We celebrate the 40th anniversary of the introduction of the oral contraceptive pill in a world considerably different from the one we knew four decades ago. How much of the change we have experienced can be traced, directly or indirectly, to the pill? Since this method first became available in 1960, many articles have been written about its impact on society. Like other publications, Family Planning Perspectives has periodically examined the pill's influence on women's roles and on the separation of reproduction from sexuality. As we begin a new century, however, we believe it is valuable to take a look at several other issues that have—despite their importance—received less attention.

The experts we asked to address these topics seem to agree that the pill has played a complex role in how we think, communicate and interact. Indeed, they may raise at least as many questions as they answer. Have oral contraceptives allowed women freedom from the risk of pregnancy, only to subject them to a physician's rigid ideas of how they should take them? Has the pill given women more control over contraception, only to burden them with responsibilities they would prefer to share with their partners? Has it encouraged women who grew up with the pill to talk about contraception and sex with their daughters, only to find that their daughters want them to believe they are taking the pill to alleviate painful menstrual cramps? Is the pill a way for black women to gain bodily autonomy, or a tool used by white society to limit black fertility? Did we think the pill had liberated us from the hated condom, only to find that we now need both? Given the dearth of new methods on the horizon, it is likely that we will struggle with these and other questions far into the 21st century.

The essays in this forum were solicited, developed and edited by Frances A. Althaus, senior editor of Family Planning Perspectives.

In 1969, Toni Cade wrote an essay entitled "The Pill: Genocide or Liberation?" about the rift between men and women over the role of birth control in the black liberation movement.¹ Cade recalls a political meeting in which a tall brother stood up and "castigated the Sisters to throw away the pill and hop to the mattresses and breed revolutionaries and mess up the man's genocidal program."² Cade rejects both the sexist implication that women's only role in the struggle is to bear children and the naïve faith that simply producing more children will improve conditions for black Americans. She doesn't believe that the pill alone can liberate anyone, but asserts that it gives women critical control over a major part of their lives. Still, the black man who condemned the pill as a genocidal tool was not a paranoid lunatic. He failed to understand the pill's importance to black women's self-determination, but his concerns about birth control as a form of genocide arose from a real history of reproductive abuse. Cade's honest and provocative essay raises themes about black women's relationship to birth control that still resonate today.

For black women, the politics of the pill doesn't fall into a simple liberal-conservative dichotomy. The meaning of birth control is complicated by the racist denigration of black childbearing, including deliberate campaigns to limit black fertility; sexist and religious norms within the black community; and many white feminists' ignorance about the unique issues facing black women. Black women's attitudes about the pill are shaped by a broader social context that includes racial injustice as well as gender inequality and religious traditions. This social context generated debates about race and birth control among blacks and white policymakers not only when the pill was introduced in 1960, but also at the inception of the birth control movement 30 years earlier and with the approval of long-acting contraceptives 30 years later. Black women's perspective on birth control—recognizing its potential for both liberation and oppression—makes an important contribution toward development of a more just vision of reproductive freedom.

The pill gave black women greater control over reproduction than ever before. Why should this seemingly positive development be so controversial? One reason is the role white-dominated birth control programs played in furthering racial injustice. As black Americans agitated for their civil rights, the white backlash included reproductive regulation. The pill was introduced at a time when scientists such as Arthur Jensen and William Shockley were promoting genetic explanations of racial differences in intelligence-test scores. During the 1960s and 1970s, thousands of poor black women were coercively sterilized under federally funded programs. Women were threatened with termination of welfare benefits or denial of medical care if they didn't "consent" to the procedure. Southern blacks claimed that black women were routinely sterilized without their consent and for no valid medical reason—a practice so widespread it was called a "Mississippi appendectomy." Teaching hospitals in the North also performed unnecessary hysterectomies on poor black women as practice for their medical residents. During this period, state legislators considered a rash of punitive sterilization bills aimed at the growing number of blacks receiving public assistance.

It is not surprising, then, that many blacks saw the pill as just another tool in the white man's efforts to curtail the black population. Two studies published in the American Journal of Public Health showed a widespread worry among blacks that family planning programs were a potential means of racial genocide, especially if the programs provided sterilization and were run by whites.³

Black concerns about family planning had arisen decades earlier during Margaret Sanger's crusade for birth control. As Sanger allied herself with the burgeoning eugenics movement, the call for birth control veered away from its radical, feminist origins to include programs to regulate the poor, immigrants and blacks, based on theories of genetic inferiority and social degeneracy. Some blacks of the period, including the nationalist leader Marcus Garvey, opposed birth control as a form of "race suicide." Yet black women in disproportionate numbers enthusiastically used the few birth control clinics that were available to them. The prominent civil rights figure W.E.B. DuBois publicly endorsed birth control as a means of improving black health and denounced the argument that blacks should rely on a high birthrate to fight discrimination. Blacks' advocacy of birth control as a tool for racial betterment sharply differed, however, from the eugenic agenda. White eugenicists promoted birth control as a way of preserving an oppressive social structure; blacks like DuBois promoted birth control as a way of toppling it.

More recently, efforts to encourage poor black women to use long-lasting contraceptives such as hormonal implants and injectables have resurrected the debate about race and birth control. The eugenic overtones of an editorial in The Philadelphia Inquirer suggesting the implant as a solution to inner-city poverty set off a firestorm of criticism.⁴ A group of black ministers in Baltimore denounced the introduction of the implant in the city's predominantly black high schools for "push[ing] the issue of social control of an ethnic minority by the majority population whose culture and values may be different."⁵

For nearly a century, black women have found themselves at the center of controversies about birth control's role in the struggle for racial and sexual equality. They have battled not only men—white and black—who discounted the importance of women's bodily autonomy, but also white women who discounted the significance of racism. The dominant women's movement has focused myopically on abortion rights at the expense of other aspects of reproductive freedom, including the right to bear children, and has misunderstood criticism of coercive birth control policies. Attending to black women's perspective on the pill and other contraceptives can help to transform the movement for reproductive freedom. It can help us understand that there is nothing contradictory about advocating women's freedom to use birth control while opposing abusive birth control practices. Social justice requires both equal access to safe, user-controlled contraceptives and an end to the use of birth control as a means of population control.