Marie Charlotte Carmichael Stopes was born in Edinburgh, Scotland, on 15 October 1880 to Charlotte Carmichael Stopes, a suffragist, and Henry Stopes, an archaeologist and anthropologist. A paleobotanist best known for her social activism in the area of sexuality, Stopes was a pioneer in the fight to gain sexual equality for women. Her activism took many forms including writing books and pamphlets, giving public appearances, serving on panels, and, most famously, co-founding the first birth control clinic in the United Kingdom.

In 1998, urologists Marc Goldstein, Philip Shihua Li, and Gerald J. Matthews published “Microsurgical Vasovasostomy: The Microdot Technique of Precision Suture Placement,” hereafter “The Microdot Technique,” in The Journal of Urology. The authors describe a novel technique for reversing a vasectomy, which blocks a patient’s flow of sperm, preventing the patient from fertilizing a partner’s egg. The technique relies on the placement of microscopic dots to guide the placement of the stitches that reconnect the vasa deferentia, which is a part of the male reproductive system. The authors, working from the Center for Male Reproduction and Microsurgery at Weill Cornell Medicine in New York City, New York, published the article to instruct surgeons on how to properly employ the surgical technique and provide data to indicate the technique’s effectiveness. Through the publication of “The Microdot Technique,” Goldstein, Li, and Matthews provide guidelines to conduct a more successful and accurate method of a vasovasostomy.

In 2012, Stephen Sidney, T. Craig Cheetham, Frederick A. Connell, and colleagues published “Recent Combined Hormonal Contraceptives (CHCs) and the Risk of Thromboembolism and Other Cardiovascular Events in New Users,” hereafter “Combined Hormonal Contraceptives” in Contraception. The authors gathered records of major cardiovascular events in patients who were using combined hormonal contraceptive treatments, or CHCs. A CHC is a birth control medication that contains both estrogen and progestin hormones. The CHCs of focus, which the authors referred to as the study CHCs, included a pill, patch, and vaginal ring that the US Food and Drug Administration, or FDA, recently approved at the time of publication. The researchers compared the rates of cardiovascular events between users of the study CHCs to users of established CHCs to find any increased cardiovascular risk. “Combined Hormonal Contraceptives” showed that the study CHCs did come with some increased cardiovascular risk, and reconfirmed the known cardiovascular risks of CHCs in general, providing safety information for people who may want to start birth control.

On 22 March 1972, in Eisenstadt v. Baird, hereafter Eisenstadt, the United States Supreme Court determined, in a six to one decision, that unmarried individuals have the same right to access contraceptives as married couples. Eisenstadt involved William Baird, a reproductive rights advocate who intentionally broke Massachusetts law in 1967 by giving a speech about birth control at Boston University in Boston, Massachusetts, and giving an unmarried, nineteen-year-old woman contraceptives. Baird argued that laws against unmarried people accessing contraceptives unfairly discriminated against unmarried people and denied them reproductive autonomy. Massachusetts law, however, stated that contraceptives could only be distributed by medical professions to married people. The case followed a similar legal challenge from 1965, Griswold v. Connecticut, hereafter Griswold, which found that married individuals have the right to access contraceptives based on a constitutional right to privacy in the US. Eisenstadt reinforced the constitutional right to privacy and equalized the accessibility to contraceptives for married and single individuals.

Abortion is a controversial topic internationally. Most current debates about abortion concern when, if at all, it should be legal. However, researchers have shown many times that after an abortion ban, maternal and infant mortalities rise significantly, as women who seek out abortions do so regardless of abortion legality. So, is it possible to reduce abortions in a population without delegalizing abortion and, if so, how? Why do some countries have higher abortion rates than others in the presence of the same law?This dissertation answers both questions. First, I present historical evidence in the first comprehensive comparative analysis of all 15 post-Soviet countries, which have very similar abortion laws originating from the Union of Soviet Socialist Republics (USSR). Second, I use those findings to build the first agent-based model (ABM) of unintended pregnancies in a hypothetical artificial population. USSR was the only country in the world to complete its demographic transition through abortion instead of modern contraception, and the Soviet government passed the first law in the world to allow abortion upon request in 1920. After the USSR dissolution in 1991, post-Soviet countries maintained very similar abortion laws, but had very different abortion rates for most years. Analysis of fertility data from post-Soviet countries shows that the prevalence of some specific contraceptive methods, namely the rhythm method (r = 0.82), oral pill (r = 0.56), and male condom (r = 0.51) are most strongly correlated with high abortion rates, and that sex education is a factor that reduces the rates in otherwise similar countries (p = 0.02). The ABM shows that even basic sex education results in fewer abortions than no sex education or abstinence-based sex education (p 0.01). In scenarios without sex education, basic quality of post-abortion contraceptive counseling (PACC) is better than no PACC or low-quality PACC at reducing abortions (p 0.01). Still, the higher the quality of sex education or PACC, the fewer abortions in the artificial population. The ABM is adaptive and policy makers can use it as a decision-support tool to make evidence-based policy decisions regarding abortion, and, potentially, other sociobiological phenomena with some adjustments to the code.

Vasectomy is one of few widely available methods of contraception for people with male reproductive systems aside from condoms, abstinence, and the withdrawal method, and it is the only one of those options that can be permanent (Amory 2016). The procedure’s prominence has led me to investigate the history of vasectomy and particularly the evolution in vasectomy technique over time. Since its introduction in the late nineteenth century, the procedure has had a variety of impacts on many people across the world. In this research project, I have sought to analyze what the technical evolution of vasectomy reveals about the changing priorities of the medical systems that use it. In particular, I point to ways the eugenics movement’s attempts to control individual reproduction have led to both vasectomy’s efficacy and its restrictiveness.