"I can't figure out for the life of me how to stop pregnancies without contraception," he said.

As with other efforts — against gay marriage, stem cell research, cloning, assisted suicide — the anti-birth-control campaign isn't centralized; it seems rather to be part of the evolution of the conservative movement. The subject is talked about in evangelical churches and is on the agenda at the major Bible-based conservative organizations like Focus on the Family and the Christian Coalition. It also has its point people in Congress — including Representative Roscoe Bartlett of Maryland, Representative Chris Smith of New Jersey, Representative Joe Pitts and Representative Melissa Hart of Pennsylvania and Senator Tom Coburn of Oklahoma — all Republicans who have led opposition to various forms of contraception.

R. Albert Mohler Jr., president of the Southern Baptist Theological Seminary, is considered one of the leading intellectual figures of evangelical Christianity in the U.S. In a December 2005 column in The Christian Post titled "Can Christians Use Birth Control?" he wrote: "The effective separation of sex from procreation may be one of the most important defining marks of our age — and one of the most ominous. This awareness is spreading among American evangelicals, and it threatens to set loose a firestorm.. . .A growing number of evangelicals are rethinking the issue of birth control — and facing the hard questions posed by reproductive technologies."

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Many Christians who are active in the evolving anti-birth-control arena state frankly that what links their efforts is a religious commitment to altering the moral landscape of the country. In particular, and not to put too fine a point on it, they want to change the way Americans have sex. Dr. Stanford, the F.D.A. adviser on reproductive-health drugs, proclaimed himself "fully committed to promoting an understanding of human sexuality and procreation radically at odds with the prevailing views and practices of our contemporary culture." Focus on the Family posts a kind of contraceptive warning label on its Web site: "Modern contraceptive inventions have given many an exaggerated sense of safety and prompted more people than ever before to move sexual expression outside the marriage boundary." Contraception, by this logic, encourages sexual promiscuity, sexual deviance (like homosexuality) and a preoccupation with sex that is unhealthful even within marriage.

It may be news to many people that contraception as a matter of right and public health is no longer a given, but politicians and those in the public health profession know it well. "The linking of abortion and contraception is indicative of a larger agenda, which is putting sex back into the box, as something that happens only within marriage," says William Smith, vice president for public policy for the Sexuality Information and Education Council of the United States. Siecus has been around since 1964, and as a group that supports abortion rights, it is natural enemies with many organizations on the right, but its mission has changed in recent years, from doing things like promoting condoms as a way to combat AIDS to, now, fighting to maintain the very idea of birth control as a social good. "Whether it's emergency contraception, sex education or abortion, anything that might be seen as facilitating sex outside a marital context is what they'd like to see obliterated," Smith says.

Senator Olympia Snowe of Maine, an abortion rights Republican who has sponsored legislation that would require insurance companies to cover contraception, has seen a major change. "Two decades or more ago, I don't think there was much of a divide on contraception and family planning," she says. "It was one area both sides could agree on as a way to reduce unwanted pregnancies. Now it becomes embroiled in philosophical disputes."

The Guttmacher Institute, which like Siecus has been an advocate for birth control and sex education for decades, has also felt the shift. "Ten years ago the fight was all about abortion," says Cynthia Dailard, a senior public-policy associate at Guttmacher. "Increasingly, they have moved to attack and denigrate contraception. For those of us who work in the public health field, and respect longstanding public health principles — that condoms reduce S.T.D.'s, that contraception is the most effective way to help people avoid unintended pregnancy — it's extremely disheartening to think we may be set back decades."