But smuggled in amid what Bergstein calls “the fun stuff” is the bloody heart of the film: the white working-class character Penny (Cynthia Rhodes), who has to have an illegal abortion. After being taken to a “butcher” with a “dirty knife” and a “folding table” — Bergstein made sure to included graphic language in the film — she nearly dies, screaming in agony. She doesn’t, but Bergstein had to fight hard to keep the Penny plot in the movie when the studio wanted to remove it: “It had to be in the movie because I could see young women were taking the rights for granted and I wanted to show them what life really could be like in the US.”

They may well be about to find out for themselves. I happen to be in the US this week and waking up to news that a leaked draft shows the US Supreme Court has provisionally voted to overturn Roe v Wade, felt strangely similar to another morning six years ago, when I woke up to learn that Donald Trump was now my president. Suddenly, on both mornings, I was in the land of the unimaginable, a development that was, really, all too foreseeable.

It seems probable that the leak, which will likely be investigated by the FBI, was from a young liberal or conservative clerk working in the court, hoping to excite their bases in the midterms. So reacting to it runs the risk of letting the tail wag the dog: it was done to incite, and incited we all are. And yet. Anyone who cares about women’s rights can’t help but react to it, and getting this confirmed insight into how close American women are to losing their autonomy should shock everyone.

Roe v Wade was always fragile, and, especially in recent years, Republicans have forged an identity out of railing against it. It is stunning to remember now that the party once supported abortion rights, including Gerald Ford and, as governor of California, Ronald Reagan. Justice Harry Blackmun, who was appointed by the unquestionably Republican Richard Nixon, wrote the majority opinion for Roe v Wade. Today, the conservative takeover of the Supreme Court was largely done with the aim of overturning of Roe v Wade. Democrats can and should rail against how nutty the Republican Party has become in the past four decades, especially on social issues like abortion. But they can’t pretend the Republicans ever hid who they are. This has all happened in the open sunlight.

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And yet, despite that, too many took women’s bodily rights too much for granted for too long. I don’t exclude myself here. I consider myself a full-throated and wised-up supporter of abortion, but I look back on, for example, my admiration for Ruth Bader Ginsburg and her stubborn refusal to make way for a younger justice, who would have been appointed by President Obama, and I cringe at my short-sightedness. Yeah, you go, Girlboss! Gimme more of those photos of you working out with your personal trainer! Ginsburg was a remarkable figure, but by working until she died, and thereby allowing Trump to appoint his third justice, she imperilled so many of the rights she fought for, and that is a tragedy.

Focusing more on the pleasing optics of an elderly lady doing press-ups than on the real risks to women’s rights was a decadent position for me to adopt, and America, the richest democracy in the world, has been distracted by too many decadent positions. Six years ago, I thought there could be no clearer proof of this than the 2016 election, when too many self-described lefties proudly disdained voting for Hillary Clinton, insisting there was no difference between her and Trump, even though one grabbed women’s pussies and the other protected them. Women’s rights? Boring, old, annoying. Like Hillary.

Once Trump was elected, I thought this would lead to a resurgence of feminism, and at first it seemed to, with the global Women’s Marches the day after his inauguration. But this nascent wave was soon overtaken by other issues. According to a 2019 survey from a non-partisan group focused on women’s political education, mass shootings, climate change and racial inequality are all of more concern to Gen Z women than abortion access. “A lot of the language I heard was about protecting Roe v Wade. It felt grounded in the Seventies feminist movement. And it felt like, I can’t focus on abortion access if my people are dying,” one 26-year-old female activist told the New York Times in 2020, explaining why she didn’t feel as impassioned about abortion as she did about police brutality. “Women in the Seventies understood very clearly that having control over reproduction is central to women’s ability to determine their own futures, to get the education they want, to have careers. As people got used to having access to abortion — and there’s a false sense that we’ve achieved a measure of equality — that radicalism women had in the early years got lost,” said Joanna Schoen, the author of Abortion after Roe. Abortion rights are seen by young women as a given — which is understandable, since they have been for their entire lives — and also a bit uncool, something associated with their mothers.

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Institutions that could have helped here instead became blithely distracted. In 2021, the president and chief executive of Planned Parenthood, Alexis McGill Johnson, wrote a hand-wringing editorial about the “harmful choices” made by Planned Parenthood’s founder, Margaret Sanger, who died in 1966, including the allegation that she was a eugenicist. Sanger’s beliefs remain a matter of debate — while Sanger did support some eugenicist beliefs, her real goal was enabling women to control their fertility — but I’d like to focus on two paragraphs McGill Johnson wrote, because they really give an insight into American feminism’s focus in recent years:

“What we don’t want to be, as an organization, is a Karen. You know Karen: She escalates small confrontations because of her own racial anxiety. She calls the manager. She calls the police. She stands with other white parents to maintain school segregation. And then there are the organizational Karens. The groups who show up, assert themselves, and tell you where to march. Those who pursue freedom and fairness, but also leverage their privilege in ways that are dehumanizing.

“And sometimes, that’s how Planned Parenthood has acted. By privileging whiteness, we’ve contributed to America harming Black women and other women of color. And when we focus too narrowly on ‘women’s health’, we have excluded trans and non-binary people.”

Look, eugenics are bad — no argument from me there. But when an organisation that is supposed to support women uses a blatantly misogynistic term like “Karen”, I’m not convinced it has found that right side of history yet. And when an organisation like Planned Parenthood — PLANNED FREAKING PARENTHOOD — puts the term “women’s health” in sarcastic single quotation marks, and prefaces it with an apology for focusing “too narrowly” on the aforementioned apparently non-existent issue, you know something has gone wrong in American feminism.

Many will disagree, but I find it hard to separate the disintegration of a woman’s right to bodily autonomy in America from the rise of gender ideology and the focus, as Planned Parenthood would put it, on trans and non-binary people. Everyone in America, howsoever they identify, should have rights, and it’s wonderful that the younger generation feels so energised by so many social justice issues. But none of this should have been at the expense of women’s sex-based rights.

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The right to abortion is specifically about who has control over women’s bodies. How, though, can this be discussed, let alone defended, when too many liberal US politicians and liberal media sites can’t even bring themselves to say the word “woman”, even when covering this issue? “Birthing bodies have the right to freedom,” Representative Francesca Hong, a US Democrat, tweeted early on Tuesday morning, apparently unaware that the bodies being fought over here don’t want to give birth — that’s the point of abortion. Hong made sure to put her pronouns in her Twitter bio, but not the word “woman” in her tweet. The ACLU similarly couldn’t say the dreaded W word in its thoughts on the matter, but, then, what to expect of a once great organisation that insists female athletes should compete against male ones, and whose deputy director for transgender justice tweeted that banning a book he didn’t like “is 100% a hill I will die on”.

Republicans, and more specifically the Christian Right, were keen on crushing access to abortion long before pronouns became a grammatical hill to die on. But by tangling itself up in knots over “birthing bodies” and “cis privilege”, the American Left has made it much harder to talk about women’s rights, and therefore much harder to protect them. Abortion is a women’s issue, and one that needs to be talked about specifically with regards to women, because they are the ones who will die here if Roe v Wade is struck down, and, contrary to gender theory’s teachings, you can’t identify out of that.

Maybe focusing on vaginas and misogyny feels super uncool and smelly and Mum-like to some, but this leak should remind everyone how necessary it still is. Decorating one’s social media bio with zeitgeisty memes and emojis is fun, like being spun around on the dancefloor. But it’s time for American feminism to do the heavy lifting again and carry the watermelon.

As the mainly female group shared their despair at the new administration, the older grey-haired man sitting on my left — conservative suit, flamboyant tie — smiled quizzically, before calmly remarking in his Southern drawl: “Well then, I suppose I am the only one here who supports our new President?” He was.

I can’t reproduce my conversation with this doctor from Arizona as accurately as I wish. I wasn’t taking notes and his story did not seem as significant to me then as it does now. But this is the gist of it.

In his small hometown, he ran not only the abortion clinic but two gun stores; he was a member of both the National Abortion Federation and the National Rifle Association. He was, he explained, a man whose values were shaped by the writings of Ayn Rand, whom he had met as a student in the Sixties. He said, and this is the one bit I do remember verbatim: “My support for a woman’s choice about abortion comes from the same place as my support for her right to bear arms. An individual’s freedom matters.”

This is not a conventional view for today’s supporters of legal abortion, many of whom seem to believe personal freedom, autonomy and self-determination are the preserve of the neo-con Right. I am not sure my gun-trading friend would now be welcome in a similar meeting. Perhaps, given what I am about to say, I would not be either.

How we talk about, indeed how we think about, abortion has changed fundamentally since it was dragged from the dowdiness of shame and secrecy to the centre of the Women’s Liberation Movement. Access to abortion was clearly about self-determination and moral autonomy. Yes, abortion was — at least in early pregnancy — a simple medical procedure that was a benefit to personal and to public health. But to those campaigning for its legalisation, abortion was so much more than healthcare. It symbolised a choice for a woman when her life was in crisis; it symbolised a new sense of personal agency, the personal power to shape nature’s plan.

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Birth control gave us control of our reproductive destiny, freeing us from the socially constructed, imposed gender-role of mother and carer. It mattered not whether a woman actually used birth control — what mattered was that she could choose to do so if she wished. With contraception to prevent pregnancy and abortion to end it, the spectres of birth and motherhood were pushed away — unless we invited them to us. It’s hard to see what else could make a bigger contribution to a woman’s liberty.

Of course, not all who claim they’re committed to freedom and liberty believe that women should be free to choose to have an abortion. No doubt an abortion doctor would be as alone in a meeting of defenders of the Second Amendment as our gun-shop owner would now be among clinic staff. But when we go beyond the feelings and self-identification of different tribal members, there remains a consistency of a principle: that the state should step back and stay out of private personal decision-making.

Crucially, this foundation is not contingent on a woman’s situation or experience — her race, or class or privilege. We live intersectional lives but some beliefs and principles remain universal concerns because we are more than our own experience. Indeed, the pro-choice principles that won abortion access only did so because they united women beyond personal experience or need.

They mobilised those who would never become pregnant because they were older, or infertile, or expressed sexual feelings in a way that didn’t risk pregnancy. Men joined us in solidarity because they understood how an involuntary pregnancy is a living nightmare. The social movement was built on an idea of what was worth fighting for.

Today, the focus is different. The sails of the movement now seem to be buffeted by winds from a different continent. Freedom of choice, once our principle, has been thrown overboard — not to anchor us as it once did, but to cut the movement loose from a legacy of white supremacy. “Freedom”, as in the personal moral freedom that gives each of us command of life, is dismissed as a privilege of the advantaged, not to be extended to all but instead to be “checked”. “Choice”, in particular the choice between abortion and motherhood, is now dismissed as elitist or consumerist or too binary.

Today’s destination is no longer a world where we have freedom to decide what is right and wrong in the private personal domain. Instead, it is a world where self-determination, autonomy and personal freedom are dismissed as privileged and arcane and insufficiently inclusive. It is as though these ideas, by being anchored in a Western philosophical canon, are forever tainted with a stench of old, white patriarchs.

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Of course, how we experience reproductive rights and wrongs are woven with the rest of our lives. But, when every aspect of life is thrown into the pot of oppression and denial — racism, poverty, homelessness, educational disadvantage, disability, sexual marginalisation — it is unclear with whom solidarity can be won.

Does my older, white, male, privileged Republican abortion doctor have no place in this movement? Does the rich, white, conservative Texan woman with a $300 haircut and Gucci shoes not suffer the same degradation as her cleaner when she is told that the law no longer permits her to end an unwanted pregnancy? Where does privilege begin and end in this intersectional quagmire? Who is inside our tent, and who is outside it? Crucially, who decides?

The Planned Parenthood Federation of America (PPFA) grew out of Margaret Sanger’s American Birth Control League, changing its name in 1942. While its origins are tainted in eugenics (like every other mainstream medical organisation formed in the early 20^th Century), it has provided birth control and sexual health care for generations of women since, particularly poor women without insurance.

So what is a poor, white, woman — with no job, no education, no home to call her own — to believe when she reads the following statement given by the President of PPFA to the New York Times last April: “By privileging whiteness, we’ve contributed to America harming Black women and other women of colour. And when we focus too narrowly on ‘women’s health’ we have excluded trans and nonbinary people…”

Might not she herself feel excluded by the very organisation on which she relies no less than a poor, black woman? And when she reads that once-champion of women’s choice go on to say that “we’ve claimed the mantle of women’s rights to the exclusion of other causes that women of colour or trans people cannot afford to ignore”, might she not howl with despair that her own colour and absence of “queerness” casts her aside?

From the perspective of today’s reproductive justice warriors, pregnancy by its very nature is problematic. After all, it defies the progressive framing of every issue around social constructions, to the exclusion of hard-wired reality. Pregnancy is starkly binary: you either are, or you aren’t. It’s old-fashionedly objective and challenges self-definition: feeling and defining yourself pregnant or unpregnant won’t make it so. It relies on, and resides in, mature, female physiology — even if you don’t define yourself as “woman”.

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Is this why so many young activists insist that I cannot or should not talk about pregnant women when I talk about abortion? Because pregnancy makes it obvious that a woman is more than just “a body with a vagina” or “someone with a cervix”? Her woman-ness is so obviously, physically real that a world committed to social constructionism simply collapses.

And does the fact that pregnancy happens to an individual, not to a community — and so calls for a personal decision that speaks to an individual’s sense of right and wrong — disrupt a narrative that seeks to frame itself as communitarian? It is not a community’s womb that becomes pregnant. It is not a society’s belly that grows, or a people’s breasts that are made heavy as they fill. All of this happens to an individual.

There is something grimly ironic about the tendency among today’s activists to deny this: namely, that their retreat from an old-fashioned commitment to individual choice leads right back to the eugenicist basis from which those of us committed to individual freedom have tried to wrest the birth control movement. A personal choice must be personal — otherwise it isn’t a choice, but social engineering.

Already we see social movements insisting that personal choices are being made for the “wrong reasons”. Advances in antenatal screening, for instance, are blamed for allowing women to make the choice to terminate pregnancies affected by conditions that a pregnant woman understands as disability, but which justice warriors see as “difference”. They protest that women are making discriminatory choices, that the world will be less diverse. But why, a woman might ask, should they get to decide for her? When it comes to her body, choice isn’t something that a woman can simply abrogate: it’s what makes her her.

The freedom to make moral choices is the most important freedom we have; the freedom to act on those choices is the most important freedom we can claim. And while Trump may be gone, that freedom is still far from guaranteed. In the battles ahead over who decides about abortion, I know I can count on the pro-choice, gun shop-owning white Republican to have my flank. I wish I could feel so confident about the twenty-something activists shouting him down.

Ann Furedi’s latest book The Moral Case for Abortion: A Defence of Reproductive Choice is available for pre-order on Amazon or directly from the publisher, Palgrave Macmillan

Pro-life culture was particularly hostile at the time, and many of us felt under siege in our Texas location. We ran drills so we all knew what to do if someone released anthrax in our building. Being hated is often clarifying, and we all believed we were doing good, even if in a sometimes shabby way.

It took a while to notice that the executive director was making six figures; that the administrative offices, unlike the clinic, never had broken chairs; that the clinic in the posh neighbourhood was nice and the clinic on the side of town where white people were a minority was not. Planned Parenthood was forever making headlines for testifying in front of Congress, or getting into a war of words with some hideous Christian fundamentalist who claimed abortion causes breast cancer (it doesn’t!). But it didn’t seem to be lobbying for healthcare expansion, or campaigning for compulsory training in abortion services for medical students. It wasn’t challenging politicians who claim to be pro-choice but only mention it when there’s an opening on the Supreme Court, instead of consistently supporting policies that would help the women who came to us in need.

But as hard as it was working in the hostile environment of Texas, back before people started to have hopes of flipping the red state blue, it also felt historically important. This is where American abortion rights were born, and this is where the greatest threat to those rights now lies. On September 1, the state blocked access to all abortion services for women beyond six weeks of pregnancy. Because most pregnancies are impossible to detect or confirm before the four-week mark, and because many women won’t realise they are pregnant until considerably later than this, the state has effectively blocked abortion access full-stop. The law was immediately challenged, and the Supreme Court has heard arguments, but so far it has not released any ruling. Still, with the way the court is packed at the moment, with a heavily conservative slant, it’s not looking good for supporters of reproductive justice.

It’s poetic, almost, that Texas is erasing a right that originated within it. Sarah Weddington was only 25 when she filed a lawsuit, in 1970, against the Dallas district attorney. She was acting on behalf of a pregnant client who was seeking to obtain an abortion, pseudonymously known as Jane Roe. Before long, Weddington found herself in front of the Supreme Court, making the argument that finally gave American women the legal right to terminate a pregnancy. But the focus of this landmark case, and the way it was handled by the professional feminist community, showed that it was only a matter of time before the pro-choice project came crashing down. Because from the very beginning there existed a gulf — one that I noticed on the frontline of Planned Parenthood — between the empowering rhetoric of the professional activists and the realities of those who found themselves pregnant and vulnerable, caught in the middle of a political battlefield.

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The Planned Parenthood promotional materials always exhibited the bright smiles and shiny hair of healthy young women, confidently making the healthcare choices that were right for them. They aren’t the ones who needed our help. I remember a week of repeated calls from a young man describing his girlfriend’s symptoms over the phone, all of them suggesting pregnancy. “But she’s not pregnant right?” All I could do was say it’s impossible to diagnose pregnancy over the phone and urge him to tell her to come into the clinic. I could hear him telling her, “They say you’re fine,” and I wondered how long he pressured her not to get help — and if, by the time she was “allowed” to take a pregnancy test, it was too late to choose whether or not to end it.

The people who most needed assistance, then, were not the independent and beautiful poster children of a Planned Parenthood ad campaign. They were much more like the woman at the centre of Roe v Wade, whose name was actually Norma McCorvey. She already had two children. Her first became the centre of a custody battle between McCorvey and her own mother; her second was adopted outside the family. When McCorvey realised she was pregnant for a third time, she tried to get an illegal abortion, but she found the clinic had recently been raided by authorities.

Her young, idealistic attorneys immediately recognised the potential McCorvey’s story held. It was the kind of case that could make it all the way to the Supreme Court, due to her already troubled maternal history. But they also knew that this wouldn’t help her individually: if she stayed in the spotlight, McCorvey would have to continue the pregnancy. She made the sacrifice, in the name of women’s rights. But she found that the feminists who championed Jane Roe, a legal persona, had very little time for Norma McCorvey.

In the 2020 documentary AKA Jane Roe, McCorvey talked about how she was sidelined. She wanted to speak at a pro-choice rally, but the organisers were more interested in Gloria Steinem and other more professional, or photogenic, activists. McCorvey was poor, identified as a lesbian, and lacked formal education. Her story wasn’t one of triumph and empowerment; it was one of abuse by men, familial dysfunction, and addiction. She was in desperate need, but she wasn’t a particularly inspirational standard-bearer.

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This same problem plagues the pro-choice movement today. In an attempt to “normalise” abortion, and thereby gain widespread support for reproductive rights, the movement focuses on an appealing minority: attractive, professional, financially stable women “shouting their abortion” on social media. It’s as if once we hear that the cute blonde girl got pregnant through no fault of her own and she really just isn’t ready for motherhood — she can barely take care of herself right now! — then we’ll finally understand that it should be fully legal and accessible. Lindy West, in a viral essay, compared getting an abortion to having a tooth removed, giving the sense that these decisions are easy to make, these services are convenient to access, and the procedure is comfortable to endure.

But pretending that the young, urban, middle-class woman who is choosing ambition over family is representative of those who need abortion services does nothing to help, well, anybody who isn’t that. And providing abortion access on the ground looks quite different from getting paid a couple of hundred dollars to write your personal pregnancy essay for an online magazine. It means dealing with death threats and harassment by protesters at clinics. It means putting your body on the line to escort clients from their cars to the clinic so they don’t have to face the screaming, praying, howling protesters on their own. It means listening to terrible stories sometimes, of people refusing to take responsibility for their own lives. It means seeing a woman coming in for an abortion six months after her last one and helping her anyway. It means letting strangers sleep on your couch because they drove for five hours to get to the clinic and didn’t have money left over for an AirBnB.

While I worked in the education department during the day, at night I often covered shifts for the abortion fund’s hotline, offering financial and logistical counselling for those who were pregnant and urgently needed to figure out how not to be. We talked about applying for credit cards, we compared prices at different clinics, we strategised places to stay if they had to go out of town. It was hard, draining work. Because often they felt compelled to explain how they got into their situation, and many ended up referring to our failings.

They went to Planned Parenthood to get an IUD but were offered no pain relief, and it hurt so badly that they vomited and passed out before the procedure could be completed. Or the clinic required a Pap smear before it would renew their Pill prescription, but when they came for their appointment, they could only wait for an hour before they had to give up and go to work, otherwise they’d be fired. And I listened to all this knowing that Planned Parenthood weren’t model employers. In fact, they have been the focus of multiple labour disputes for underpaying and exploiting their clinicians. The consequences for our institutional failings never affected our CEO, but it left me flat on the floor night after night.

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In a recent essay for Harper’s Bazaar, Sarah Schulman wrote about her experience working with an underground abortion network in Seventies Fascist Spain. As an American, she could enter and leave the country without much notice, making it easier for her to smuggle in illegal contraceptives and other materials needed by the group. The activists were risking imprisonment in order to help one another end pregnancies, creating a kind of solidarity and sense of purpose that’s lacking in the American pro-choice community. Our professional feminists are heavy on the rhetoric and weak on hands-on action. They are focused on institutions, like the Supreme Court or Planned Parenthood, instead of the women who need them most. They have managed to squander support from the majority of the population and allowed our rights and access to fall in disarray. This time, we can’t only point our fingers at the religious Right and the patriarchal stereotype of Texas.

When I had to have an abortion in Germany, I was extremely nervous about the general anaesthesia. I had never gone under before. What would it be like? What if something happened while I was there all alone, in a country where no one knew me? I didn’t speak any German, but as the nurses and doctor moved around me in the room, I managed to squeak out, “I’m scared.” And immediately everyone stopped what they were doing and just put their hands on my arms and legs. They applied just a brief pressure before they returned to their tasks, but it was the most comforting and caring gesture I had ever experienced. I think of it often. Pregnancy is a crisis, and the only moral and compassionate response should be: all hands on.

Of course, women in the modern world have options. My GP was happy to prescribe me the Pill when I was a teenager. When I was in my twenties in 00’s London, sexual health clinics plied drop-in clients with great fistfuls of condoms packed in brown paper bags like party favours. My years of prime fertility unfolded in a culture where an active sex life is seen as normal and healthy, and contraception as a basic healthcare right.

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We seem sometimes to have forgotten that birth control is at least as central to women’s participation in public life as universal suffrage. Today, it’s expected that women will join the workforce on reaching adulthood, and pursue careers on equal terms with their male colleagues. But that couldn’t happen without contraception.

Shorn of the ability to control our fertility, a woman might pay others (if she can afford it) to care for her children, give her babies away to be adopted, or avoid sex altogether to ensure she doesn’t have them in the first place. But as for ‘having it all’ (or ‘having it’ at all without getting pregnant), forget it.

A century or so before I reached my prime shagging years, Margaret Sanger was making this case in a very different world. “Enforced motherhood”, she wrote in 1914, “is the most complete denial of a woman’s right to life and liberty.”

Sanger is no less controversial today than she was a century ago, albeit for different reasons. Recently Planned Parenthood, the contraception and abortion charity she helped found, disavowed Sanger for her enthusiasm for eugenics, which was considered a progressive cause in Sanger’s time. But 100 years ago, Sanger faced threats and even arrest for campaigning to make contraception and contraceptive knowledge widely available.

In 1929, she published Motherhood in Bondage, a collection of excerpts from letters sent to her by women desperate for help with fertility. The book gives an inkling of what life looks like when you’re poor and your fertility is not within your control: a litany of exhausted, ground-down, ill and impoverished women, many on their seventh or eighth pregnancy in their mid-twenties, begging Sanger for information or help on “how to don’t have more children”, as one correspondent put it. One writes:

My smallest baby is three months old and I’m afraid I’ll get pregnant any time from now on. So please give me some kind of advice because I cannot support what I got and when they are four I don’t know what to do. I’m only twenty years of age.

Sanger was one of the first feminists to campaign for a woman’s right to be, as she put it, “the absolute mistress of her own body”. A century on, in the developed West, her goal has been largely reached. While accidental pregnancies still happen, the vast majority of women are able to access contraception, emergency contraception and — should they wish it — abortion services.

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The grim condition of those impoverished early twentieth-century women, struggling to feed and clothe an ever-growing brood, is happily a thing of the past. But I wonder if we can take this for granted in perpetuity.

The story of contraceptive manufacturing is, broadly speaking, the story of manufacturing generally: offshored to Asia to reduce overheads, with only branding, administration and R&D still predominantly based in Europe. Durex, once the British Rubber Company, has based its entire condom manufacturing capacity in China, India and Thailand. The vast majority of oral contraceptives, as well as the component ingredients used in their creation, are manufactured in China and India. No one makes contraceptives in Britain.

This is just fine in a situation where relatively frictionless international trade is assumed as a permanent feature of the modern world. But this turns out to have some drawbacks when there’s a political, economic or biomedical shock to supply chains.

It doesn’t even take a pandemic. Last year, doctors were worrying about the impact of Brexit on contraceptive supplies. In February this year, the estimated 3.1 million British women who use the contraceptive pill faced severe shortages, for reasons that still remain unclear.

Then when Covid-19 hit in the spring, India banned the export of pharmaceuticals, including progesterone — one of the key ingredients in the Pill. The ban only lasted three weeks, but still caused shortages of oral contraceptives. According to the global development organisation Devex, the ripple effects of coronavirus-related disruption to manufacturing also triggered a condom shortage in Mozambique and import delays in IUDs to Iran.

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An optimist might tell me that none of these incidents is likely to be more than a blip. And perhaps they’d be right. Provided, at least, that the global economy stays stable, China stays friendly (and doesn’t go to war with India), global commercial shipping is able to continue, and there are no more surprises in store that threaten the fabric of globalised trade. A year ago I’d have said that scenario looks a reasonably safe bet. Halfway through the madness of 2020, I’m not so confident.

Of course, new factories can be built closer to home, if they seem economically viable. Women’s contraceptive security, though, is threatened not just by de-globalisation but also environmental concerns.

The contraceptive pill is one of the most widely used pharmaceuticals on the planet. 3.1 million British women use it, making it our most common prescribed contraceptive. It works by mimicking the hormones released during pregnancy, and its main hormonal component is a synthetic estrogen known as 17α-ethinylestradiol — a compound that is disastrous for aquatic life. Its presence in rivers and groundwater disrupts the endocrine systems of a range of species, causing intersex conditions in frogs and fish and severely harming their ability to reproduce. It is also difficult and expensive to clean from waste water.

Environmentalists tend to be broadly liberal-feminist in their sympathies, which may help to explain why this issue generally gets soft-pedalled. No one who supports women’s reproductive autonomy will be enthusiastic about confronting the ecological harms done by synthetic estrogens. So the topic remains, to date, mostly a talking-point for the Weird Right.

But there’s a clear trade off between a woman’s desire to be “absolute mistress of her own body”, and our collective duty to ensure oryzia latipes (and all the other aquatic species turned intersex by 17α-ethinylestradiol) can remain even to a degree masters of theirs. Eventually, we will have to confront this issue.

Let’s hope that when we do, science prevails, and we come up with a better way of cleaning waste water. If we don’t, sooner or later the contraceptive pill will be banned.

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By Tim Marshall

Such a ban might be hastened by demographic fears. The BBC recently reported a “jaw-dropping” global crash in fertility rates. In the developed West, fertility has been below replacement for generations, but the report predicts that the global birth rate — currently around 2.4 — will on current trends plummet to 1.7 by 2100. Extrapolated long-term, this is an existential threat to humanity: as Professor Christopher Murray, one of the reports’ authors, puts it: “If you can’t [find a solution] then eventually the species disappears.”

I doubt we’ll remain so committed as a species to reproductive autonomy that we shrug our shoulders while the birth rate plummets toward human extinction. Far more likely is that we’ll see growing pressure on women to get gestating. Oryzia latipes may yet find itself championed by pro-natalists, keen to use the ecological downsides of the Pill as an argument for restricting women’s contraceptive choices.

Though not (yet) on ecological grounds, some countries are already restricting contraception as part of efforts to drive up the birth rate. Iran has ceased to offer birth control and vasectomies via state healthcare — a policy that explicitly targets the country’s slumping birth rate. In effect, for Iranian women, worry-free sex has become a bit like cashmere jumpers or safari holidays: nice, but only if you can afford it.

Should contraceptive manufacturing be expensively re-shored, in response to de-globalisation, we might face an analogous situation in Britain: birth control still available, but only as a luxury product.

None of these scenarios is inevitable. But those of us concerned for women’s welfare should take the question of contraceptive security seriously. We should also take seriously the question of why women don’t seem to want to have babies.

Suggested reading

Has Hungary conceived a baby boom?

By Paul Morland

The Left tends to blame this on sexism and the immiserating effects of capitalism (see for example Laurie Penny here), arguing that these factors make child-rearing arduous and unaffordable. The reactionary Right, on the other hand, tends to blame the baby strike on the pernicious effects of feminism. They’re both partly correct.

As that “jaw-dropping” BBC article puts it, falling birth rates are partly a result of “more women in education and work, as well as greater access to contraception”. In other words, they’re a consequence of the increase in women’s choices and as such are — in the article’s words — a feminist “success story”.

But recent research from the US-based Institute for Family Studies also shows that, worldwide, women are having fewer children than they’d like to. This implies that the supposedly ‘free’ choice to have fewer children is indeed, as Laurie Penny suggests, constrained by structural factors.

It ought to be possible for public policy to recognise that unwanted pregnancies are a nightmarish prospect for women — especially given today’s uncertain economic outlook — while also acknowledging that many women wish they could have more babies. Hungary’s birth rate has increased by 5.5% following Viktor Orbán’s introduction of subsidies aimed at encouraging larger families; this implies that state intervention can indeed tip the balance for would-be mothers, without coercive measures such as taking birth control away.

Those Right-wingers who are indifferent to women’s interests, safety or subjectivity might be tempted to leap on the prospect of contraceptive shortages as a straightforward solution to shrinking populations. But this would mean returning women to forms of bondage that Margaret Sanger fought to end a century ago. If we’re to stabilise the birth rate without embracing this kind of anti-women approach, the Right will need to learn from Hungary and embrace an activist, pro-family state.

Meanwhile, the Left will need to get over its obsession with abolishing the family. Both these perspectives, in different ways, treat human reproduction as a matter solely of individual choice. But bringing new generations into the world is the responsibility not just of individuals and families, nor just of women. Rather, it’s on all of us: a shared duty to our collective human future.