; a number of possible causes have been suggested, with some also occurring with other vaccinations.

But this comes as scant consolation for the women who’ve experienced unexpected side effects and have, yet again, had to fight to be heard. Distrust can be infectious, and many women have been left feeling understandably uncertain about the ability and willingness of healthcare providers to listen to their concerns and to research the effects of the vaccine on their bodies. Is it any wonder that young women remain one of the cohorts most likely to refuse the jab?

So it seems natural that the NHS vaccine mandate would strike a particular chord with female staff. The policy might not be intrinsically misogynistic — after all, it will affect male staff too — but it’s not inconceivable that female staff will feel particularly alienated. Women possess an already precarious grip on their own bodily autonomy, and for many, their relationship with the NHS, both as patients and as employees, is beset with mistrust and coercion. The constant battle to try and retain control of their own healthcare decisions and the encroaching powerlessness they feel has now begun to even seep into their career.

And yet, it seems peculiar that the same people who pride themselves on supporting a woman’s right to choose in other settings — such as abortion — find no issue in coercively demanding retrospective changes to contracts that further strip the rights of its predominantly female workforce. The progressive emphasis on the right to choose, it seems, only applies if you decide to make the right choice.

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Whether or not the NHS vaccine mandate goes ahead — and it seems increasingly doubtful that an overstretched NHS can afford to sack 70,000 employees — for many women who feel deeply resentful of the mandate, the damage has already been done. To them it must seem galling that, after demanding so much from staff, including expecting them to work in Covid-ridden hospitals with minimal protection, the NHS now feels entitled to discard them for the sin of attempting to cling on to their bodily autonomy.

Even if the threat is removed, the continuing willingness of the NHS to disregard women, now with the encouragement of those who were once allies, will be the final straw for many. As its female staff are now discovering, the NHS remains institutionally sexist — and it will take more than a few rainbows and ‘claps for carers’ to cure it.

When the stripper-turned-rapper initiated divorce, claiming the relationship was “irretrievably broken”, rumour had it that she did so because her husband was upset about her making “thot music”. Others have claimed his repeated extramarital affairs were to blame. But just this week Cardi defended her decision to return to her husband, adding that their two-year-old daughter is always asking for her dad at home.

The effort to plot a course between individual libido and the long view is as old as humanity. Some two millennia ago St Paul advised the Corinthians that while it’s better to be celibate, for those that really can’t keep it in their pants “let them marry: for it is better to marry than to burn.” More recently, that poet of chronic inner conflict Sigmund Freud argued in Civilisation and its Discontents (1930) that the essence of advanced societies is a capacity to repress desire in pursuit of long-term goals.

Writing to his wife Martha Bernays in 1883, Freud saw “the extreme case” of civilised repression as marriage: “people like ourselves who chain themselves together for life and death, who deprive themselves and pine for years so as to remain faithful”. Who said romance was dead?

But even before Freud’s time, the opposing view was gathering momentum. The 19^th-century ‘free love’ advocate Mary Gove Nichols was a pioneering advocate of pursuing love wherever it led even if that ended a marriage, declaring in 1854: “Marriage and slavery are alike the grave of human liberty, and that which comes nearest to the inner life is, of the two, the greater wrong”.

And yet two years later 1856 the Memnonia Institute founded by Mary with her second husband, Thomas Gove Nichols, was walking free love back in favour of responsible procreation. An Institute circular declared it a “law of sexual relations” that “Material Union is only to be had, when the wisdom of the Harmony demands a child”.

St Paul may have been preoccupied with the spiritual ramifications of desire, but until relatively recently most people — even free love advocates — were unable to avoid the biological one. That is, sexual intimacy has a way of producing children regardless of what “the wisdom of the Harmony” recommends. And before the 20th-century development of technologies to prevent conception or gestation, marriage was the only available mechanism for controlling human fertility — or, rather, de-risking our inability to control it.

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A whole genre of folk songs concerns young women persuaded by unscrupulous men that (as Gove Nichols put it), ‘Love alone sanctions the union of the sexes’. Cold Blow and the Rainy Night tells of a soldier who arrives, hat frozen to his head, pleading with a young woman to let him in. She’s eventually persuaded, whereupon one thing leads to another. Presumably in the afterglow, she asks him: “Now since you had your will of me/Soldier will you marry me?”. Nope, he replies:

O then she cursed the rainy night
That ever she let him in – O
Then he jumped out of the bed
He put his cap upon his head
And she had lost her maidenhead
And her mother heard the din – O

The immediate harm caused the young woman in Cold Blow and the Rainy Night is her mother learning of her loss of ‘maidenhead’ and thus, potentially, of her reputation. From a contemporary perspective, this association of premarital sex with shame for women tends to be read as evidence of a patriarchal obsession with controlling female desire. Less often discussed, though, is the fact that for most of human history, reputational damage is a second-order risk whose foundation is the grim realities of solo pregnancy.

The worst-case scenario for the horny soldier was catching some kind of STD. But in a world before contraception and social safety nets, the worst-case scenario for the young woman he sweet-talks (and who, the song strongly implies, is also well up for it) would have been pregnancy but no husband. That is, a grim choice between dangerous medical interventions aimed at ending the pregnancy, abandoning her baby to an orphanage, a decade at least of solo struggle to care for a dependent infant, or infanticide.

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The starkness of this, for women, lies dormant underneath the mostly bawdy ‘faithless soldier’ musical genre. When it comes to the surface, the result can be almost unbearably bleak. Another song, The Greenwood Side, recounts the story of a young woman who falls pregnant in an illicit affair, is abandoned by her lover, gives birth alone in a wood and conceals the truth by murdering her twin babies. The affair, abandonment, birth and infanticide are briskly narrated, and the body of the song is a hallucinated dialogue with her murdered babies. The deeply unsettling lyrics blend horror at her deed with profound pity for the woman:

Now, bonny boys, come tell to me
Oh, the rose and the linsey, oh
What sort of life I’ll have after dying?
Down by the Greenwood side, oh

Seven years of visions of blood
Oh, the rose and the linsey, oh
And seven years of hurt in the womb
Down by the Greenwood side, oh

Contemporary feminism has a great deal to say about how unfair it is to shame women for putting out, while letting men off the hook for being faithless. But while this is indeed asymmetrical, in a Pill-and-condom-free world the underlying givens are also unfair, and inescapable. Only women get pregnant. The raw misery in The Greenwood Side conveys something of the suffering faced by countless now-forgotten women, who found themselves making appalling choices in such impossible situations.

Far from being a patriarchal imposition of purity culture, then, aimed at repressing women’s innate libidinousness, before contraception ‘no sex before marriage’ was a profoundly pro-women position. Norms forbidding pre-marital sex might seem repressive to the modern eye, but shielded young women from the risk of being knocked up by faithless shaggers and left to deal with pregnancy alone.

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So it’s no coincidence that the drive, already nascent in the 19^th century, to pursue human flourishing by liberating sexuality from commitment, didn’t get much buy-in from women until a century later, when birth control became widely available. At that point, social norms that sought to constrain human libido in the interests of the longer-term project of child-rearing came to seem more oppressive to women than to men.

In 1970, ten years after the FDA approved the birth control pill, the radical feminist Shulamith Firestone argued in The Dialectic of Sex that the root cause of women’s oppression is our reproductive role. Gestation makes women physically vulnerable, and human infants have an unusually long period of dependence, so creating and raising them takes time and resources. Thus women and children have historically leaned on men for support and protection, and the temptation for men to exploit that dependency has been irresistible. The result has been millennia of male supremacy.

Firestone thought that the way to liberate women from reproductive oppression was decoupling sex from reproduction. Abortion, contraception and — eventually — artificial gestation would free women from the ungainly and physically risky business of motherhood. And as these technologies developed, the principal means of dismantling  male dominance would be destroying the institution at its heart: the nuclear family. Mallory Millett, sister of the groundbreaking radical feminist Kate Millett, recalls attending a 1969 ‘consciousness-raising’ group with her sister:

“Why are we here today?” she asked.
“To make revolution,” they answered.
“What kind of revolution?” she replied.
“The Cultural Revolution,” they chanted.
“And how do we make Cultural Revolution?” she demanded.
“By destroying the American family!” they answered.
“How do we destroy the family?” she came back.
“By destroying the American Patriarch,” they cried exuberantly.
“And how do we destroy the American Patriarch?” she replied.
“By taking away his power!”
“How do we do that?”
“By destroying monogamy!” they shouted.

Firestone’s vision was of a world that had achieved “not just the elimination of male privilege but of the sex distinction itself”, as she put it. She dreamed of a world in which it simply doesn’t matter which type of reproductive organs you have, and as such there was no need for monogamy at all. In the course of this radical de-coupling of desire from reproduction and the family, heterosexual relations could be disentangled from the historically unbalanced power relations between men and women, and Eros liberated to suffuse society.

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Do men want sex more than women?

By Tom Chivers

Some decades on, this has to a great extent been achieved. We no longer see sex and reproduction as inextricable, because they aren’t. The project to unchain libido from commitment only remains unfinished to the extent that people still (on the whole) prefer to see their kids grow up. Were it not for two-year-old Kulture Kiari Cephus, the desires of Cardi B and Offset variously to make ‘thot music’ and shag everything that moves wouldn’t even be an issue, because no one other than them would have any serious stake in their continuing a relationship should their desires lead them elsewhere.

But even leaving aside the question of whether this brave new world of unchained desire really is that desirable, we should be cautious of taking the unchaining for granted, or imagining it’s irreversible. Shulamith Firestone’s radical feminism accords with centuries of folk wisdom in showing how women’s reproductive role makes us vulnerable, and she’s right to see contraception as key to freeing women from sexual constraint. But while this change is understood today as a priori evidence of our moral progress, in truth it’s a fragile state of affairs, wholly dependent on technology. Only take contraception off the table, and the entire illusion of women’s sexual liberation evaporates.

It would take a cataclysmic shock to modern social and technological infrastructures to disrupt the mass availability of birth control. But the last twenty years have seen 9/11, the Great Crash, and now a pandemic that’s driving a global economic downturn likely to make 2008 look like a Monaco yacht party. Add climate change and the looming prospect of a new era of great-power conflict into the mix, and only the delusionally optimistic could insist without a flicker of doubt that (as Tony Blair’s 1997 landslide victory celebration declared) things can only get better.

Let’s hope they don’t get much worse. Because if we’re to be confident that abolishing marriage in favour of a sexual free-for-all is in women’s interests, we’d better be equally confident that welfare states and reproductive healthcare will always be with us. Should that ever change, we’ll need a radical revision of what ‘feminism’ looks like. And in that unsettling scenario, we might discover that far from ‘free love’, the pro-women position is once again ‘no sex before marriage’.

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.

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Why aren't women having more babies?

By Mary Harrington

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.

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By Peter Franklin

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.

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By Louise Perry

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.

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By Tim Marshall

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.

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Has Hungary conceived a baby boom?

By Paul Morland

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.

It was because of the threat to life, and not for any other reason, that the Judge solemnly authorised the procedure. “This case is not about eugenics,” he emphasised. And even so, even though the details of the case make it very clear that leaving DD to conceive again would do nothing good for her, and that no other course but sterilisation could work, it feels like a terrible conclusion to have reached. A letter from DD is quoted, and her words hang heavily over the proceedings. “My body is mine,” she says, “by human rights.”

My body is mine, by human rights. It seems like the most basic principle, and one which could only be breached in circumstances as extreme as those of DD. But of course, for much of history and in many places, it’s been breached with casual utilitarianism: the reason Mr Justice Cobb had to say his judgement wasn’t about eugenics is that there have been thousands of women like DD whose fertility was stolen from them only on the grounds of improving the gene pool. For as long as contraception has existed, people have been using it to stop the wrong people from breeding.

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Why doesn't porn ever get cancelled?

By Sarah Ditum

Marie Stopes introduced the world to birth control in her book Married Love, then later she tried to stop her son from marrying a woman with glasses on the grounds that weak eyesight was “dysgenic” and should be excluded from the racial stock. Her passionate interest in eugenics put her into unsavoury connections: she gave Hitler a book of her poems.

But then, it also put her in step with a respectable and broad-based international movement of the rationalist and progressive: John Maynard Keynes, Beatrice and Sydney Webb, and George Bernard Shaw were among her fellow-travellers. (Given that Ronald Fisher has just had his memorial window removed from Cambridge for his views on eugenics, one wonders how long the Stopes clinics will bear her name.)

Under the influence of the ideas that Stopes espoused, thousands of women judged unworthy of breeding have been cajoled or coerced or downright deceived into sterilisation. They might have been judged “feeble-minded” – under a definition of feeble-mindedness that was expansive enough to cover heavy drinking and “promiscuity” (if you were unmarried and you got pregnant once, that could qualify you as promiscuous). It took the undeniable horror of Nazi Germany to make eugenics synonymous with atrocity; and even then, people have kept putting the idea into practice, while avoiding the word if they can.

Between 2006 and 2010, 150 women in the California prison system were sterilised — some with full consent, but others reported being pressured when they were under sedation for a different operation. One of the doctors involved defended the cost to the state: “Over a 10-year period, that isn’t a huge amount of money compared to what you save in welfare paying for these unwanted children — as they procreated more.”

Because black, Hispanic and Native American woman in the US have higher rates of incarceration than white women, targeting prisoners for sterilisation means (even if inadvertently) targeting racialised women for sterilisation. That, too, is a grim chapter of the eugenic inheritance, in the US and elsewhere.

In Peru, at the end of the last century, a programme under the misnomer Voluntary Surgical Contraception overwhelmingly captured poor and indigenous women, many of whom could not read the Spanish in which the consent forms were written as they signed away their fertility. And then there’s what’s happening now in the Chinese province of Xinjiang.

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By Geordie Stewart

The persecution of Xinjiang’s Uighurs has only recently made Western headlines, but it is hardly new, and reproductive coercion has long been part of it. What has changed over recent years is how explicitly the goal of exterminating the Uighurs is discussed, and how systematically it is pursued. While President Xi Jinping is a proponent of natalism (he oversaw the end of China’s one-child policy in 2015, for demographic rather than bodily autonomy reasons), not all population growth is wanted population growth.

The babies required are those of the dominant Han group. Chinese of other ethnicities must either assimilate, or be eliminated. State-mandated abortion, IUD insertion and sterilisation of Uighurs has caused the birth rate in Xinjiang (where Uighurs make up 45% of the population) to fall by 24% in the last year; for comparison, the nationwide decline in birth rate is only 4.2%. The attack on reproduction is the most extreme aspect of a programme designed to destroy the Uighur as a people, through prohibition of their language and culture, and “re-education” in brutal camps.

The Uighurs are a problem to the Chinese state because of the way the Chinese ideal of statehood is constituted. David Tobin, Hallsworth Research Fellow in the Political Economy of China at the University of Manchester, explains that since 2012, “policy became about engineering identity”. China’s leadership holds the position that “the disappearance of cultures and language is natural and should be celebrated” — it’s simply a matter of evolution.

While, theoretically, the country is not a Han ethnostate (under Mao, “Han chauvinism” was actually framed as a problem to be abolished), the Han are given a privileged role in the national myth, presented as the stable, civilising entity into which other, less developed groups must be absorbed. It’s for this reason that intermarriage between Han and Uighurs is encouraged, rather than abhorred, in the way that Western racism’s traditional horror of miscegenation might lead you to imagine. The stubborn otherness of the Uighurs is an affront to national unity that must be corrected, by any means necessary.

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By Maajid Nawaz

If you study anthropology in Xinjiang, at the top of your reading list you’ll find an American name: 19th-century anthropologist Lewis Henry Morgan. Morgan researched and recorded the lives of Native Americans, especially the Iroquois. He was also an avid assimilatist, establishing a narrative of civilisation’s progress which has influenced the treatment of the Uighurs: the First Nations would have to give up their nations, and submit to being “civilized, Christianized, and humanized”.

Lewis helped to formulate early plans for the Indian Reservation system. These turned out to be sites not only of deprivation, but of control: Native American rituals were proscribed, and effectively remained so until the 1990s. And the logic of assimilation developed after Lewis’s death, perhaps inevitably, to include reproductive coercion. The Family Planning Services and Population Research Act, passed in 1970, subsidised sterilisations: as many as 25% of Native American women of childbearing age underwent the procedure over the next six years. Rote sterilisations were nicknamed “Mississippi appendectomies”.

The surgical banality of this violence shouldn’t obscure the fact that it is violence. For the individual, it’s a vicious sundering of her from her future, as well as a physical attack on her insides. That’s another reason to read the DD judgement: it is unflinching in its account of what must be done when an unwilling woman is sterilised. DD would be surprised at her home. She would be restrained. She would be anaesthetised, and she would wake up infertile and in pain.

Compulsory sterilisation is one of the gravest things that can be imposed on a person. When imposed on her because of her ethnicity, it is a genocide — the female body as ground zero in the pursuit of better breeding. It is being done, methodically and barely concealed, now, to the Uighurs.