20th-century history of women's healthcare in the United States

During the 20th century, women's healthcare in the United States changed through shifts in medical practice, reproductive law, public health policy, and insurance coverage. At the beginning of the century, federal and state laws restricted contraception, while women reformers campaigned for maternity benefits in compulsory health insurance. Race and class shaped access to care and treatment by public health agencies. State eugenics programs subjected people classified as unfit to compulsory sterilization; racial and class hierarchies and prejudice against disabled people shaped those classifications.

The first pill form of birth control was released in 1960.

From the 1960s, the women's health movement challenged paternalistic care, gender-biased diagnosis, limited medical information, and restrictions on contraception, abortion, and choice in childbirth. Activists formed self-help groups and feminist health centers and pressed hospitals to change maternity care. The same period saw greater participation by women in medicine and health policy. Griswold v. Connecticut expanded contraceptive rights in 1965, and Roe v. Wade established a constitutional right to abortion in 1973. Women of color also pushed the movement to address sterilization abuse, poverty, welfare rights, and unequal access to care. By the end of the century, more women obtained insurance through their own employment and Medicaid eligibility had expanded, although many remained dependent on a spouse's plan or lacked coverage.

Effects of the feminist movement on women’s healthcare

The contemporary women's health movement emerged alongside second-wave feminism in the 1960s and 1970s. Although activists differed in their priorities, common demands included greater control over reproductive decisions and an end to sexist treatment in healthcare. By 1973, more than 1,200 women's self-help health groups existed across the country; they opposed paternalistic medical practices and encouraged women to take a more active role in decisions about their health. Feminist writers also challenged the tendency to dismiss women's physical complaints as non-serious or psychosomatic. Evidence for systematic diagnostic bias was limited and sometimes conflicting, but the criticism brought medical assumptions about women's symptoms under closer scrutiny.

Activists also challenged inadequate informed-consent procedures and limited information about the risks of drugs and medical devices. The movement helped establish feminist health centers and freestanding birth centers, prompted reforms in hospital childbirth, and contributed to federally required information inserts for oral contraceptives. Alongside civil-rights legislation barring sex discrimination in federally funded education, it also encouraged more women to enter medicine: the number of women physicians more than doubled between 1970 and 1980, and women accounted for 30% of obstetrician-gynecologists by 1995. During the 1980s and 1990s, activists increasingly worked through federal agencies and professional institutions, extending their agenda beyond reproduction to biomedical research and health across the life course.

Reproductive healthcare

The Supreme Court legalized abortion in 1973 in the Roe v. Wade case.

At the beginning of the twentieth century, federal and state Comstock laws restricted the circulation of contraceptives and information about them. Margaret Sanger challenged these restrictions and opened the first birth control clinic in the United States in 1916. By the 1960s and 1970s, activists campaigned for access to contraception and abortion and for greater choice in childbirth. They supported childbirth education, less routine medical intervention, and the participation of husbands during labor; hospitals later introduced prepared-childbirth classes and more family-centered maternity care.

Birth control

Margaret Sanger popularized the term "birth control", and opened the first birth control clinic in the United States.

Sanger later promoted research into oral contraception. During the 1950s, Katharine McCormick supplied much of the private funding for the development and early trials of the pill, and the Food and Drug Administration approved Enovid for contraceptive use in 1960. In 1965, Griswold v. Connecticut struck down a state prohibition on contraceptive use by married couples. The pill provided an effective method that could be used independently of intercourse, but its development also raised ethical concerns. Trials conducted in Puerto Rico used high hormone doses, and participants received little information about the drug's safety or possible adverse effects.

Abortion

For most of the 1960s, state laws generally permitted abortion only when it was considered necessary to save a pregnant woman's life. Abortion-rights activism became a central part of the women’s health movement, and in 1973 Roe v. Wade legalized abortion nationwide. Legalization was followed by the growth of nonhospital facilities offering abortion services. In 1972, the Centers for Disease Control and Prevention recorded 39 deaths associated with illegal abortion.

Healthcare for women of color

Race and class affected both access to care and the treatment women received from public health agencies. In 1916, a maternal and infant health project in Columbus Hill, a largely African American and British West Indian neighborhood in New York City, required Black pregnant women seeking assistance to undergo testing and possible treatment for syphilis, although tuberculosis, respiratory illness, and infant diarrheal disease were also widespread. The same organizations later emphasized tuberculosis, pneumonia, and enteritis in an Italian neighborhood. During the 1960s, civil-rights and anti-poverty activists helped establish neighborhood health centers that combined medical care with social services. Women of color later pressed the women's health movement to address sterilization abuse, welfare rights, poverty, and unequal access to care, contributing to the development of reproductive justice.

Eugenic sterilization laws were used by 32 states to prevent people classified as unfit from reproducing. Although California’s law did not designate racial or ethnic groups, racial and class hierarchies and prejudice against disabled people shaped who was classified as fit or unfit under the program. The state carried out about 20,000 compulsory sterilizations—roughly one-third of the documented national total under state eugenics laws. Among patients in California institutions from 1920 to 1945, Latina women were 59% more likely than non-Latina women to be recommended for sterilization. Sterilization abuse continued after state eugenics programs declined; federally funded procedures performed at a Los Angeles County hospital in the early 1970s became the subject of a lawsuit brought by women of Mexican origin.

Women's health insurance

Women trade unionists and suffragists supported compulsory health insurance with maternity benefits during the Progressive Era; in New York, they joined a labor rally for such legislation in 1919. By 1980, employment-based plans were the largest source of coverage for women aged 25–64, but many women worked in part-time, temporary, service, or small-business jobs that did not provide benefits. A substantial share of insured women obtained coverage as dependents through a spouse; such coverage could be lost through divorce, widowhood, or the spouse's loss of employment.

In the early 1970s, women labor leaders and feminist activists pressed national insurance campaigns to include primary and preventive care; during the Clinton health-reform campaign, the Older Women's League also sought coverage for reproductive, mental-health, and long-term care. During the 1980s and 1990s, more women secured insurance through their own employment and Medicaid eligibility expanded for pregnant and low-income women, yet rising private-insurance costs left a growing share uninsured.

See also

• Contraceptive mandate
• Feminist movement
• Abortion-rights movement
• Women's Health Initiative