One hundred years ago, a group of prominent doctors, social workers, economists and advocates convened at what was then called the Hotel Plaza in New York City for a first of its kind conference. Their aim was to explore the benefits and legality of a technology that was simultaneously novel and impossibly ancient: birth control.

“Our definite aim is to repeal the laws so that the medical profession may give women at their request knowledge to prevent conception,” organizer Margaret Sanger said in her opening speech at the conference. “We believe that with the assistance of the intelligent members of the community we can bring this about in a very short time, but we need your help.”

The First American Birth Control Conference, as it was called, began on Nov. 11, 1921, with speakers and presentations that considered the potential of contraception to end social ills, and of strategies for repealing laws that prevented the dissemination — and even discussion — of birth control.

The conference marked the official launch of the American Birth Control League (ABCL), which later became the Planned Parenthood Federation of America, as it’s still known. It also launched a national, widespread campaign to advance access to contraception in the United States — an effort that is ongoing, as many antiabortion advocates, lawmakers and religious groups continue to tie contraception to abortion and advocate against its inclusion in sex education and access in publicly funded insurance plans.

Although the conference itself was novel, birth control was not, said Linda Gordon, a professor emerita of history at New York University. Gordon is the author of “The Moral Property of Women,” an early and influential history of birth control.

“What we call birth control today has existed in every society from the earliest times that we have records of human beings,” Gordon said. “People were constantly trying to control or limit births.”

The reason for this is simple: Having children has always been both expensive and dangerous.

Early methods of birth control, which ranged from inserted sea sponges to act as diaphragms to the use of lemon juice as spermicide, weren’t always safe — but they were often much less dangerous than giving birth, Gordon said. For most of history, this notion of birth control also included abortion, which was often administered by midwives. The two only came to be thought of separately about 100 years ago, due in large part to the ABCL, according to Gordon. The league consciously separated itself from abortion at first, in a bid to be more palatable to an American public concerned with “family values.”

Revolutionary though it was, the fight for reproductive history in the United States has also been marked by an ugly alliance with the eugenics movement. Sanger’s belief in eugenics has long marred her legacy — a legacy that Planned Parenthood itself has acknowledged and denounced.

White advocates like Sanger advanced the racist, classist and ableist idea that birth control could be used to prevent “undesirable people” from having children. Scientists also exploited marginalized people in scientific trials to develop the technology itself, and states often enforced the compulsory sterilization of Indigenous and Black women. In recent years, antiabortion activists have often used these views to criticize Planned Parenthood and the reproductive rights movement.

“The Sanger legacy unchecked or unmet with a reckoning has been weaponized against women of color, and has effectively hampered our ability to be in a right relationship with women of color,” Merle McGee, chief equity and engagement officer for Planned Parenthood of Greater New York, told The Washington Post in 2020. “And we have left women of color to grapple with the totality of Sanger’s legacy.”

On the conference’s 100th anniversary, we revisited some of the moments in this long, complicated history that you might not know about.

This was the first of what came to be known as “obscenity laws” that prohibited any instrument, drug or item that could be used for contraception or abortion, even if prescribed by a physician. The law also made it a misdemeanor to circulate any books, advertisements or written materials of any kind related to contraception. It was mainly enforced by the Post Office, which could seize and confiscate any materials that were found in violation of the law.

Signed into law by Gov. J. Frank Hanly, this law specifically targeted people in state custody, including prisons and psychiatric institutions. Eventually, though, 32 other states came to pass similar sterilization laws and their increasingly broad language came to target anyone deemed “unfit” to reproduce. Informed by racism, colonialism and eugenics, institutions disproportionately targeted Black and Native American women, poor people and disabled people for forced sterilization as a form of widespread birth control.

More than 2,300 of the state’s “most vulnerable citizens” were involuntarily sterilized before the state’s last compulsory sterilization law was repealed in 1975, according to the Indiana University-Purdue University Center for Bioethics. An estimated 60,000 people were forcibly sterilized throughout the country under such laws.

Inspired by the arrest of Margaret Sanger for opening a birth control clinic in nearby Brooklyn, the Women’s Political Association of Harlem held lectures on the subject, according to Joyce Follet, director of the Reproductive Justice History in Action Project at Smith College. Maternal and infant mortality rates for Black people in Harlem were twice those of Whites in the city.

Though Planned Parenthood is now known as a champion for reproductive rights in all forms, Sanger’s organization began with the single-minded mission to increase birth control access for married women, Gordon said. Sanger began her career as a visiting nurse in poor neighborhoods in New York City, where she saw firsthand what the lack of contraception meant for poor women and women of color.

“She was so convinced that birth control was a major aid that she dropped her other concerns and very quickly spent the rest of her life campaigning for birth control,” Gordon said.

In the early 20th century, contraception was a controversial topic that most women’s rights groups avoided, writes Follet. Informed by a desire for “reproductive self-determination,” the NCNW broke with popular opinion in an official resolution endorsing birth control.

The organization was led by Mary McLeod Bethune, who was the highest-ranking Black woman in the federal government at the time. As a highly respected civil rights leader and educator, Bethune helped to make the issue less taboo at a time of intense religious and political opposition.

“With this action, Black women stepped to the forefront of the movement,” Follet writes.

John Rock and Gregory Pincus began testing the hormonal birth control pill on patients at the Worcester State Psychiatric Hospital in Massachusetts under the guise of “fertility research,” and then on more than 200 poor women in Rio Piédras, Puerto Rico. The women were not told they were taking part in a clinical trial.

“You had a huge reservoir of women who were dying to get their hands on it and couldn't easily,” Gordon said.

This lack of access meant women in Puerto Rico were eager to accept the medication scientists offered them — and it was easier for the scientists to exploit them. Pills in the early trial had extremely high doses of the hormone progesterone, which led to extreme side effects like nausea, dizziness, headaches, stomach pain, blood clots and vomiting. The researchers discounted women who reported these side effects as “unreliable historians.” Three women died while participating in the trials, though the researchers did not investigate whether their deaths were related to the pills.

“Despite the substantial positive effect of the pill, its history is marked by a lack of consent, a lack of full disclosure, a lack of true informed choice, and a lack of clinically relevant research regarding risk,” physicians Pamela Verma Liao and Janet Dollin wrote in a 2012 historical review of the pill.

Enovid, the first commercially available birth control pill, was at first only prescribed for menstrual cycle control to married women. These early versions of “the pill” contained vastly elevated levels of hormones compared to birth control pills now: For example, Enovid had 9.85 mg of the progestin norethynodrel, while today’s pills contain from 0.1 to 3.0 mg of modern versions of the hormones, which are more targeted in their effects. The pill was an immediate success, and by the late ’60s, almost 9 million Americans were taking it to prevent pregnancy.

“It gave women a kind of privacy about what they were trying to do,” Gordon said.

In the Supreme Court case Griswold v. Connecticut, the court ruled that the state’s ban on contraceptives violated the right of marital privacy. The court wouldn’t legalize birth control for unmarried people for another seven years.

Following the birth control pill’s success, a variety of hormonal birth control methods flooded the market: implants, intrauterine devices, injectables, rings. Contraceptives also became relatively safer as scientists addressed the extreme hormonal levels and side effects that had been dismissed in earlier versions of the pill.

At the same time, a shift in the political strategy of the Republican Party fueled a backlash against reproductive health care, Gordon said. The conservative movement’s strategies of anti-communism and conservative economic policy “weren’t working,” so they shifted focus to social issues, which they branded as “family values”: abortion, gay rights and birth control. This, Gordon said, was the beginning of the antiabortion movement we know now.

Following a century-long battle, Democrats passed historic legislation to overhaul the American health-care system. Nicknamed Obamacare, the legislation in part mandated coverage of all preventive health care, including contraception.

This also launched a renewed campaign against birth control, this time in a debate of whether publicly provided health care should cover contraception. In 2014, the Supreme Court ruled in favor of craft store chain Hobby Lobby that employers with religious objections can refuse to cover contraception. In 2020, the court again ruled that employers and universities can opt out of the ACA requirement because of religious or moral objections.

This year has seen an unprecedented wave of antiabortion legislation, including a near-total ban in Texas and a Mississippi law headed to the Supreme Court this month that seeks to overturn Roe v. Wade. Although many see birth control access as settled precedent in contrast to the antiabortion movement, that’s not the case, Gordon said.

“One thing really hasn’t changed, and that is that having children is expensive,” Gordon said. “Not everyone can afford it, and it involves a major transformation of how people live their lives. So it’s just too important to most people to just let pregnancies happen one after another. And that’s why the data shows that it’s only contraception that makes the difference.”

At the same time, many of the initial concerns for reproductive health-care access in communities of color remain true: For one, racial disparities in maternal mortality remain disproportionately high, with Black women three times as likely to die of a pregnancy-related cause than White women. Women of color and poor people are more likely to rely on the Affordable Care Act for contraception coverage, which means they’re most affected when courts roll back mandates for this coverage.

Although hormonal birth control is much safer than doses of the past, its side effects also continue to be painful, uncomfortable and unpredictable, leading to scientists to continue to seek alternatives.

As physicians Dollin and Liao write: “The pill led the way but we need creative exploration of choice, access, and safety in controlling fertility for the future.”