Premodern Women Had Birth Control

A brief history of bringing on the menses

Pennyroyal, one of the most popular premodern abortifacents. By Raffi Kojian, CC BY-SA 3.0.

Many people believe that, before the invention of the pill, women¹ didn’t have access to birth control and were having a child every other year. In reality, according to the book Eve’s Herbs: A History of Contraception and Abortion in the West, women in most cultures around the globe had access to birth control—though not as reliable as the birth control we have today.

Birth control that was fully under the woman’s control (that is, not the withdrawal method, condoms, or outercourse) came broadly in two forms: pessaries and emmenagogues.² Pessaries are devices placed inside the vagina. Some merely mechanically blocked the cervix, preventing sperm from getting in; others also included herbs that, in vitro, often appear to be spermicidal. Emmenagogues are herbal preparations (almost always taken orally) that “bring on the menses”: that is, they’re abortifacents that work early in pregnancy. Many emmenagogues listed in historical herbals have been studied in vitro or on lab rats, and appear to have abortifacent properties. Because embryos and early-stage fetuses are much more fragile than older fetuses, women could take smaller abortifacent doses and still miscarry. Thus, emmenagogues had far fewer side effects than later-term abortions.

Of course, many women used birth control techniques that simply didn’t work, from prayers and amulets to drinking a man’s urine or swallowing a live bee. But magical or outre methods of contraception tend to differ from herbal to herbal and medical text to medical text. Conversely, herbals and medical texts repeatedly refer to the same handful of herbs, such as pennyroyal, artemisia, and Queen Anne’s lace—and these herbs typically show some abortifacent effect in modern studies.

Neither pessaries nor emmenagogues were reliable forms of contraception. They enabled women to have fewer pregnancies than they otherwise would, but a sexually active woman would still have many pregnancies and give birth to many children. “Every child a wanted child” was still far in the distance. But women were often able to space their pregnancies, giving their bodies more time to recover and reducing the chance that they had more children than they could feed.

Pessaries and emmenagogues are old. The earliest known reference to birth control is in the Ebers Papyrus, from 1550-1500 BC. Internal evidence suggests it may have been drawing on medical works from the Old Kingdom (2700-2200 BC). The Ebers Papyrus recommends using an herbal pessary as an abortifacent.

You may also have heard of silphium, the culinary and medicinal herb which the Romans drove extinct due to overharvesting. The juice from a chickpea-sized amount of silphium was drunk once a month to prevent conception. Silphium was so economically important to Cyrene, the city where silphium grew, that it used silphium as its symbol on its coins. It is believed to be a species of giant fennel (Ferula), and other giant fennel species have proven effective contraceptives in rat models.

Our understanding of premodern birth control is very limited. In nearly all cultures, birth control is “women’s knowledge” that isn’t shared with men. Although we normally think of them as attending births, in most cultures midwives are more like a modern ob/gyn: they handle not just pregnancy and childbirth but also birth control, abortion, fertility, irregular menstrual cycles, and STIs. Since vanishingly few women were literate, midwives’ knowledge was nowhere recorded. Eve’s Herbs primarily draws on premodern medical texts and herbals—but these texts reflect only what men think women were doing. For example, medieval texts describe clearly abortifacent herbal remedies as helping with “stomach trouble” or as “bringing on the menses.” Sometimes, Eve’s Herbs draws on even more circumstantial evidence, such as the numerous men in the classical and medieval period who thought that midwives could prevent births by giving women a cup of herbs. If men widely believe that midwives could give women herbal contraceptives, a plausible explanation is that they actually could—but this isn’t exactly the most reliable evidence possible.

At the same time, even when we have records of what herbs people used, we rarely know how effective they were. It would be unethical to run human trials of suspected abortifacents when we have safe abortion pills already. And researchers show limited interest in rat studies of herbs that almost certainly are less effective and have more side effects than the contraceptives we already have. So anything we say here is very uncertain. Still, it seems that the balance of the evidence is that women were trying to control their fertility, and that they occasionally found methods that worked.

Interestingly, medieval Europeans did not see emmenagogues as abortifacents: after all, there were plenty of reasons for a period to be late other than pregnancy. Medieval medical writers typically wrote that pregnancies took a while to firmly establish. Within that time period, a woman could take an emmenagogue to bring on menstruation without anyone understanding it as an abortion. In general, abortion was only considered murder once the fetus was fully formed or after quickening; Christians only started believing that life began at conception in the nineteenth century, with the rise of modern embryology. Using an emmenagogue was considered a sin, but medieval writers did not conceive of emmenagogues differently from contraception. Since sex was for procreation, attempting to prevent conception meant you were lusting. Thomas Aquinas even considered the use of fertility drugs to be a sin, because only God should control whether you procreate.

We believe that premodern women didn’t use contraceptives in part because Western women of the nineteenth century mostly didn’t know about herbal contraceptives.³ Why? What caused such valuable knowledge to get lost?

In part, the witch hunts of the early modern period. Tens of thousands of people—about 80% women—were executed as witches. It’s important to take a nuanced approach here. Many people incorrectly believe that witch hunts exclusively targeted midwives, cunning women, and other female healers. This is not true. Even in the most anti-midwife witch hunts, midwives never made up more than a third of the women executed.

At the same time, historians debunking feminist exaggerations go too far by saying that there was no correlation between midwifery and being executed as a witch. Midwives were usually more likely to be executed than other women, which makes sense—their entire thing is knowing secret herbal knowledge other people don't. Some historians point out that many midwives encouraged anti-witch sentiment, but that’s exactly what you’d expect if midwives were suspicious: best to make it very clear who is an evil devil-worshipper and who is an innocent woman who happens to know a lot about herbs.

Witches were well-known to provide contraception and abortions. In fact, manuals for witch-hunters monotonously emphasized the connection between witches and preventing procreation: witches gave men erectile dysfunction, castrated men, made both men and women unable to conceive, performed abortions, and murdered babies. It seems reasonable to extrapolate that midwives would quietly decide that offering contraceptive services wasn’t worth the risk.

The chain of transmission of contraceptive knowledge was fragile and easy to disrupt. Herbal medicine is immensely complicated. A midwife would have to know the season, part of the plant, method of extraction, and amount and frequency of administration. Often, these were very specific and made the difference between medicine and poison. Since midwives were illiterate, the only way to pass the knowledge down was through apprenticeship. If a woman was executed before she could train a successor, or kept her knowledge to herself for fear of persecution, what she knew was gone forever.

Eve’s Herbs doesn’t mention the rise in state capacity in the early modern period, but I think it’s another explanation. Medieval peasants simply didn’t know what the church taught about anything. The Reformation by Diarmaid McCullough, for example, discusses the following incident:

One sixteenth-century Portuguese Archbishop was dumbfounded when in the course of his visitation a well-meaning procession of peasants welcomed him to their community, chanting “Blessed be the Holy Trinity and His sister the Virgin Mary.”

For various reasons too complicated to include in this post, in the early modern period both the church and the state started to have more idea of what was going on and more effective administrations to do something about it. As the church grew more able to enforce its anti-birth-control teachings, knowledge of birth control was lost.

Finally, throughout the early modern period and again for reasons too complicated to get into here, medicine became more professionalized. More and more often, women got medicine from apothecaries rather than midwives.⁴ In the early modern period, pharmacopeias—reference manuals for working pharmacists—generally included emmenagogues and abortifacents. (Knowledge of herbal pessaries seems to have been lost at this point.) Abortifacents were described vaguely, perhaps to avoid prosecution: one, for example, was characterized as being “good for women, rectifies the disposition of the womb and airs it.”

In general, pharmacopeias recommended combining many abortifacents in a single mixture. These more complicated recipes required a professional’s knowledge and couldn’t be made at home. Of course—from we now know about polypharmacy—they were also likely far more dangerous.

Meanwhile, doctors were entirely ignorant about herbal birth control. Some gynecology texts even recommended the use of emmenagogues to make patients more fertile, by causing them to menstruate more regularly. In 1760, a medical journal ran a case study where a doctor, faced with a patient who had failed to expel a dead fetus, prescribed her herbs from an ancient Roman medical text because he had no other way of learning how to induce a miscarriage.

By the late eighteenth century, abortifacents were sufficiently stigmatized that they’d dropped out of the pharmacopeias. However, records suggest that pennyroyal was still a widely sold drug, even though it’s essentially only useful as an abortifacent. Nineteenth century health guides for women mostly included relatively useless emmenagogues (diet, exercise, chamomile tea), but pennyroyal tea and other classics made appearances.

In the nineteenth century, enterprising pharmacists began to sell patent medications:

Examples of medicines included “Farrer’s Catholic Pills,” “Poudre Unique,” “Velnos’ Vegetable Syrup,” “French Lunar Pills,” “Hooper’s Female Pills,” “Dr. Peter’s French Renovating Pills,” “Hardy’s Woman’s Friend,” “Colchester’s Pennyroyal and Tansy Pills,” “Chichester’s Pennyroyal Pills,” “Dr. Champlin’s Red Woman’s Relief,” “Dr. Monroe’s French Periodical Pills,” and just plain “Female Monthly Pills.”

A single issue of the Boston Daily Times (January 4, 1845) carried advertisements for five “medicines” for females. A survey of newspapers in Great Britain during one week showed 100 newspapers with advertisements for abortions thinly disguised. The wording of the promotions was usually clever and seldom direct: “restores female regularity”; “Females laboring under weakness, debility, fluorual bas [vaginal discharge], often so destructive and undermining to health”; “purifying blood, in debilitated and nervous constitutions, and restoring a healthy action to the internal system”; and “removing from the system every impurity.” A single issue of the Central Times in the small town of Dunn, North Carolina, on Febrary 26, 1891, contained advertisements for three brands of Pennyroyal Pills for four cents.

Typical among the testimonies for such pills was this one from a Mrs. G. of Shelton, England: “Your mixture cured me after Three Months last spring .. .No less than Twelve Times you ... have Cured me!" Dr. Peter’s French Renovation Pills gave “Authenticated Certificates from ladies who have used them” and gave notice that these pills had “rendered the usual practice of quacks, that of puffing, not only unnecessary but unworthy.” An even more revealing certificate was required by a late-nineteenth-century German proprietor. The sale of the medicine required the customer to sign this statement (translated into English): “I hereby declare that I will not take this cure to terminate pregnancy but only to restore monthly cycle, since period disruptions can indeed have several causes.”

Sorry for the long quotes, but I just love patent medicine advertisements.

Many of the patent medicines did nothing. But many contained the same herbal medicines, such as pennyroyal, that women had been taking for thousands of years.

Doctors, jealous of their professional prerogatives, claimed that patent medicines did nothing; any miscarriage after taking one was pure coincidence. In an 1871 case, a man was found not guilty of causing an abortion, because the defense found numerous medical witnesses who said that pennyroyal could only bring on a menstrual period and couldn’t possibly cause an abortion.⁵ Since doctors get to write the medical textbooks, all patent medicines were dismissed as quackery.

A lot of anti-contraception and anti-abortion arguments implicitly assume that women’s control over their fertility isn’t “traditional.” Women would never have thought of ending a pregnancy before Margaret Sanger singlehandedly brainwashed them all into man-hating baby-hating feminism. In fact, women have been using herbal medications to perform early-term abortions for thousands of years. While the knowledge was mostly lost in the early modern West, some scraps of it survived into the twentieth century.

Of course women figured out how to have abortions. As I’ve written before, women can’t exercise basic control over their own lives without the ability to prevent pregnancy. And—even in the modern era, where we’ve invented highly reliable contraception—abortion is crucial for women who don’t have access to highly reliable contraception, who were raped, who face pregnancy-related health issues, or who have any number of other reasons to need to end a pregnancy. It’s important that our government protects these basic rights.

1. Throughout this post I will be using “women” synonymously with “dyadic cis women,” for conciseness, to emphasize the role of sexism in the history of birth control, and because the history of trans people is even murkier than the history of abortion.

2. The author of Eve’s Herbs says there might have been herbal hormonal contraception, but I think he’s stretching beyond a reasonable interpretation of the evidence.

3. Eve’s Herbs mostly doesn’t address the topic, but gives the strong impression that in non-Western cultures knowledge of herbal contraceptives was passed along until the present.

4. One reason was increasing urbanization, which made it harder to gather your own herbs.

5. Lawmakers, however, believed that patent medicine abortifacents worked and came up with increasingly elaborate methods to ban them: in 1924, Louisiana even banned selling any drug specifically to women.