In the late nineteenth century, the Comstock Act of 1873 made the distribution of contraception illegal and classified contraception as an obscenity. Reflecting the predominant attitude towards contraception at the time, the Comstock Act was the first federal anti-obscenity law that targeted contraception. However, social acceptance of birth control changed at the turn of the twentieth century. In this thesis, I analyzed legislation, advocates, and literature pertinent to that social change to report on the events leading up to the decriminalization of contraception.

Hans Peter Dietz and Judy Simpson published, “Levator Trauma is Associated with Pelvic Organ Prolapse,” in the journal BJOG: An International Journal of Obstetrics and Gynecology in 2008. In their article, Dietz and Simpson estimated the risk of pelvic organ prolapse in women who attained injuries to the pelvic levator muscles. The levator muscles, also known as the levator ani, are a major muscle group that comprise the pelvic floor. Along with other muscles, the pelvic floor supports organs in a woman’s pelvis, such as the bladder, uterus, and rectum. Vaginal childbirth can cause a weakening of the pelvic muscles. That can lead to pelvic organ prolapse, which results in the descent of the pelvic organs towards a woman’s vaginal opening. In, “Levator Trauma is Associated with Pelvic Organ Prolapse,” Dietz and Simpson found that women were more likely to have pelvic organ prolapse if they had levator trauma, and called for further research to understand the relationship between levator ani trauma and pelvic organ prolapse.

A Treatise on the Theory and Practice of Midwifery is a three volume collection of patient accounts that William Smellie published from 1752 to 1764. Smellie, a physician and instructor in obstetrics in Great Britain, published these compilations to share his expertise in reproductive medicine, while also providing his students and colleagues with a source of reference in their own medical practices. Smellie wrote these books to shift obstetrics from a discipline practiced by midwives with limited medical training to one practiced in a medical context by physicians. Throughout his books, Smellie describes effective and ineffective treatments, tools, and interventions for complications during pregnancy. Due to the popularity of Smellie's writings, access to Smellie's work expanded beyond his students, allowing obstetricians, man-midwives, and physicians to refer to scientific literature and apply Smellie's teachings to their own practice.

James Young Simpson was one of the first obstetricians to administer anesthesia during childbirth in nineteenth century Scotland. Before his work in the 1800s, physicians had few ways to reduce the pain of childbirth. Simpson experimented with the use of ether and chloroform, both gaseous chemicals, to temporarily relieve pain. He found that those chemicals both successfully inhibited the pain women felt during childbirth and pain during other surgeries. Patients under the influence of chloroform fell asleep and were unaware of the intense pain of childbirth. Simpson’s work was not popular for a variety of reasons, and the major claim against his practice being that pregnant women should not receive a form of pain relief during labor and childbirth. Against common beliefs at the time, Simpson advocated in favor of using anesthetics for pain-free labor, which later became the standard for surgical procedures and childbirth.

Margaret Goldwater advocated for birth control and reproductive rights in the United States during the twentieth century. Goldwater was a socialite and philanthropist and was married to Barry Goldwater, US Senator from Arizona. She spent much of her life working to further the women's reproductive rights movement, which sought to expand women's legal, social, and physical access to reproductive healthcare, including contraception and abortions. Goldwater, with guidance from birth control activist Margaret Sanger, helped establish the second birth control clinic in Arizona, the Mother's Health Clinic in Phoenix, Arizona. She conducted large fundraising events and authored articles in local newspapers on the need for contraceptives and family planning. Goldwater's advocacy helped launch and sustain The Mother's Health Clinic, which became the largest provider of women's reproductive healthcare in Arizona, and it later became Planned Parenthood of Central and Northern Arizona.

The 1973 case Nelson v. Planned Parenthood Center of Tucson established the legality of abortion in Arizona. The Arizona Court of Appeals ruled that the Arizona Revised Statutes 13-211, 13-212, and 13-213, collectively called the Arizona abortion statutes, were unconstitutional. The statutes had made illegal receiving, providing, or advertising abortions. After the Arizona Appeals Court heard the case, it decided that the Arizona abortion statutes were constitutional. However, two weeks later the US Supreme Court decided in Roe v. Wade (1973) that abortion was constitutional at the federal level. The Arizona court followed the precedent set by the US Supreme Court and amended its decision to rule that the Arizona abortion statutes were unconstitutional. Afterwards, Planned Parenthood, other family planning clinics, and hospitals were legally allowed in Arizona to advertise, discuss, and offer abortions as an option to their patients.

In the 2002 case Simat Corp v. Arizona Health Care Containment System, the Arizona Supreme Court ruled that the Arizona Health Care Containment System must pay for abortions when they are necessary to preserve the health of pregnant women in the system. In the case, the Court ruled that the Arizona Revised Statutes 35-196.02 and the Arizona Health Care Containment System (AHCCCS) policies, which banned public funds from being used for abortions, were unconstitutional. AHCCCS is Arizona's Medicaid insurance system, which enables low-income residents to receive medical care. The decision in Simat Corp v. Arizona Health Care Cost Containment System required AHCCCS to pay for abortions in cases for which pregnancies put women's health at risk, allowing low-income women greater access to therapeutic abortions.

In the 2013 case Isaacson v. Horne, the US Court of Appeals in the Ninth Circuit ruled that Arizona House Bill (HB) 2036, which prohibited abortions after twenty weeks of gestation, was unconstitutional. The Arizona State Legislature passed the law in 2012, which was then challenged by three physicians who filed a lawsuit against the state, arguing that the law violated women's constitutionally protected rights to abortions, rights that may only be infringed once fetuses are viable outside of the womb. In hearing the case, the Ninth Circuit US Court of Appeals relied on the precedent set by the US Supreme Court in Roe v. Wade (1973) that ruled that states could not constitutionality prohibit abortions prior to fetal viability at twenty-four weeks. The case Isaacson v. Horne strengthened the precedent in Arizona that laws prohibiting abortion prior to fetal viability are unconstitutional, and it upheld women's rights to decide to terminate their pregnancies prior to fetal viability.

In 1955, obstetrician Edward Bishop, a physician specializing in childbirth, published the article “Elective Induction of Labor,” in which he proposed the best conditions for pregnant women to elect to induce, or begin, labor. Elective induction of labor requires an obstetrician to administer a drug to help a pregnant woman to start her contractions, and to rupture the fluid-filled sac surrounding the fetus called the amniotic sac. In the early 1950s, Bishop analyzed the results of one thousand elective inductions and discovered that some pregnant women had faster and easier deliveries with induced labor than other pregnant women. In “Elective Induction of Labor,” Bishop describes the characteristics an obstetrician can look for in a pregnant woman to determine if she can safely undergo an elective induction, metrics still used into the twenty-first century to determine whether or not to pursue elective inductions.

The Malthusian League, founded in London, England, in 1877 promoted the use of contraception to limit family size. Activists Charles Bradlaugh and Annie Besant established the Malthusian League after they were arrested and exonerated for publishing a pamphlet describing techniques to prevent pregnancy. Founders based the league on the principles of Thomas Malthus, a British nineteenth century economist, who wrote on the perils of a population growing beyond the resources available to support it. The Malthusian League advocated for limiting family size voluntarily through contraception to avoid the overpopulation and poverty cautioned in Malthus’ work. After fifty years, the Malthusian League closed due to the increasing disapproval for Malthus’s economic theories of population and poverty. However, the Malthusian League’s activism during the late nineteenth and early twentieth centuries led to more tolerant views of contraception and family planning in Great Britain in the twentieth century.