Let’s all take a moment and give thanks for modern birth control. It’s difficult nowadays to imagine a time when such a thing wasn’t readily available. But of course, for most of our history, being a sexually active woman meant that, without a healthy dose of good luck, you could end up like Michelle Duggar of 19 Kids and Counting — and without the benefit of today’s medical advances to pull you and your baby through the birth.

And why this sudden thoughtfulness about something that, up until recently, I accepted as a basic human right — something I’d earned simply by being born female? Well, I’ve just finished Dr. Aa’s Pennyroyal Tabules, a new novella by Lisa Annelouise Rentz. Despite its whimsical title, Dr. Aa is a story of the deepest gravity, one of injustice, of desperation, even hopelessness. The tale takes place in 1927, when disseminating information about birth control was still illegal and women had to resort to ill-begotten concoctions of indeterminate makeup (and a whole lot of hope) to try to prevent conception.

Dr. Aa follows three progressive young women as they seek to understand why something so basic, that so many women want, is being denied to them. Dr. Aa himself actually makes only the briefest of appearances as a scam artist peddling anti-conception “female tabules,” later blackmailing the women who order them with threats of scandal and jail time. The three girls — an unnamed narrator, a young beauty named Pennington, and a young schoolteacher named Dinah — discover the scam when Dinah receives one of the doctor’s threatening letters. They are all dating young men and going as far as two people can go together, with nothing but luck to prevent a pregnancy.

It is at this point that the deadly seriousness of the whole no-birth-control situation becomes apparent. Rentz includes heartbreaking letters from Dr. Aa’s victims that show the kind of helplessness so many women, especially working-class ones, feel as they discover that they are, again, pregnant with a child that they know will grow up sickly and malnourished. They say things like, “I am just wishing I would die giving birth to this child if I can’t stop having any more, but I feel sorry for the children I have,” and “I think I shall die of it this time,” and “The doctor said I should stop giving birth to children, but will not tell me how.”

Dr. Aa’s Pennyroyal Tabules is veiled in a misty aura of menace whose promise is delivered, again and again. An African-American store owner who dispenses some tablets and powders that “should” help prevent pregnancy dies in childbirth shortly afterward. There is random violence, loss of love, and the ghosts of women who have died in childbirth — both literally and figuratively. Rentz has done an amazing job of stripping away the mundanity of modern birth control, giving her readers a shockingly clear view of what it truly has meant for women’s independence and equality.

Rentz’s style is simple and spare — There is nothing unnecessary here, yet one often stumbles upon a beautiful description or moving phrase. One high and mighty (and wealthy) woman, whose moral stance denies giving poor women access to birth control, is described as being required to “purchase hats woven by raw fingers, and keep erect the moral timbers of workhouses.” The city of Charleston is described as being “Dug in. The foundations of the buildings and the seawalls held the city like a pie in a pan.”

There are places where Rentz could be accused of underwriting, especially at the story’s end, when the subtleties are perhaps too subtle. Yet the emotional punch of Dr. Aa’s Pennyroyal Tabules comes from just that: from this questioning about bits of information that are not given, that we cannot obtain. But luckily for us, this matter is not one of life or death.