BIRTH, CONTRACEPTION, AND ABORTION

John M. Riddle

Historians long avoided analyzing private lives, partly because matters of conception and birth were just that—private. Even if such knowledge were to be regarded as worth the effort, what went on in peasant and burgher bedrooms was believed to be beyond possible scrutiny. How people were conceived and born escaped scholarly attention, but, in avoiding the investigative enterprise, questions arose that urgently needed reflection. Prior to the advent of the modern era in the nineteenth century did people (in distinction to the elites who were presumed to know what they were doing) reproduce like rats in hay or did they engage in practices that resulted in control of their reproduction? How can we explain the low birth rates in the early modern periods and the attention that leaders gave to population increase incentives? Was the corpus of common obstetrical knowledge safe, natural, effective, and practiced by women whose arts were separate from male inspections and influence? How do we evaluate the processes of modernization by which women were increasingly pushed away from controlling birth and even their pregnancies?

Most Europeans in the early modern period were born in an overheated room, their parents' room, with neighboring women and female relatives hovering in the background, while an experienced midwife assisted the parturition process. If rural and poor, the husband may very well have eschewed a midwife's service, either unwilling or unable to pay the relatively small fee. In those cases, an experienced neighbor or friend would substitute. In almost all cases, the mother-to-be would be either seated on a birth stool brought for the occasion by the midwife, especially if they were in central Europe, or on a chair or squatting on the floor or even, infrequently, on another woman's lap. Depending where they were geographically, few women remained in bed once the water burst and the contractions began. Known since classical antiquity, the birth stool received extensive usage among German midwives, but its use extended over most of Europe. A familiar scene was the midwife with her bag of instruments and drugs hurrying to her next delivery and carrying her stool with her.

Many of the women present at childbirth helped in various ways, such as making sure that the birth amulet—eagle stones, haemites, agate, and oriental or occidental bezoars being common—remained on the stomach. Meanwhile, the expectant father was apt to be with male friends in a nearby room or tavern awaiting congratulations. Some fathers practiced the couvade, an ancient, bizarre ritual of posing as the woman in labor by going through the moans, contortions, and ordeal of birth and, when the birth parody was over, pretending to suckle a newborn. Anthropologists and historians disagree over the couvade's meaning, offering such interpretations as sympathetic magic, aversion of dangers, and protection for the newborn. The entire birth scene raises a number of questions about early modern society.

EARLY MODERN MIDWIVES AND OBSTETRICS

As idealized in historical perspective, midwives were schooled through the experienced guidance of an older practitioner and generally knew more about obstetrics and even gynecology than male physicians. During the parturition process, they assisted the natural course whenever intervention was necessary. Recent interpretations modify this image. Up until approximately 1750, midwives generally provided safer and better services than physicians could have done given their training and knowledge. Still, midwives intervened from the moment of arrival and in ways modern science considers either harmless superstition or dangerous interference. Examples of meddling included breaking the waters with nails or a pointed instrument, massaging the vagina with an herbal preparation, widening the birth canal with manipulations even before the cervix opened, and placing women on birth stools before the water broke. The overheated room dates back to pre-Christian notions that cold drafts are harmful to the newly born. The medical skills of early modern midwives were substantially unchanged from classical times, save for additional Germanic folk practices whose utility from the modern perspective was confined to the psychological province. Few received training or experience in handling obstetrical emergencies or in when to call a physician. All too often, when a physician arrived it meant the death of either the baby or the mother.

Another form of intervention now considered harmful was the retrieving of the placenta immediately after birth. Normally the placenta will be expelled naturally within a half hour, but often midwives, perhaps desiring to conclude the ordeal, entered and pulled it out, causing an occasional hemorrhaging or inverted uterus, sometimes fatally. Following a delivery the woman was prescribed bed rest for nine days. Even bed linens were not expected to be changed during this period for fear of disturbing the mother. Reports of foul and smelly rooms were standard. Economic and family circumstances did not always allow what was considered to be the best therapy. When physicians in the late twentieth century supported "natural births," the historians followed by stressing the wisdom of old midwives who witnessed and helped natural processes unfold. Clearly such romantic notions were overdrawn because midwives and experienced older women were not reluctant to intervene. This attitude, however, has another side: western European birth practices called for intervention in obstetrical emergencies, unlike some other traditional societies, and many a mother and child were saved by skillful applications of therapeutic procedures.

Medieval terms for midwives, such as rustica (rustic), vetula (old woman), mulier (woman), obstetrix (midwife), and herbala (herbalist), reveal their informal origins. As late as the eighteenth century, a French word for midwife was sage-femme (wise woman). By the second half of the fifteenth century, various attempts were begun throughout Europe to control by an oath abuses of midwife behavior. Oaths varied according to time and region, but three elements were essential: helping any patient, rich or poor; preventing the murder of a neonatal; and dispensing no miscarriage or abortion medicines. Women received from other women advice and direction concerning the entire regimen of women's health and reproduction, including irregular menstrual cycles, breast-feeding, sterility, rape, venereal diseases, fertility enhancement, contraception, and abortion. Barbers, physicians, and, less frequently, midwives bled women at least three times per pregnancy in the fifth, seventh, and ninth months. But the knowledge and practices of women outside the birth scene also caused many troubles for women who knew about women's health and reproduction.

The diagnoses of pregnancy were little changed from antiquity. The signs of pregnancy were explained, mostly for the benefit of men, in a seventeenth-century work attributed to Albertus Magnus, called Aristotle's Masterpiece: they included cessation of menstruation; fullness and milk in the breast; strange longings, especially for foods; a slight greenness of veins under the tongue; swollen veins in the neck; and a tightly closed cervix. Urine examination, so-called uroscopy, took account of smell, sediments, suspensions, color, and taste. Because a pregnant woman's albumen in her urine is highly elevated, it is possible that skilled practitioners were detecting a sign. Midwives claimed abilities to detect the sex of the unborn. Until the witchcraft suppressions, women seemed to have trusted midwives, as judged by their prestige in their communities.

The seventeenth century saw the beginnings of bringing the "secrets of women" to the high medical and learned culture through developments in gynecology. Ambrose Paré (1510–1590) described one development, a manipulation to shift the fetal position for a feet-first movement through the birth canal. Paré was first to record the procedure but said he learned of it from two Parisian barber surgeons. Eucharius Rösslin (c. 1500–1526) published, first in German, a work entitled The Pregnant Woman's and Midwife's Rose Garden, in which he disclosed much that had been mysterious to men. He recommended abortion only for cases where the woman's life would be imperiled through delivery. More information, perhaps none innovative, was disclosed in works in German by Walter Ryff (1545); in Italian by Scipione Mercurio (1595), a practicing obstetrician; in Spanish by Luis Mercado (d. 1611), who wrote four large books on diseases of women; and in French by François Rousset, whose description of a cesarean section in 1581 was outstanding. Thus what happened in birth rooms was becoming the subject for academic examinations. The primary question facing historians is to what degree were the sixteenth-century gynecology and obstetrics writers innovative and how much critical modification they made to traditional knowledge. Even though women orally transmitted much information, there are sufficient medical and anecdotal writings to analyze early modern popular knowledge, as social and medical historians are beginning to do.

EARLY MODERN BIRTH CONTROL

The subject of birth control is a complex one in early modern Europe. Prior to the beginning of the eighteenth century, the birthrates were low even considering external factors, such as wars, celibacy, famine, plagues, land use, and nutrition. Birthrates were well below the biological potential, even leaving aside the probably 20 percent of all couples in which one person was infertile. We know from other data that, if left unchecked, average per-couple birthrates will total sixteen to eighteen children from the onset of female puberty to menopause. European rates were well under half this total. The precise reasons are complex and ultimately escape historical confidence. Assuredly important factors include a delayed marriage age, relatively prolonged lactation after the birth of each child, probably a decrease in sexual activity within marriage as couples reached their mid-thirties, and bastard infanticide. Of these, delayed marriage age is best documented and undoubtedly an important element. The medical and anecdotal data from the early sixteenth through the eighteenth centuries indicate artificial birth control on top of these arrangements. The effectiveness of birth control and even family planning is the subject of debate among historians, demographers, and scientists.

The nature of artificial birth control on top of these arrangements is debatable, though there were definitely a number of methods (some linked to beliefs in magic) and probably some successes. Until recently historians and demographers believed that, prior to the late eighteenth century, women did not possess sufficient knowledge for dependable birth control, although midwives, witches, and old women were accused of engaging in practices that led to fewer children. Older historians such as Henry Lea regarded these kinds of accusations as a vast conspiracy by the inquisitors to accuse innocent people. In contrast, Margaret Murray, Thomas Forbes, and Barbara Ehrenreich observed that a disproportionate number of those accused of witchcraft were midwives. Murray said that "in the sixteenth and seventeenth centuries, the better the midwife the better the witch." An English midwife oath, typical in its sentiments, prohibited not only the administration of birth control drugs but the giving of counsel about "any herb, medicine, or poison, or any other thing, to any woman being with child whereby she should destroy or cast out that she goeth withal before her time." A church dictum stated, "If a woman dare to cure without having studied she is a witch and must die." Witches and midwives, whether the same or different, were accused of engaging in various practices, usually involving "poisons," that interfered with reproduction, ranging from impotency for men to contraception, abortion, and sterility for women and death for the newly born, notably those born and not yet baptized. Social historians and historians of science are more inclined toward accepting the accusations, at least to the degree that women possessed knowledge that allowed them to exercise effective and relatively safe birth control.

Clearly, various forms of artificial birth control were known or attempted, but primarily drugs were used. Coitus interruptus was seldom employed as a contraceptive measure, to judge by the paucity of references to it, although in Italy there are a number of anecdotal allusions to it. The act requires strong male cooperation and, in general, males are less strongly motivated in restricting conceptions. Those few references, however, indicate that the procedure was known. Barrier methods were not known. Some pessaries prepared as drug prescriptions with specific ingredients and administered on wool pads could possibly have resulted in mechanical blockage of sperm progression. Gabriel Fallopio is credited with the first medical description of the condom, in a publication in 1563. The name of the device comes from a Dr. Condom, physician in the court of Charles II of England (ruled 1660–1685), and it was popularized by Casanova (1725–1788), who called it "the English riding coat." In its original form, made of animal skins, it did not receive widespread usage.

The primary means of contraception and abortion were drugs, mostly herbal. A number of plants that, usually taken orally, contracepted and/or aborted were known from classical times and recorded by medical writers such as Hippocrates, Dioscorides, and Galen. Prominent among the contraceptives were white poplar, asplenium (a fern), juniper, barrenwort, the chaste plant, squirting cucumber, dittany, and artemisia; among the abortifacients were rue, pennyroyal, tansy, and birthwort. Modern scientific studies, especially in the realm of animal science, have shown that these plants interfere hormonally in a variety of ways with the reproduction processes. The chaste plant (Vitex agnus-castus) affords an intriguing example. Not only was the plant used historically as a female contraceptive but, in modern testing on dogs, the bark of this small tree reduces spermatogenesis to infertility. The opposite of the new drug Viagra, it was taken by ancient priests to prevent erections. Witches or midwives were accused of tying a ligature, or invisible string, around the penis to prevent erections. Formerly we assumed these allegations to be either malicious or illusionary. Now, on the basis of scientific data, we can reassess entire aspects of sexually related charges related to old women, witches, and midwives.

Interspersed with pharmaceuticals were amulets, charms, and various practices that we today consider superstitious. Medical, ecclesiastical, and municipal authorities sought to eliminate these vulgar practices. A part of a Parisian midwife oath in 1560 was "I will not use any superstitious or illegal means, either in words or signs, nor any other way." As with the fertility-enhancing medicines, modern evaluators of the early modern period give various explanations of the role of magic and the occult and the importance that psychological factors could have played. Modern investigators' uncertainty about that role applies to the entire spectrum of fertility, gestation, and birth.

Credence can be given to the substance of some of the accusations aimed at midwives or supposed witches, but many questions are unanswered. Among them, if women possessed effective means of birth control, why did early modern medicine not recognize what was happening? How could knowledge once widely held be diminished and restricted to a few marginalized practitioners, most of whom were women? If the birth control agents were effective, what about the fertility-enhancing herbal preparations that were perhaps even more prominently mentioned in mid-wifery and medical accounts? The short answer to the last question is that modern science has not sufficiently studied the actions of these preparations to begin addressing the question historically.

A large factor in the loss of knowledge was how birth control learning was transmitted. As medical education became formalized within the universities, the curriculum did not include "women's medicines." Practicing physicians working within their guilds eschewed folklore while combating irregular, informally trained practitioners. That distrust continued throughout the twentieth century.

WITCH-HUNTS AND CONTRACEPTIVE "POISONS"

Another reason for the diminution in birth control information is that such knowledge was dangerous in the sixteenth and seventeenth centuries. As a woman revealed before the Inquisition in Modena in 1499, "Who knows how to heal knows how to destroy." A version of Pseudo-Aristotle's Secrets in 1520 advised men "never to confide in the Works and Services of Women" and to "beware of deadly poison, for it is no new thing for Men to be poison'd." And what did these poisons do? They were said to destroy a fetus or to make men either impotent or sterile and women unable to conceive. Thus the focus of witchcraft persecutions on midwives came to center on birth control "poisons" and other preparations that to some were poisons and to others medicines.

Two German investigators, Gunnar Heinsohn and Otto Steiger, connect the poisons, witches, and midwives with economic policy and demography. Heinsohn and Steiger see a direct relation between the women persecuted as witches and the steady increase in population that began in the sixteenth century. As proof they provide statistical evidence that in areas where virulent witch-hunts were conducted there followed a population upswing. Juxtaposing their thesis with the evidence for a decline in effective birth control measures, we can hypothesize that the targets were women who knew the "poisons" that were contraceptive and abortifacient plants. Town and ecclesiastical leaders who promoted witch-hunts may genuinely have been concerned with devilish activities by "weisen Frauen" (wise women) that they saw as preventing babies from being born and baptized.

Critics of Heinsohn and Steiger are not persuaded by their data. The medical and pharmaceutical literature, especially from the official dispensaries employed by apothecaries, indicates that the preparations were still known and sold but in a different form. The herbs and minerals were compounded, mixing twenty or more "simples," for retail distribution. Early modern women became dependent on purchased drugs, rather than gathering the plants for themselves. In order to know the plants, harvesting, morphology of site for extraction, amounts, frequencies, and when to take them, they needed information formerly taught by their mothers and the "wise women" of the community. To gather the plant "simples," or even to know how, was dangerous because it would make one a suspect in procedures where proving innocence was difficult and failure to do so was often fatal. Approximately half a million people died at the stake, the overwhelming majority being women, most of whom were old. Heinsohn and Steiger's thesis has challenged social historians to view birth and population controls during the early modern period in a different way.

Laws on infanticide were tightened throughout most of Europe in the early modern period. Between 1513 and 1777 in Nürnberg eighty-seven women were executed for killing their babies, and all but four were single. Nürnberg's town council enacted an ordinance that prohibited midwives from burying a fetus or stillborn child without informing the city council. In Essex, England, between 1575 and 1650 fifty-one women were tried for the offense, and two-thirds were convicted and executed. In comparison, during the same period in Essex 267 women were tried for witchcraft, and only one-fourth were found guilty. Clearly, these figures are relatively low, so that infanticide cannot be considered a major factor in population size, even acknowledging that many crimes were undetected by authorities.

ABORTION AND THE BEGINNING OF LIFE

Knowledge of effective birth control measures continued to appear in medical, pharmaceutical, and anecdotal accounts, but normally it was carefully circumscribed.

Abortifacients were referred to in early modern medical literature as menstrual stimulators. When a woman took an emmenagogue (menstrual stimulant) because of a delayed monthly period due to pregnancy, she would have committed an abortion in modern terms but not in the early modern era. Based on classical Greek concepts, it was thought that the male sperm remained in a woman's body until her womb accepted it and a fetus was formed. This period was not defined but could be a number of weeks. The question of "when does life begin" was not examined in the way it is today prior to the nineteenth century in European society, either in high learning or popular culture.

Knowing that an accident or cesarean section could result in a live birth, Aristotle asked when the fetus developed independent life. When the fetus had all of its form, Aristotle said that it had psyche, meaning "life." The Stoics developed the notion of "soul," and, by employing the word psyche, they altered its meaning. Learning from the Stoics, the Christians read Aristotle's question about the beginning of independent life as a discussion of ensoulment. The only explicit reference to abortion in the Bible or Torah occurs in Exodus 21:23, in answer to a question about the fault of a person assaulting a pregnant woman and causing a miscarriage. The question's answer was "life is for life." The Hebrew word for life, nefesh, was translated by the Greek Septuagint as psyche, thus suggesting that a "soul for a soul" was the punishment decreed for the act. Most of the church fathers adapted Aristotle's views and agreed that ensoulment came at that point in a pregnancy when there was fetal movement. The popular term in English, with equivalents in other vernaculars, was "quickening." They envisioned the soul to have come from God, not the parents, and the divine act came when the fetus was formed. Christian doctrine ultmately incorporated Aristotle's assertion that there was a single act (or, as Aristotle said, a relatively short period) from which time the fetus goes from "unformed" to "formed." Prior to ensoulment a woman was free to terminate her fertility by returning to her menstrual cycle. There was a notable restriction to this freedom, however. Roman law, Judaic pronouncements, and early medieval law codes held that a woman did not have the right to deny a child conceived in wedlock if the husband wanted the child.

The medieval and early modern churches, Greek Orthodox and Roman Catholic alike, condemned abortion, contraception, and, indeed, any agent or means that interfered with fertility. In practice, however, as John Noonan has demonstrated, both contraception and abortion were practiced prior to fetal movement or quickening. But several trends in the early modern period began to restrict even more reproductive practices and so-called rights.

Following the Black Death and the resultant economic distresses, medieval town councils recognized a connection between population growth and economic prosperity. Consequently medieval towns on the Continent became more involved in legislation declaring pregnancy terminations criminal by punishing those who assisted a woman. To rectify abuses medieval towns first regulated and licensed midwives. The laws of the Holy Roman Emperor Charles V in 1532 essentially took the provisions of some towns and promulgated them into state law. The Caroline laws regarded one who assisted a woman in an abortion as guilty of homicide and a woman who performed the act on her own as guilty of a lesser although severely punished felony. A woman who terminated a fetus "not yet living" (not formed or quickened) or a person who assisted her was to be punished by penance, a physical punishment (such as pillory), or exile. In 1556 French law condemned as a criminal any woman who concealed her pregnancy and allowed a fetus to be killed or a child to die prior to baptism. In contrast, a review of English common law in a relatively few trials reveals that juries would not punish anyone, assistant or woman, who aborted a fetus prior to birth.

The strongest stance against abortion came in a bull issued by Pope Sixtus V (1585–1590) that condemned abortion of a "conceived fetus" with "severe punishments" for both the woman and anyone who advised or assisted her. It is unlikely that the bull had any effect on European practices and may have been intended primarily for prostitution in the city of Rome. Some Catholic theologians, such as Thomas Sanchez (1550–1610), argued for a woman's right to terminate a pregnancy in cases of rape or threat to her life. Nonetheless, a woman sinned who terminated a pregnancy to protect her reputation or prevented conception in order to protect an estate from being divided among too many heirs. In response to liberal views by some theologians, Pope Innocent XI (1676–1689) reaffirmed the medieval church's stance against any interference with fertility and birth but left vague the so-called therapeutic abortion to save the life of a woman. Few differences regarding birth or birth control practices appear in Protestant communities. Luther and Calvin both spoke out against the "sin of Onan," a biblical passage, Genesis 38:8–10, now considered misinterpreted as a condemnation of contraception and masturbation.

MARRIAGE AND PREGNANCY

Studies comparing marriage dates and birth or baptism dates in England and Germany have shown that roughly one-fifth of the brides between 1540 and 1700 were pregnant at marriage. In later centuries the number rose to two-fifths. A major reason was the delayed marriage age in the early modern period. These data indicate that women engaged in premarital sexual relations as a marriage strategy.

Surprisingly few illegitimate births occurred in early modern Europe, however, which greatly reduced pressures for abortion or infanticide. Community controls discouraged young adults to engage in outright sexual intercourse before marriage. The effectiveness of these controls is surprising, given late average age at marriage. Some cities even sponsored prostitution houses, especially for foreign, single workers (or so they said), so that their daughters would receive fewer pressures for favors. Some women who did not marry would deliver a child out of wedlock, but they were too few for demographic significance. One set of figures shows that illegitimate births were 2 percent of total births in 1680 and rose to 6 percent by 1820, a trend that may have horrified the contemporary custodians of morality but, in comparison to modern times, is startlingly low. Given the data on the number of brides pregnant at the time of marriage, what happened to those women who were rejected for marriage? Given the low illegitimacy rates, some must have resorted to abortion.

Anecdotal information portrays women who failed to receive a bridal offer and who then had to seek clandestine means to procure abortions. Because surgical abortions were considered more dangerous than chemically induced abortions, most of the anecdotal and medical data emphasize drugs taken orally. For example, a woman reproved another because she had delivered a "base child," thus soiling her reputation and the community's as well, all because she was "not acquainted with it [the medicine] in time." As late as the nineteenth century, a man commented that juniper had saved the reputation of many young women.

Many factors affected childbearing in the early modern period: late marriage ages, time intervals for births, wars, immigration and migration, economic opportunities to establish work and living space, infanticide, famines, diseases (especially in the sixteenth century), illegitimacy, and altered life styles (such as the rise of factory workshops, wet-nursing, prostitution).

CHANGES IN MODERN EUROPE

The eighteenth through the twentieth centuries saw the development of several broad themes: attention of formal, "high" medicine to obstetrics and gynecology; numerous technical improvements; scientific developments in the understanding of physiology, pharmacology, and the mechanics of reproduction that altered age-old concepts and attitudes toward contraception and abortion; diminished importance and involvement of women in birthing procedures and decisions; dependence upon apothecaries for birth control drugs; intervention by secular governments in abortion laws; and revised Christian and, to a lesser degree, Judaic canons concerning sexuality and reproduction.

Women and male medicine. Changes in birthing procedures and the involvement of newer kinds of experts were gradual. The movement that ultimately led to less control for women can be ascribed to a woman, Jane Sharp, who in 1671 wrote The Compleat Midwife's Companion, with the aim of helping women: "I have often sat down sad in the consideration of the many miseries women endure in the hands of unskillful midwives." She sought to correct abuses, but in doing so she disclosed practical information unknown to men of science, thereby making the issues of the birth scene a matter for public view.

In 1668 the French physician Francis Mauriceau published a book on obstetrics in French that was translated into English, Dutch, German, and Italian. Among his achievements were the treatment of placenta previa (expulsion of the placenta), the condemnation of cesarian section (as too dangerous to be performed), and the assertion that fetal development is gradual, with no difference in male and female development times. Women who enjoy sexual intercourse, he claimed, are less fertile because their orifices are more closed to seminal fluid. In England Nicholas Culpeper wrote a Directory for Midwives in 1651, whose purpose was to take away the mysteries of reproduction and correct abuses. Culpeper followed this work with an immensely popular pharmaceutical guide because he lambasted the proprietary control of drugs by druggists. Growing in yards, parks, and woodlands were the sources for drugs that people needed, and, strangely, he included thinly disguised contraceptives and abortifacients.

One technological invention greatly assisted women in childbirth but, at the same time, opened the birth scene more to males. In 1647 Peter Chamberlen constructed a practical obstetric forceps based on an earlier instrument made by a family member. The manufacture of the cleverly designed instrument remained a monopolistic secret for about 150 years. The two halves could be separated, inserted, and reassembled inside the pelvis, allowing the fetal head to be grasped safely and extracted. The Chamberlen family said that when a doctor was called, they did not want him to make the decision on whether to save the mother or the child. Probably the most critical technological innovation was the invention of the stethoscope in 1816 by René-Théophile-Hyacinthe Laënnec because it enabled a physician to hear the heartbeat. There are individual variations in when the heart can be heard, but by the 1840s and 1850s physicians could determine pregnancy by no later than the fourth month. Heretofore pregnancy was either determined and declared by the woman or, late in the pregnancy, obvious to all. With the now familiar stethoscope around their necks, physicians declared when a woman was pregnant.

Prior to around 1720 most births involved exclusively women as attendants and supporters. After that time male midwives, formally trained and licensed, began to appear and gain popularity. Heretofore males were called for obstetrical emergencies, but as the eighteenth century progressed, males, as midwives and physicians, were increasingly involved at the beginning of the birth process. Adding to the loss of prestige as a result of the association with witchcraft, the publication of many new works on the subject vulgarized midwifery "secrets." Women were being pushed aside in a world that they had controlled for thousands of years. Changing attitudes toward sexuality contributed to women's losses. Seventeenth-century English works on pornography portrayed women as eager and aggressive for sexual contacts, but when intercourse was described, the man jumped on the woman and pushed her around. The new industrial order altered vocabulary. A new term "opposite sex" implied that women were opposite, separate, unequal, just not men.

Scientific discoveries and technical innovations such as the vaginal speculum, introduced early in the nineteenth century to allow more effective examinations before childbirth, encouraged expanded roles for physicians in the birthing process. (Fathers, too, were more likely to be present at births beginning in the late eighteenth century, at least in upper-class households.) The introduction of anesthetics in the mid-nineteenth-century greatly increased the benefits physicians might offer to women. Childbirth increasingly became a physician-dominated event, and then in the twentieth century, a hospital-based event. Infant and maternal mortality rates did drop in the process, though there was a period in the 1860s and 1870s when physicians, scorning sanitary procedures, actually introduced new infections. But the big mortality reductions after the 1880s were due in part to improved medical knowledge and the new interventions. Whether the cultural experience of giving birth suffered in the same process is something historians and feminists have debated.

Science and abortion. In 1651 William Harvey (1578–1657) discovered the "eggs" in deer and declared that "all living things come from an egg." To this he added that the fetus developed "gradually," not in stages, as Aristotle implied. Marcello Malpighi (1628–1694) and Jan Swammerdam (1637–1680) examined fetal development in eggs, and Swammerdam declared that the black spot in a frog's egg is "the frog itself complete in all its parts."

The hypothesis was that each ovum contains the individual seed of the entire species that is to come afterward. The preformationists regarded the egg as central to reproduction, while the male triggered the process. But with the invention of the microscope, the debate was enriched. Antonie van Leeuwenhoek (1632–1723) saw first that each drop of seminal fluid contained millions of "worms" or, in the less dramatic term, "animalcules." Contemporaries were fascinated by the news, but they were baffled by all those worms. The preformationists and epigenecists—the egg-people and the sperm people—debated what they saw murkily. The debate spilled from the drawing rooms to the public arena. Europeans saw that older theories about fetal life were wrong, and the new ideas caused them to reexamine their positions on abortion. Even though it was not until 1876 that Oskar Hertwig actually saw a sperm fertilizing an egg, the event was known to science and to much of the public.

France made abortion criminal in 1792 with words based on the provisions of medieval town ordinances. In 1803, through Lord Ellenborough's bill, Britain declared anyone who administered an abortion a criminal, specifying only drug-induced abortions. The same act defined abortion as a procedure performed on any woman "being quick with child." In 1810 Napoleon's Penal Code declared criminal any act whereby someone gave "food, beverage, medicines, violence or any other means" to procure an abortion. By the 1830s it was recognized that the concept of quickening, based on Aristotle, was untenable. The question was when was an abortion an abortion? In 1837 abortion was defined as eliminating pregnancy at any period, thereby dropping reference to quickening. In 1851 Pope Pius IX declared as subject to excommunication anyone who procured "a successful abortion." Even though conception per se was not specified, gone were concepts such as ensoulment and "formed fetus" (quickened). One by one the nation-states of Europe defined abortion as occurring anytime after conception that pregnancy was deliberately terminated: Austria, 1852; Denmark, 1866; Belgium, 1867; Spain, 1870; Zürich Canton, 1871; Netherlands, 1881; Bosnia/Herzegovina, 1881; Norway, 1885; Italy, 1889; and Turkey, 1911.

The actual history and context of abortion both explained and defied legal patterns. Sexual activity was rising, particularly among young people and the lower classes. Many women found themselves pregnant before marriage, and while rates of illegitimacy increased, there was also a new desire to terminate pregnancy. Wives might also seek means of reducing the threat of unwanted children in overcrowded, impoverished families. The desire for abortion increased, at least in some quarters. This helps explain the new efforts at legislation, but also their considerable ineffectiveness. Many women experienced illegal abortions—one estimate held that a quarter of working-class women in Berlin had had at least one abortion by the 1890s. Even in the twentieth century, when more effective birth control limited the need for abortion within marriage in Western Europe, premarital sexual activity among youth maintained considerable demand. In Eastern Europe, where available birth control devices remained limited or poor quality into the late twentieth century, abortion was even more common, serving as a basic means of birth control, even though here too it was frequently illegal. Only in the later twentieth century did most European countries move to legalize abortion, thus reducing the often dangerous gap between law and practice.

Birth control. Even so, and far more than with abortion, there were huge gaps between legal and cultural prescriptions on the one hand, and actual developments in the nineteenth and early twentieth centuries on the other. Need for and rates of birth control both increased.

The need was clear. Beginning with the middle classes in the late eighteenth and early nineteenth centuries, European families redefined the pluses and minuses of children. Middle-class parents, eager to provide some education for boys and dowries for girls, were hard-pressed to meet their obligations without reducing the birthrate. A bit later, working-class families, affected by child labor laws and technical changes that reduced the earning power of children, in addition to schooling requirements and frequent poverty, also discovered the desirability of reducing traditional birthrates. Peasant families varied in their movement in this direction. Overall, however, the burdens of rapid population increase plus changes in work meant that, during the nineteenth century, most groups in western Europe found children becoming more an economic liability than an asset and reduced birthrates accordingly. Similar patterns set in in eastern and southern Europe by 1900.

Methods of birth control varied. Initially, there were few new methods available and widespread legal and cultural contraints on artificial measures. Many families resorted to coitus interruptus or abstinence; this was true in working-class families into the twentieth century. In the long run however, new devices, made possible and affordable by developments such as the vulcanization of rubber (1840s), increased the artificial means available and permitted increasing recreational rather than procreational sex, both within marriage and without. Middle-class families gradually turned to the use of diaphragms (called pessaries in the nineteenth century), while workers more often used condoms. Knowledge spread gradually; condoms were seen as exotic—called "Parisian articles"—by German laborers as late as the 1870s. But the development of new levels of artificial birth control was steady and involved major changes in family life and sexuality alike.

Well into the twentieth century, most governments, whether communist, fascist, or democratic, continued to promote population growth and oppose birth control. The gap between policy and widespread practice widened. Even in Nazi Germany, birth control levels receded only briefly. By the 1960s, faced with new levels of adolescent sexual activity, most European governments moved toward legalizing the availability of birth control devices. Concerns about disease supported this move. One result was a far greater decline in adolescent pregnancy in Europe than in the United States, where the legislative framework differed considerably and where programs to promote abstinence won greater favor.

The control of birth. In the nineteenth century a woman's body was opened to the public in ways held private in early centuries. To learn whether she was pregnant a woman would go or be sent to a physician, whose eyes would observe the darkening of the areola and view her vagina. His hands would feel her breasts and his fingers the cervix for the so-called Hegar's sign, enlargement and softening of the uterus and cervix. Male midwives increased in numbers and importance, partly because they received formal education for licensing. In eighteenth-century France male accoucheurs (midwives) were said to be driving women from the profession. In England it was said that female anatomy was designed to fit the male midwives' fingers.

The late nineteenth century witnessed important events for birth in what Angus McLaren calls the medicalization of procreation. Increased attention on germ theory made the environment of the birth chamber increasingly important. The result was the move to hospitals for delivery. The "lithotomy position" (the woman on her back) for childbirth replaced the standing or squatting position. "Twilight sleep," or the use of anesthesia, pioneered by Bernhard Krönig in Germany in 1899, promised the removal of pain. These gains, undeniably beneficial for women, brought with them the price of men and the state controlling their reproductive processes. The womb was made public.

Birth control drugs once known by women, learned from mother to daughter, came to be dispensed by druggists, many of whom did not know proper preparations or even the correct plants and their amounts. Proprietary menstrual regulators were peddled and some women relied on them. The concerns by nineteenth-century political and ecclesiastical leaders about declines in birthrates resulted in more rigorous legislation and enforcement about birth control laws relating to contraceptive and abortion drugs and surgical procedures for abortions. Thomas Malthus, famous for his dismal pronouncement about population increase, said that he was even more worried about dangers of population decreases. Reproduction was too important to be left in the control of women.

By the twentieth century, in what Barbara Duden calls the iconography of pregnancy, the fetus was spoken as having "life" and as being "human." The question of theologians about when ensoulment occurs was altered to when does life begin, and the answer was at conception. The controversies swirled around these issues of the age-old right of women to employ birth control techniques and the right of society to protect its newly formed definition of life. Procreation was safer for women, but safety was purchased with freedom.

See also sections 15, 16, and 17 (volume 4), and other articles in this section.

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