Last week, the Department of Health and Human Services and the FDA broke a formal promise to issue a decision by September 1 on over-the-counter access to emergency contraceptives.
I wrote about this question two years ago in the New York Times, when an FDA advisory panel first recommended that Plan B be made available without a prescription. Incredibly, the issue remains unresolved.
As I argued some time ago (and much of the following language is culled from my original piece), opponents of the emergency contraceptive, known as Plan B, are misguided in their concern that widening access to the morning-after pill will encourage sexual promiscuity, particularly among young people. One prominent opponent of Plan B worried that emergency contraception was no less revolutionary than the birth control pill, which he claimed ushered in "a new day and age for the expression of sexuality among young people."
This argument is a common one. But it is based on a misunderstanding of the history of America's sexual revolution and the pill's role in it.
Before 1960, the story goes, the natural constraints of human biology held Americans to strict standards of sexual discipline; after 1960, and after the pill, Americans threw off the shackles (or, depending on one's political perspective, the civilizing influence) of sexual propriety.
That's a lot of power for one little pill. In truth, this narrative is flawed. Though the pill made contraception easier, and while it gave women more power and responsibility in family planning, it hardly created a sexual revolution. American sexual habits had been changing long before the pill found its way onto the market. Early sex surveys revealed that about half of all women who came of age in the 1920's admitted to engaging in premarital sex (defined as coitus), a figure that held steady for women in later decades.
Americans were also practicing birth control long before the pill. As early as 1938 a poll commissioned by The Ladies' Home Journal found that roughly four of every five women approved of using birth control. Just over two decades later, on the eve of the pill's legalization, 80 percent of white women and 60 percent of nonwhite women reported practicing some form of family planning.
Even the heightened sexual permissiveness of the 1960's can't be attributed to the pill. Throughout the better part of the decade doctors generally prescribed the first oral contraceptive, Enovid, only for married women, who made up the drug's largest market share in its early years. As late as 1971 only 15 percent of unmarried women age 15 to 19 used the pill. Even in recent times, only about 23 percent of women age 15 to 24 report using it.
The pill, then, did not create America's sexual revolution as much as it accelerated it. And that revolution had been a long time in the making.
Over the course of the 19th century the average number of children born to married couples dropped to about four from about seven. Americans probably weren't having less sex. Instead, couples -- particularly those in the growing middle class, whose families no longer required legions of children to work on the farm -- were practicing birth control. They were coming to view sex as an activity that wasn't merely procreative, but also central to pleasurable and loving marriages.
In the early 20th century many Americans began experimenting with sex outside of matrimony -- partly because they could. By the 1920's a majority of Americans lived in urban areas where they enjoyed greater anonymity and social freedom. Meanwhile, a growing leisure culture provided a host of places -- from dance halls to movie theaters -- where men and women could meet.
At the same time, as an educated work force became increasingly important to the vitality of America's advanced economy, more young people (75 percent by the 1920's) attended high school, creating a new heterosocial peer culture.
In the early 20th century more young women also entered the work force, where they came into increased contact with men and enjoyed a limited amount of financial and social freedom that could translate into a loosening of sexual mores.
Though many young women from the 1920's onward engaged in premarital sex, they probably did so with the intention of marrying their partners. The revolution in morals was tame by later standards. Nevertheless, women and men were steadily redefining the boundaries of romance and sex long before the pill appeared.
The history of America's encounter with the pill helps inform today's debate over Plan B. Oral contraception was a vital development in women's reproductive rights and health, but it didn't cause a revolution in morals and behavior any more than Plan B is likely to sexualize a nation of young people who are already sexually active. Surveys suggest that more than 75 percent of young people have sex before they turn 20, yet only about one-fifth of sexually active high school girls use the pill.
None of this minimizes the importance of either the birth control pill or Plan B. Technology has always been an important catalyst of historical change. But America's sexual revolution was a long, complicated phenomenon. No pharmacist can stuff it into a bottle. Cultural critics shouldn't try to do so, either. The FDA and HHS should stop playing politics with women's health.