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

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.

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