IT'S HARD TO REMEMBER how rosy the future of birth control in America looked only five years ago. Access was expanding, thanks to the Affordable Care Act, and technology promised choices that were easier and cheaper, had fewer drawbacks, and would finally place more responsibility on men. The day seemed near when, finally, every pregnancy would be a wanted one.

Instead, now that Donald Trump is president, science is suspect, and the future of birth control looks more like The Handmaid's Tale than Scientific American. Beyond the many threats to abortion rights in the United States, the simple practice of seeking to prevent pregnancy through medical means is now under attack. If you thought the fight for birth control was a relic of the distant past—when a woman needed her husband's approval to get a checkbook let alone a prescription for the pill—think again.

Contraception is not a modern phenomenon. It's one of humanity's oldest technologies and has existed in nearly all societies since before the days of settled agriculture. The arguments against it are also age-old: In the early 20th century, American family-planning pioneer Margaret Sanger had to battle 19th-century obscenity laws rooted in religious objections to sex, and President Theodore Roosevelt said that white women using contraceptives were committing "race suicide." Under Trump, both arguments are making a comeback on the national stage.

Almost immediately after his January 2017 inauguration, Trump set about filling his administration with people who were openly hostile to birth control. Katy Talento, for example, a health-policy adviser for the Trump-Pence campaign who advocated for eliminating contraception coverage from the Affordable Care Act, was appointed to the White House Domestic Policy Council. Talento had falsely claimed that the pill could cause "miscarriages of already conceived children" and that "the longer you stay on the pill, the more likely you are to ruin your uterus for baby hosting." (Her conflation of contraceptives with abortifacients is a common one in anti-birth-control circles, but it's false, since the pill generally works by preventing ovulation altogether. Talento resigned her position in June 2019.)

"Women don't care about contraception," Trump's first UN ambassador, former South Carolina governor Nikki Haley, told hosts on The View. "We don't want government to mandate when we have to have it and when we don't." Under her leadership, in March 2017 the US stopped contributing to the United Nations Population Fund, the largest global supplier of contraceptives and reproductive services. Also under Haley, the United States named Valerie Huber to the UN Commission on the Status of Women. Huber, a longtime advocate of abstinence until marriage, is a proponent of "natural" family planning—in other words, the rhythm method.

In May 2017, Trump placed antiabortion activist Teresa Manning in charge of the Department of Health and Human Services' Title X family-planning programs. One might assume that those who want to limit abortions would be staunch advocates for birth control, but that is often not the case. In fact, Manning opposes the use of birth control and told NPR (falsely) that "contraception doesn't work."

In September 2017, the department released a draft plan "protecting Americans at every stage of life, beginning at conception." While not legally binding, it was nevertheless intended to guide federal policy regarding, for example, the morning-after pill, which Manning has claimed results in "the destruction of a human life already conceived." Under her guidance, Health and Human Services increased its support for abstinence-based sex education, even though at least one comprehensive study had shown that such programs "are not effective in delaying initiation of sexual intercourse." Manning resigned in early 2018 and was replaced by Valerie Huber.

Hostility to contraception has also been a hallmark of Trump's judicial appointments. As an appeals court judge, Neil Gorsuch, Trump's first nominee to a seat on the Supreme Court, supported Utah governor Gary Herbert's defunding of Planned Parenthood in Utah. On the US Court of Appeals, he twice sided with efforts to remove access to contraceptives from health plans under the Affordable Care Act, arguing that coverage violated the religious freedom of those opposed to reproductive rights.

In addition to Justice Gorsuch, other lifetime appointments to the federal courts in the first year of the Trump administration included L. Steven Grasz, who believes that fertilized eggs have "personhood" rights even before implanting in the uterus; Kyle Duncan, who represented Hobby Lobby in its successful effort to get the Supreme Court to affirm its right to deny birth control coverage to employees; and Amy Coney Barrett, who signed a petition calling birth control coverage "a grave violation of religious freedom." Another nomination (later withdrawn) was Jeff Mateer, who linked the contraceptive mandate under Obamacare to Nazi Germany.

Appeals to religious freedom play a crucial role in efforts to limit women's reproductive freedom. Many of those opposed to birth control are also opposed to all sex that is not intended to result in a pregnancy, even when it's between married, heterosexual adults—the only kind of couple that most anti-contraception organizations, like the Catholic church, approve of. In the Trump administration, the religious freedom of people who see sex solely as a necessary evil in the service of procreation is deemed more important than the religious freedom of the majority of people—be they Christian, Jewish, Muslim, Hindu, Buddhist, or atheist—who believe otherwise.

Christianity has long cast a suspicious eye on sexual pleasure. Puritanical beliefs, combined with anxieties over women's liberation, gave rise to the anti-contraceptive Comstock Laws, passed between the 1870s and 1920s. When the laws were struck down by the 1965 Supreme Court ruling in Griswold v. Connecticut, the decision hinged on a right to "marital privacy," found by Justice William O. Douglas within the Bill of Rights. (The right to birth control was not extended to unmarried people until 1972, just one year prior to Roe v. Wade.)

Griswold directly contributed to the feminist achievements of the past 50 years, especially the rising levels of female representation in government. Even with that boost, women and nonbinary people still make up less than a quarter of Congress. More men are in Congress right now than all the women who have ever served. Trump's actions take us in the opposite direction: Cutting access to birth control and other reproductive medicine is an effective way to systematically disadvantage women and keep them out of the halls of power.

Jenny Brown, author of the book Birth Strike: The Hidden Fight Over Women's Work, shows that while countries like France have made it easier for working women to be mothers—with generous paid family leave and ample childcare, among other things—the United States has gone toward a de facto policy of enforcing maternity by making birth control and abortion increasingly difficult to access. This is compounded by government insistence on abstinence-only sex education policies, which leave young people in the dark about reproductive options and girls more likely to end up pregnant.

Before the Industrial Revolution, arguments against birth control mainly focused on the desire to increase the population. With high rates of infant mortality, women were expected to do their duty for the community by having as many babies as possible. But in recent decades, opponents of birth control have shifted their arguments from the practical to the moral. When Sandra Fluke, a married law student at Georgetown, spoke at a 2012 congressional hearing about the financial hardship she suffered when birth control was not covered by the Catholic university, conservative radio host Rush Limbaugh responded by calling her a slut and a prostitute. Her demand for birth control coverage, Limbaugh said, was akin to "wanting to be paid for sex."

Regulating birth control has always been a way to control women's desires. The decision to limit the number of one's children has often been linked to "selfish" goals like professional gain, academic success, creative achievement, or—heaven forbid—adventure. Of course, these aims are considered selfish only when embraced by women. Otherwise they are simply things that men routinely enjoy—and consider it their right to pursue—thanks, in many cases, to women's free labor in the home, taking care of the children.

CONTRACEPTION AND ABORTION often overlap in the minds of those who oppose them—some believe they amount to the same thing, even though they are wildly different. Medically, a pregnancy begins with an egg's implantation in the wall of the uterus, which usually takes place one to two weeks after sperm has been introduced. Some birth control opponents reckon that pregnancy starts at fertilization—and want to grant personhood to that egg.

Declaring every fertilized egg, zygote, and fetus a person opens up a Pandora's box of Atwoodian consequences. Take the case of 27-year-old Marshae Jones of Alabama. In December 2018, she was five months pregnant when another woman shot her in the stomach. Although Jones survived the attack, she miscarried. While charges against the shooter were dropped, Jones herself was arrested and charged with the manslaughter of her own fetus, because police claimed she had initiated the argument that led to the shooting and had therefore endangered her child's life. Charges against Jones were ultimately dropped, but not before raising a chilling notion: If a pregnant woman can be charged with manslaughter for being the victim of a shooting, what else might she be blamed for?

As many as half of all early pregnancies end in miscarriage, often for reasons that can never be determined. Many miscarriages occur before a woman even knows that she is pregnant. If the Health and Human Services' draft plan becomes official, and personhood is legally defined as starting at conception, even these early pregnancy losses would—at least theoretically—be considered deaths and have to be investigated. In addition to the usual worries and fears, every pregnant woman would potentially have a 50 percent chance of being investigated for murder.

When high-ranking government appointees like Talento falsely claim that using contraceptives can cause miscarriages and that a miscarriage is a death, it follows that birth control could be criminalized, as could many actions taken by a pregnant or potentially pregnant woman. Alabama's Human Life Protection Act, enacted in May 2019, makes abortion a Class A felony—the same as rape and murder. A bill proposed in Texas would potentially impose the death penalty on women who receive abortions. If we go down this road, it may not be long before all women of childbearing age are considered "prepregnant," their every action (or inaction) judged based on the hypothetical consequences for hypothetical children.

On top of representing a potentially catastrophic threat to the freedom and autonomy of women, anti-birth-control activism also smacks of the racism inherent in President Roosevelt's "race suicide" remark. In July 2019, Arizona Republican state senator Sylvia Allen worried about the "browning of America," because white people "are not reproducing ourselves with birth rates." At its most extreme, this fear leads to the "replacement theory" cited by the white supremacist charged with the New Zealand mosque shootings and the neo-Nazis in Charlottesville, Virginia: that falling white birth rates will result in the replacement of white people. As a New York Times story on the subject noted, "Like so many fundamentalist ideologies, the foundation of this one requires the subjugation of women."

In February 2019, that subjugation kicked up a notch. In a national version of the "global gag rule" (see "Choke Hold on Contraception,"), the Trump administration demanded that Planned Parenthood cease referring women to abortion providers or forfeit the $60 million a year it receives through Title X for birth control and other reproductive services for 1.5 million poor women.

"We refuse to cower to the Trump-Pence administration," said Alexis McGill Johnson, Planned Parenthood's acting president and CEO. "This gag rule could mean that we will see women driving hundreds of miles just to find a provider who can help them access birth control such as an IUD." Title X funds will continue to flow, however, to antiabortion-counseling organizations like Obria. "Do you know what Obria does not provide?" McGill Johnson asked.

"Contraception."

The Handmaid's Tale is no longer just on your television.

This article appeared in the November/December 2019 edition with the headline "Mandatory Maternity."

This article was funded by the Sierra Club's Gender, Equity, and Environment program.