Why Reproductive Health Care Is Neither New nor Unique to Humans

And why it played a far greater role in the survival and advancement of our species than we might realise

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What do you think is the greatest invention in human history? The one thing that propelled our species forward and helped us evolve into the complex, interconnected societies we are today?

I imagine most people would point to weapons or tools. After all, the story of humanity has been written almost exclusively by men. And it usually goes like this: once man figured out how to use conveniently shaped rocks to dominate both his peers and the natural world, the wheels of progress — and human evolution — began to turn. Thousands of years later, here we are, still finding new ways to dominate one another and wreak havoc on our planet. At least we’ve stayed consistent — or so the story goes.

In her recently published book Eve, American academic Cat Bohannon challenges this ‘macho’ myth and offers an alternative theory: the reason we’ve survived and thrived as a species isn’t thanks to tools or weapons but to the continually evolving body of medical knowledge and practices related to the human reproductive system — what she calls, for lack of a better term, ‘gynaecology.’ Bohannon acknowledges, though, that ‘this might be hard to accept.’ Not only because we’re accustomed to the androcentric version of history but also because we’ve been conditioned to think of pregnancy and childbirth as ‘not that big of a deal,’ given that people assigned female at birth experience them every single day.

Some people today — particularly of the ultra-religious, conservative and pro-natalist kind — even claim that women popping out one baby after another throughout most of their reproductive years is ‘normal’ and ‘desirable.’ On the other hand, birth control, abortion or even pain relief during childbirth are certainly not — they’re the unnecessary ‘evils’ of the modern world that ought to be banned.

Only those practices are hardly modern inventions. Reproductive health care has existed, quite literally, since the dawn of humanity.

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There are quite a few things that set humans apart from other animals, including our primate cousins. One of them is human reproduction.

Humans are among the species that invest the most energy in having a baby — recent estimates suggest a total of 208,303 kJ per pregnancy, not including any postnatal care like breastfeeding. (For comparison, an hour of running requires around 3,000 kJ of energy.) We also face some of the highest rates of infant and maternal mortality, as well as birth complications. Globally, more than a third of women experience lasting and often debilitating health issues following childbirth.

While our massive brains certainly come with a lot of advantages, they are also a key factor in making pregnancy, birth, and child-rearing biologically expensive and, at times, dangerous. Compared with other apes, our babies have a really big head, while we have a really small pelvic opening — this leads to what’s known as the ‘obstetric dilemma.’ And even when those big-headed human babies are successfully born, they require near-constant care for several years. Sure, some birds might be ready to leave the nest just a day or two after birth, while some primates, like lemurs, achieve complete independence by six months of age. But you wouldn’t exactly expect a human child, at four or even six years old, to venture out, gather food on their own and come back in one piece, would you?

Clearly, human child-bearing and rearing demand some serious work and problem-solving. And so, you’d naturally expect the bodies that have to do the bulk of that labour to be the ones finding ways of making the process a bit less gruelling. And deadly.

In her book, Bohannon argues that the foundations of gynaecological knowledge were laid by female Homo erectus — one of our ancestral ‘Eves’ — who lived from about 2 million to 100,000 years ago. With brains significantly larger than those of Homo habilis but narrow pelvic openings, childbirth for Erectus was a risky business. To survive, she had to be able to somehow control reproduction, which likely included a combination of behavioural adaptations — Erectus was already exceptionally social — and taking advantage of whatever she could from nature’s pharmacy.

How do we know this happened? Well, Erectus wasn’t just surviving — she was thriving enough to spread not only across Africa but also throughout the Middle East, Europe, Central and Southern Asia, and even down to the Pacific Rim. As Bohannon writes:

For each transition point in humanity’s ancient migrations, you should expect to find a group of skinny, scrappy people just barely producing enough kids to replace themselves, finding ways around the inherent problems of inbreeding, and miraculously surviving. A huge portion of that survival would have been tied directly to gynaecology. Our Eves used the gynaecological toolset to overcome their greatest challenge: the wonkiness of their own poorly designed reproductive system.

Unfortunately, the brainier we became, the costlier reproduction grew. But at least we could use all that extra brainpower to develop even more gynaecological knowledge. Taking direct control of reproduction through social and medical practices then didn’t just help our ancestors create enough of a viable population to migrate across most of the planet but also successfully adapt to vastly different environments. In barren areas, it made sense to widen birth spacing — the time gap between pregnancies — reducing the strain on available resources. In more fertile environments, though, reproductive timing could be aligned with fruit and nut harvests or migrating animals.

But environments rich enough to support more frequent reproduction came with their own challenges — like surviving repeated pregnancies and then living long enough to nurse and raise the children to independence.

This is what prompted the emergence of midwifery, which Bohannon describes as the moment ‘when we started to become human.’

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Of course, pinpointing exactly when all of this began is challenging. Unlike tools or weapons, social practices don’t always leave a neat record.

Some of the earliest documented descriptions of birth control methods — such as the use of honey, acacia leaves, and lint as a barrier to block sperm — date back to around 1800 BCE in Ancient Egypt. It was also the Ancient Egyptians who first transformed midwifery into a respected, scientific and paid profession primarily undertaken by women. Still, evidence of reproductive practices and gynaecological knowledge can be found in nearly every historical culture — from the ancient Greeks and Romans to Indigenous people like the Māori of New Zealand and even among the (allegedly) prudish and conservative Victorians.

In The Women’s Encyclopedia of Myths and Secrets, feminist author Barbara G. Walker even suggests that the origins of calendars may also have been tied to women tracking their menstrual cycles, which is one of the oldest methods of birth control.

But there’s another compelling reason to believe that early humans actively developed reproductive strategies — we’re not the only animals, or even the only primates, that influence their reproductive outcomes. One of the most widespread and well-documented examples is the Bruce Effect: a phenomenon where females terminate pregnancies after encountering an unfamiliar male. This behaviour has been observed all over the mammalian world, including in rodents, horses, dogs, lions, and some primates. Aborting a problematic pregnancy in response to changes in social environments is simply something female mammals evolved to do.

Humans don’t have such internal mechanisms in place — which, again, makes us unusual — but, instead, we have developed other methods, ones requiring a certain level of social cooperation and shared knowledge.

Interestingly, some primates do exhibit behaviours that parallel our gynaecological practices. Female chimpanzees in Sudan, for instance, have been seen eating leaves from certain Ziziphus and Combretum plant species, which local women use to induce abortions. Primatologists who first observed it suggest that the chimps deliberately use these plants for the same purpose and that, similarly to humans, they learn to treat themselves this way from other chimps. Meanwhile, in Madagascar, pregnant lemurs often nibble on tamarind and fig leaves to boost milk production and improve the likelihood of a successful birth. Some primates also seem to use plants to influence their fertility. In Brazil, female woolly spider monkeys add plants to their diet to increase or decrease their fertility. And in Uganda, red colobus monkeys seasonally consume leaves from estrogenic plants — which, at times, constitute as much as a third of the animals’ diet — which then changes their hormone profiles and increases mating activity.

But perhaps the most fascinating example has been found in bonobos, the highly matriarchal and strongly averse to violence ape species. In 2014, researchers in Congo observed a female bonobo giving birth in a small nest tree with two other females by her side. One appeared to stand guard while the other assisted the labouring mother. Over the following years, three more cases of this bonobo ‘midwifery’ were observed. In each case, other females gathered around the labouring mother, grooming her, swatting away the flies, and standing watch. In a couple of instances, they even cupped their hands to catch the newborn as it emerged.

It’s not really surprising, though, that this behaviour has been most commonly observed in a female-dominated species. Primatologists have noted that such practice requires a high degree of female trust and collaboration — qualities that wouldn’t exist without social structures that encourage female sociality. But the same can be said of humans. Could midwifery and gynaecological knowledge have developed and spread without highly collaborative and egalitarian or even female-dominated societies among Homo erectus or early modern humans?

That seems rather unlikely. And if it wasn’t for any of it, humanity might not have evolved into the species we are today — or even survived at all.

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Somewhere along the way, some human societies and the ideas that governed them took a troubling turn.

Female sociality and knowledge of the female body certainly weren’t always ridiculed, devalued or even demonised, but in the last few hundred years, they have been. The most prominent example is the centuries of witch-hunts that both destroyed women’s unique body of knowledge and shattered networks of female cooperation.

Unfortunately, it seems we haven’t learned much from that dark chapter.

In recent years, and despite decades of progress in reproductive health and rights, those advances are being rolled back in countries across the globe — including Poland, the United States, El Salvador and Nicaragua — accompanied by a growing backlash against women gaining ‘too much’ empowerment, particularly when they choose not to have children.

This backlash, unsurprisingly, has had devasting consequences for women, girls, and other people assigned female at birth. Restricted access to safe abortions, quality contraceptives, comprehensive sex education, etc., all correlate with a range of harmful outcomes: higher rates of sexually transmitted infections, unplanned pregnancies (including adolescent pregnancies), gender-based violence, and maternal and infant mortality. Unsafe abortion actually remains the leading cause of maternal death worldwide, killing nearly 70,000 women every single year.

Criminalising and stigmatising reproductive health care like abortion doesn’t stop women from seeking it. The only thing it accomplishes is increasing the number of women dying from perfectly preventable causes.

Yet these grim facts are contested at every turn by those who insist on turning women — and girls — into little more than breeding stock because they don’t see us as people, but also because of the misguided belief that if it weren’t for women’s rights movements and its advancements, everyone would happily bear fifteen children with no problem whatsoever.

No, we really wouldn’t. Long before the invention of the Pill or the landmark Roe v. Wade decision in the US that influenced so many other countries, women were already taking control of their bodies and reproductive health in the best ways they could. It’s the assault on reproductive freedom that’s the aberration, the inhumane deviation from the norm, and not women’s ability to decide if, when and how often to have children. But gynaecological knowledge and practices passed down through generations over tens of thousands of years — and likely even longer than that — weren’t just beneficial to women. They were also highly beneficial to humanity.

It might seem audacious to say so, but is it truly audacious? Or are we simply so steeped in male-centric narratives about the past that anything offering a fresh perspective feels frighteningly radical?

I think it’s the latter. Humanity’s survival has always depended on how well we managed reproduction. What’s actually audacious is pretending it hasn’t — and ignoring this critical part of our history.

As Cat Bohannon concludes in the chapter devoted to this topic:

What got us here is not tool triumphalism but womb triumphalism. Our species’ success was, and still is, borne on the labouring bellies and backs of women who made difficult choices throughout their reproductive lives. The deep history of gynaecology isn’t just the story of how we found ways for women to suffer less; it’s the story of why we are alive today at all. So maybe we need a better narrative to describe humanity’s ‘triumph.’

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If our ancestors had just ‘hoped for the best’ and ‘let nature take its course,’ I doubt I’d even be here to write these words. Even rodents understand that reproductive free-for-all isn’t a great reproductive strategy. And while they can be clever, humans are arguably more intelligent.

That’s why we developed so many brilliant inventions over the centuries and why our ancestral Eves came up with behavioural adaptations and medical practices to deal with their buggy hominin reproductive systems.

Perhaps that was really the most important tool of all.

After all, none of the other tools or weapons would even be useful if there were no surviving humans left to use them, would they?

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