Chapter Six
Negotiating the Contraceptive Quid pro Quo
Birth Control Advocates and Reproductive Scientists, 1910–63

In the arena of reproduction in the United States throughout the twentieth century, the social worlds that have mattered most to the development of the reproductive sciences have been those of birth control advocates. These included divergent groups such as feminists, physicians, eugenicists, and demographers. From 1910 to 1963, relations between reproductive scientists and various birth control advocates were exceptionally complex and changing, while at the same time extraordinary reconfigurations were also occurring within each grouping. In what became an intimate dance of realignment, these once distinctive and often oppositional social worlds were reconstituted, transformed, and ultimately integrated, if not fused, through a quid pro quo that met each group's revised needs and goals. The story of these changes is complicated and rife with contradictions and conflicts. None of these multiple worlds was monolithic, nor were they ever fully segregated since their boundaries were permeable. This chapter offers a classic story of the development of "scientific solutions" to the major "problem of sex" in modernity: unwanted pregnancy.

In 1915, in a "frenzy of renown" provoked by feminist activists, the birth control cause hit the major American newspapers and magazines with a force not again equaled for twenty years. Later in the decade, advocates began speaking out, organizing, setting up clinics, distributing illegal birth control information and devices, and seeking improved means of contraception.^[1] Then, between roughly 1920 and 1945, the very nature of modern contraception was negotiated between reproductive scientists and several varieties of birth control advocates. The reproductive scientists ultimately captured definitional authority over what would constitute modern contraception. After endless petitioning by birth control advocates to produce and test improved, simple contraceptives, reproductive scientists finally

agreed to play the contraceptive research game, but only on their own "basic" research terms. That is, to recruit reproductive scientists into the birth control arena, the means of contraception had to be made scientific. Here the process of professional transformation of lay problems to meet professional requirements is fundamental. As Latour (1987) notes, scientists "should be" seen as the driving force even when they are enlisted by others. Who was enlisting whom in this instance is, contra Latour, problematic. Regardless, the power of the culture of science is vivid here. Ultimately it pervaded the worlds of birth control, eugenics, and population control.

It is crucial to remember how very radical birth control was early in this century in the United States. Women were not full citizens with voting rights until five years after Margaret Sanger's first arrest in 1915 for distribution of contraceptives. Distribution to unmarried people was not legal in all of the states until 1972, the year before the Supreme Court decision legalizing abortion. For most of the twentieth century, birth control has been at least as charged and controversial an issue as abortion is now. In many ways the moral propriety of contraception remains the underlying and contested issue: Does using contraception mark women and girls as immoral? What is "natural" for the heterosexual couple? Certainly it is here we see the struggles concerning what Foucault (1978:103–5) described as the "socialization of procreative behavior" and the construction of "the Malthusian couple" as a target and anchor point "for the ventures of knowledge."

From 1920 to 1945, reproductive scientists used several strategies to assert their legitimacy, autonomy, and authority to their often insistent market audience of birth control advocates. First, they carefully distinguished reproductive research from contraceptive research and refused to participate in studies of "simple" contraceptives (such as spermicides, douches, and diaphragms), marginalizing any reproductive scientists who did so.^[2] Second, they argued for basic research as the ultimate source of modern contraception and made token offerings from their "basic" research work (such as accurate information on the timing of ovulation). Third, they redirected contraceptive research toward "scientific" methods that would utilize basic reproductive science (hormonal contraception, spermatoxins, IUDs, and sterilization by radiation).

In short, reproductive scientists were successful in insisting upon the culture of science, which operated as what Bijker (1987) has recently called a "technological frame." Such a "frame of meaning" can come to be associated with technologies (such as contraception) positioned among multiple social groups/social worlds. A technological frame—in this instance the primacy of the culture of science within the contraceptive research world—then further guides and shapes the development of those technologies.

Through deployment of the culture of science, reproductive scientists

sought to protect and promote the legitimacy, autonomy, and "basic" nature of their work and to simultaneously gain considerable funding and support. By about 1945, a quid pro quo between the reproductive sciences and birth control worlds was established. Through the relations and negotiations among and about birth control advocates, reproductive scientists, hormones, foundations, laboratories, the National Research Council, primates, and others between about 1925 and 1945, a congruence of interests was arrived at that adequately "fit" the changed and changing needs of the major actors in the arena. In the 1950s and 1960s, the quid pro quo began to consolidate as reproductive scientists (largely outside the academy) produced the major modern scientific means of contraception—birth control pills, IUDs, injectable hormones, and improved means of sterilization. The working out of this quid pro quo, prior to and fundamental for the actual development of modern scientific contraception, is the focus of this chapter.

In addition to social worlds and arenas analysis through which it was generated, this chapter also illustrates other recent developments in the social construction of technology.^[3] Several emphases are especially important: (1) examining the earliest moments in the making of the technology; (2) analyzing the interests and commitments built into the actual design of the technology by analyzing all the engaged social worlds, their perspectives and commitments, including their interpretations of the technology itself (interpretive flexibility); (3) taking the technology itself to include the eventual institutional distribution, regulatory, and other related systems or networks; and (4) attending to processes of closure when interpretive flexibility supposedly vanishes. Both Woolgar's (1991) key point that we can examine how technologies configure their users and Latour's (1991) notion that technology is society made durable have long histories in feminist technoscience studies (e.g., Cockburn 1985; Wajcman 1995). They resound here as well. Configuring women as the primary users of contraceptive technologies was, in fact, a core goal of population control groups. Callon's (1991) darker point that these are often techno-economic networks and often close to irreversible also pertains. Contraceptives are, after all, what Foucault termed "disciplinary technologies" (Rabinow 1984:17). The reproductive arena was full of conflict from the beginning. Over the decades, further conflicts have been generated as the implicated actors—women users of scientific contraception—have organized resistance and set new agendas.^[4] The arena remains conflictful today (Clarke 1997), and closure is not necessarily permanent where controversy lurks (e.g., Hard 1993).

I begin with a brief historical orientation to various technologies of contraception, followed by an overview of the key birth control movements: lay, medical, and social/academic groups, including changes in the kinds

of contraceptives these groups advocated from 1925 to 1945. Third is an extended analysis of the responses of reproductive scientists to the ongoing demands of these birth control advocates that scientists do contraceptive research. Here I focus on the specific strategies reproductive scientists used to manage these recalcitrant markets. Finally I examine the quid pro quo that fused the reproductive sciences and birth control and population control advocates into a shared arena where most still dwell today.

Contraceptive Technologies: A Historical Overview

The following list documents the major means of contraception, with the year of first development; the dates refer to the introduction of these means, not their general availability.

In premodern and early modern times (and in places where similar conditions still obtain today), there was often fairly extensive knowledge of contraceptives and abortifacients, mostly of plant origins. This knowledge was communicated through both oral traditions and printed texts (e.g., herbals).^[5] In the seventeenth and eighteenth centuries, the distribution of information about these means of reproductive control was curtailed; the topics were deleted from physicians' texts and given less coverage in herbalist works. The early nineteenth century saw even further limitations on access to such knowledge (Riddle 1992:160). But in the United States by the 1830s and 1840s, linked in part to the popular health movement of the Jacksonian era, this knowledge began traveling again. It often did so through newspaper advertisements and printed brochures that hawked both older approaches and newer devices such as douches, "womb veils," and "female protectors" (probably vaginal sponges). Abortionists and abortifacients were also advertised and increasingly utilized. The late nineteenth century also saw a minor transformation of contraception due to both the vulcanization of rubber (used in condoms and diaphragms) and the development of surgical sterilization (thanks to anesthesia and asepsis).^[6] The social "fact" that most powerfully demonstrates the effectiveness of these and other methods such as coitus interruptus is that the average birth rate among white native-born married women dropped by almost half over the

nineteenth century, from 7.04 in 1800 to 3.56 in 1900 (Brodie 1994:2). In the past as well as the present, most means of contraception listed above were intended for female users.

However, the last decades of the nineteenth century also saw the rise of a number of "social purity" movements aimed at criminalizing reproductive control and disempowering women, whether or not by direct intent. Many of the means of reproductive control had been commercialized, and opponents could point to increased rates of vice, prostitution, and other "social ills," claiming that these were promoted by women's recent access to means of contraception. Campaigns against both abortion and contraception were led largely by white, middle-class, professional men, many of them physicians. Federal and state legislation and judicial decisions criminalized both abortion (which had been legal before "quickening" for over two centuries) and marked contraception as "obscene" (Brodie 1994; Mohr 1978).

Despite the dates on the chart, in the United States birth control was essentially illegal from about 1873 until 1936, and much later in some states. A federal law, the Comstock Act of 1873, made it illegal to put through the mails any contraceptive advice, device, or information, and the subject was then omitted from new editions of books in which it had appeared. The Comstock Act, aimed largely at controlling vice and prostitution, explicitly defined "the prevention of conception" as obscene, and the law prohibited the mailing of obscene matter. The mails had been (and may well have continued to be) the primary means of distribution of birth control (including abortifacients) for some decades. A variety of state and local statutes also prohibited distribution of contraceptive devices and information.

Twentieth-century birth control advocates mounted many challenges to such laws. Margaret Sanger was especially active, drawing on her leftist roots and allies to mount direct actions against Comstockery. Her arrest with her sister, their related trials and those of other activists, their imprisonment, their forced feeding, but especially their powerful arguments for birth control became part of the "daily news" in 1915 and remained visible for years. The most important early decision on the legality of contraception was made in New York in 1919 when a state court permitted physicians to provide contraceptive advice, but only "to cure or prevent disease" (McCann 1994). The roots of Roe v. Wade , the Supreme Court decision of 1973 that made the choice of abortion a matter between a woman and her physician, go back to this earlier decision. The next major legal change did not occur until 1936, when Judge Augustus Hand of a federal appeals court gave doctors the right to advise and prescribe contraception under federal law. This case dealt with seized imported diaphragms destined for a birth control clinic. Judge Hand ruled that while the language of the Comstock Act was uncompromising with regard to contraceptive devices and infor-

mation, if in 1873 Congress had had available the clinical data on the dangers of pregnancy and the safety of contraceptive practice that were available in 1936, birth control would not have been classified as an obscenity. But state and local statutes remained, impairing physicians' prescription of diaphragms and other means of contraception well into the 1960s. The final two Supreme Court cases focused on legalizing the distribution of contraceptives were Griswold v. Connecticut (1965), which stated that the private use of contraception by married Americans is an inherent constitutional right, and Eisenstadt v. Baird (1972), which extended the right of contraceptive practice to the unmarried (Dienes 1972; Chesler 1992:376). Not until 1977 did the Supreme Court rule that advertisement and display of contraceptives could not be prohibited. Only since the advent of AIDS, however, have such ads, especially for condoms, appeared in popular magazines. Television networks still refuse to broadcast them (Gamson 1990:271–75).

Despite the increase of birth control activism in the early years of the century, the next round of development and improvement of contraceptives did not begin until the 1920s and 1930s, when better diaphragms, spermicides, douches, cervical caps, and IUDs became available. Importantly, these were the results of birth control advocates' efforts and were not technoscientific products of the modern reproductive sciences that only became available decades later during what became known as the "contraceptive revolution" of the 1960s and 1970s. Then the Pill, new plastic IUDs, and injectable hormonal contraception became available. Continued efforts at technical improvement in the 1980s and 1990s produced implantable hormonal contraceptives such as Norplant, a new over-the-counter spermicidal sponge, the abortion pill RU486 (variants of which are also used as "morning after" hormonal interventions to prevent implantation), and a variety of immunological "vaccines" now in development (Mastroianni, Donaldson, and Kane 1990).

My focus in this chapter is especially on the years 1925–63, which saw the shift from what I call "simple" to "scientific" means of contraception (see Table 7). While this classification is not perfect, it is reasonably easy to divide all the available means of contraception into these two main groups. Simple means include spermicides (jellies, creams, foams), barrier methods (condoms, diaphragms, cervical caps, vaginal pessaries, vaginal sponges), douches, the rhythm or "safe period" methods, testicular "heat" methods, and herbal treatments (Langley 1973). These are low-technology means of contraception, though many did require some science to formulate, test, and produce.^[7] Simple means are indeed relatively simple to use. Control lies in the hands of the user; use can be discontinued at any time; they can usually be used or not at the time of a given intercourse; the effects are localized to the reproductive system; and most are considered safe enough

to be distributed over the counter.^[8] Although virtually all of these simple methods existed by 1915–20, their availability was quite limited until after World War II, and even later in some regions (Gordon 1976). Scientists typically view them as nonscientific, derived instead from clinical practice and "applied" research. And scientists' perspectives are of special concern in the negotiations.

Modern scientific means of contraception include birth control pills, plastic IUDs, surgical sterilization, immunological means (vaccines), and injectable and implantable hormonal contraceptives (e.g., Depo-Provera and Norplant). These are high-technology methods. Hormonal methods (pills, injectables, and implantables) are systemic; sterilization was then and must still be considered permanent and involves major surgery (under general anesthesia) for the female; IUDs must be inserted by specially trained personnel. All require medical intervention for initiation, monitoring for safety, or removal. All derive from extensive "basic" research. According to the FDA, none can be distributed safely over the counter.^[9] Of these high-technology "scientific" methods, only sterilization, spermatoxins, and IUDs were available prior to 1960, and then only on a very limited basis (Langley 1973). This chapter is concerned with the cumulative shift from advocacy and production of simple means of contraception to complex, scientific

means and the divergent ways the heterogeneous social worlds concerned with contraception were involved in this shift.

Birth Control Movements

This section offers a substantial discussion of the three major birth control advocacy groups or social worlds in the United States during the first half of the twentieth century: lay, medical, and social/academic (eugenicist and neo-Malthusian) groups. I emphasize each group's specific patterns of contraceptive advocacy (Berkman 1980), referring to its preferred means of contraception and the rationales offered for those choices. I examine both contraceptive advocacy of extant methods and contraceptive research advocacy of new and/or improved methods. Different constituencies within birth control and reproductive research worlds preferred different means of contraception, at different times, for different categories of users, and for a wide variety of reasons.

Lay Birth Control Movements

The lay birth control movements of the first half of this century became organized phenomena composed of many divergent groups ca. 1915.^[10] Initially, decentralized groups appeared on the grassroots level in many areas of the country, mostly deriving from progressive labor and socialist groups, and including such personages as Margaret Sanger and Emma Goldman. Sanger, herself a nurse, had come to advocate what she ultimately named "birth control" through treating women who were sick and dying after undergoing abortions to prevent unwanted children. Many women turned to her as a nurse for birth control information when they did not dare ask their physicians (Sanger 1938/1971). Through the work of her birth control clinic, her arrests, and her speaking tours between 1915 and 1917, Sanger became the leader of the lay (nonphysician and nonscientist) movement and remained a key actor for many decades (Chesler 1992). World War I gave birth control a boost through massive distribution of contraceptive information and condoms to stem the tide of venereal disease among soldiers. In a Baltimore study, prewar sales of condoms were estimated at 2 to 3 million per year; postwar (mid-1920s) annual sales were about 6.5 million (Gordon 1976:206).

During the 1920s, just after women obtained the vote, birth control could have become the next central feminist issue. However, the decade following World War I was largely one of conservatism and antifeminism. The major women's groups were (re)focusing on two streams of feminist work. One group sought to sustain women's citizenship and seek equal

rights via the League of Women Voters and the National Women's Party. A second focused on women's work and maternal and infant health via the Children's and Women's Bureaus of the Department of Labor and the federal Sheppard-Towner Act, which provided, between 1922 and 1929, what we now would call "well baby clinic care" at little or no cost. Women active in these latter efforts have become known in recent scholarship as "welfare feminists." They were mostly white, middle-class women who sought state sponsorship and protection for all women, especially (but not only) in their capacities as mothers (e.g., Fildes, Marks, and Marland 1992). The lay birth control movement became the third stream of feminist work, but the birth control cause was still considered so radical in the 1920s that neither the civil rights nor the welfare feminist groups would publicly support it (McCann 1994).

In 1921 Margaret Sanger and colleagues founded the American Birth Control League (hereafter the ABC League). By 1926 it claimed thirty-seven thousand members, mostly women (Cott 1987:91). Their main strategy was to open local birth control clinics and provide, under medical guidance, contraception to all women who sought it. Sanger's ultimately successful strategy enrolled both physicians and academic scientists, who were among the first eugenicists to support contraception. Sanger explicitly deployed the academic biological scientists (including Raymond Pearl, Edward M. East, and Clarence C. Little) to limit the authority of physicians in the merging and expanding birth control movements. Her rhetoric for contraceptive advocacy simultaneously shifted from enhancing women's bodily autonomy to producing better babies (McCann 1994:120–21). Through such alliances, the birth control movement became a more liberal and centralized cause, increasingly shorn of its feminist roots (Gordon 1976:238).

The other major, and competing, lay birth control movement organization and strategy was the National Birth Control League, founded in 1917. Led by Mary Ware Dennett, this group focused on legal reform, seeking both federal and state-by-state repeal of the prohibitions on contraception as obscene. They explicitly rejected Sanger's direct-action strategy of providing birth control and opening clinics. Yet despite their more general conservatism, they opposed physician authority over diaphragm and other contraceptive use, arguing instead for women's autonomy in a more fully feminist fashion. However, it was the Sangerists' clinic-founding strategy that ultimately won the day for birth control. This strategy has endured under multiple names up to the present, but with considerable medical rather than feminist authority.^[11]

An ideology that families should have only as many children as they could afford started to emerge by the beginning of the twentieth century.

The Great Depression seems to have consolidated this "economic ethic of fertility" into the ultimate cultural arbiter of parenting decisions (McCann 1994). Ironically, the depression also challenged traditional economic (and eugenic) theory, since even many individuals of "good stock" found themselves thrust into poverty. Lay birth control theory then shifted emphasis from reducing the population of the inferior to helping the poor (including the "new" poor) to plan their families, using birth control, so that they could "afford" their children. This shift fit well with medical, clerical, and social work ideologies. The ABC League began to argue that birth control provided a flexible tool offering greater choice for all. Most women agreed: a survey conducted by Gallup in 1938 for the Ladies' Home Journal found that 79 percent of women favored birth control and 76 percent thought that family income was the most important consideration in decisions about having children (Ray and Gosling 1984–85:401).

In the 1930s, birth control clinics began offering infertility therapy as well as contraception, although efforts to include birth control clinics as part of the New Deal failed. Clinic rhetoric changed to "child spacing" or "family planning" rather than "birth control," seeking to include men in the project. Reflecting these changes, advocates who had founded the Birth Control Federation of America in 1939 as the new central organization for the movement changed its name in 1942 to Planned Parenthood Federation of America. Eugenicists in the birth control movement were strong advocates of this new name (Gordon 1976:344). Sanger hated it and resented the euphemism. She also specifically rejected encouraging the middle and upper classes to have more children (positive eugenics). However, by 1942 Sanger was sixty-three years old and tiring. Her influence was beginning to wane in her own organization, and she had also failed to cultivate a successor who shared her vision, much less a core bloc within the organization (Reed 1983:122; Chesler 1992:391–92). The radical-to-liberal tack of the birth control movement after the 1920s was reflected in the shrinking importance advocates placed on female reproductive autonomy (Gordon 1976). The lay female and often feminist birth control advocates who had been so active and outspoken in the 1910s and 1920s had gradually been replaced by professional men, including physicians, who were much more organizationally minded and quickly grasped the reins of leadership of the family planning/population–oriented infrastructure composed of over 350 clinics and advocacy groups in the United States and abroad (McCann 1994:175). World War II made birth control important to even more people than before.

By about 1945, the ideology and rhetoric of birth control, emphasizing women's rights and freedom for all to enjoy sexuality without fear of pregnancy, had changed to one promoting family planning that directly

addressed family economics, including men in its appeal. This new rhetoric of "planned parenthood" offered the possibility of bringing Taylorist approaches of "scientific planning" and "scientific management," drawn from the factory and marketplace, into the "private" sphere of the family (Banta 1993). If in business Taylorist rationalizations and efficiency allowed greater control over production processes, in the family they allowed greater control over reproductive processes—not only conception but also child spacing and family size. Sexuality, like the uncertainties of the marketplace, could be tamed and controlled to some degree. This kind of social engineering with the help of biology had actually been the ideal of Jacques Loeb, whose tradition and experiments Gregory Pincus (soon to be father of the Pill) chose to emulate (Pauly 1987).

The expansion of "family planning" services to include problems of infertility and sterility was also strategic. These services were designed to provide something for everyone—even the infertile and Roman Catholics—within the broader planned-parenthood frame (e.g., McLaughlin 1982). Consumer demand among the infertile was starting to develop (Pfeffer 1993). For the movement to progress, it also had somehow to address the tremendous Catholic opposition to contraception at the time. Obviously, such expansion widened social legitimacy. This aura of social beneficence clung to the "family planning" movement through its next shift to a "population control" rhetoric from 1945 to 1965 and beyond. The focus and rhetoric of controlling fertility and treating infertility thus served as a segue between two radically different movements.

Lay birth control proponents initially sought woman-controlled rather than male methods explicitly to enhance women's bodily autonomy. They cited "sex experts" who had condemned coitus interruptus and periodic abstinence as unhealthy and sexually repressive (Gordon 1976:xiv). Lay women's contraceptive advocacy initially focused on the doctor-fitted diaphragm with spermicides as the most effective means of contraception. The Sanger-led birth control movement introduced this method through hundreds of local clinics spread across the United States. But the safety and efficacy of these methods had not been studied in the United States. In 1923, Sanger therefore founded the Birth Control Clinical Research Bureau as a department of the ABC League to serve as the research arm of the lay birth control movement. Several prominent scientists, most with eugenic goals, served on the advisory board.^[12]

Women physicians working in movement-sponsored clinics then did pioneering (and illegal) American research on diaphragms and other contraceptives (Kopp 1933; Reed 1983:106, 114–15, 124–26). The bureau began publishing its own Journal of Contraception in 1936. Since the diaphragm was more effective when used with spermicides, research and testing of

spermicides were then sought from reproductive scientists. Since there then was no consumer guarantee of product contents, efficacy, or safety, birth control advocates also sought government regulation of spermicidal products (Borell 1987a). Ironically, the contraceptive advocacy strategy of Margaret Sanger's ABC League gave the power to prescribe birth control to physicians, not to women. Another feminist organization, the Voluntary Parenthood League led by Mary Ware Dennett within the lay birth control movement, objected strongly, if unsuccessfully, to both the diaphragm-only and the prescription-only/"doctors-only" contraceptive advocacy of Sanger and her associates (Gordon 1976:292). However, Sanger had calculated that the price of acceptance of contraception by the medical world would be a medical monopoly on the new service. She also thought nothing could bring greater prestige to contraception than to have it associated with the magic of medical science (Reed 1983:101). On this point remember that Sanger was a credentialed public health nurse.

Through the 1930s, lay birth control advocates began to seek contraception that was cheaper and easier to use for the masses of women who had no access to a physician or clinic for diaphragm fitting and prescription. Considerable debate ensued about the best means of contraception for the "uneducated," "poor," "indigent," or "lower social types." Sanger's ABC League ferociously held out for the diaphragm. There were two other alternatives: new and improved "simple" methods (such as better spermicides that might also prevent sexually transmitted diseases) or new "scientific" methods (hormonal or immunological). Sanger's industrialist husband, Noah Slee, ended up producing spermicides to assure quality and availability for the ABC League clinics. A Canadian industrialist, Alvin Kaufman, also began working to produce improved simple contraceptives, as did American industrialist Clarence Gamble (Reed 1983:114, 221).

Birth control advocates ultimately looked to reproductive scientists for scientific solutions (Borell 1987a), seeking a "magic bullet" (Vaughn 1970) or a "technological fix" (Reed 1983). By 1940, lay birth control advocates were actively seeking more sophisticated and scientific means of contraception specifically for "the masses" both nationally and abroad: "The future of Birth Control necessitates the discovery of a method which is simple and effective and which does not require the cooperation of the individual" (Baskin 1934:94). A major strategy used by lay birth control advocates to recruit biomedical scientists and others to their cause was organizing both national and international conferences on birth control, neo-Malthusianism, eugenics, and population issues and inviting leading scientists to present their work. For example, Sanger chaired the World Population Conference of 1927 held in Geneva, one of the earliest moments when population control discourse began to supplant that of birth control (Horn

1994:50). Birth control advocates and sexologists also attended the International Congress for Sex Research in 1930, focused primarily on reproductive biological research.^[13] These were lively sites of intersection for all.

Medical Birth Control Movements

Physicians also had their "own" birth control movement and organizations, primarily the National Committee on Maternal Health (NCMH), which included clinicians as well as both medical and biological reproductive scientists. The goal of this organization was professional medical control over contraceptive practice as preventive medical work.^[14] But the NCMH represented only some physicians' positions. Prior to 1940, many if not most physicians opposed birth control. In 1924, Robert Latou Dickinson, founder of the NCMH, published "Contraception: A Medical Review of the Situation," which marked the beginning of informed, open discussion of birth control as clinical technique in the leading medical journals. This article was read to the American Gynecological Society and mailed to three thousand physicians in defiance of the Comstock Act. Dickinson sought to establish the subject as "susceptible of handling as clean science, with dignity, decency and directness" (Reed 1983:183–4).

Dickinson's other major strategy was to "wrest birth control from the hands of agitators"—essentially to take over the Sanger-led ABC League and its clinics and place them under "proper medical guidance." The physicians who worked in the many ABC League clinics around the country, mostly women, were somehow not "proper" enough or not "guiding" enough. However, Dickinson's and others' efforts in this direction were confronted directly by Clarence C. Little, geneticist, eugenicist, president of the University of Michigan, and member of the ABC League advisory board. Little stated: "The medical profession has not lived up to its obligations or opportunities in this particular matter ... [and] has not earned the right to take over the work in a field which others have tilled for them" (McCann 1994:83–84). Sanger drew deeply on the support of such "progressive eugenicists" as Little, East, and Pearl in her confrontations with organized medicine. She sought to maintain both as allies, playing them off against each other while she retained the key leadership role.^[15]

During the 1920s, the contraceptive advocacy of the NCMH was mixed. The committee sponsored two lines of research: basic studies of reproductive problems that might lead to improved contraception, and studies of simple chemical contraception—spermicides. Hoping to sponsor joint research, the NCMH approached the main sponsoring agency of the reproductive scientists, the National Research Council Committee for Research in Problems of Sex (NRC/CRPS). Its queries were summarily rejected. Because of the Comstock laws and refusals by reproductive scientists to un-

dertake such projects, the NCMH could not place its sponsored spermicide research in American universities. It therefore contracted with F. A. E. Crew's Department of Research in Animal Breeding at the University of Edinburgh (Borell 1987a; Reed 1983:242). The Bureau of Social Hygiene, supported by Rockefeller monies, funded the research.

By the 1930s, both the legitimacy and the legality of birth control expanded. Professional medicine responded. With pressure from Dickinson and the NCMH, the American Medical Association created a Committee on Contraception in 1935, in part as a response to the dangers of the totally unregulated contraceptive products industry. This was about a $250-million per year business, specializing in condoms and other means carefully billed as "disease prevention" devices.^[16] In 1937, thanks to considerable effort by the NCMH, this committee recommended an AMA-sponsored study of techniques and standards, promotion of birth control instruction in medical schools, and physican advice on contraception based "largely on the judgment and wishes of individual patients" (Reed 1983:122–24).

By this time, in the middle of the Great Depression, medical contraceptive advocacy was also changing. Many physicians formerly opposed to birth control, such as Kosmak of the AMA, now asserted that birth control did not reach those who needed it most—the indigent. Echoing eugenicists, physicians now asserted that the poor lacked clinic access and in any case were deemed incapable of learning "the birth control habit" required for effective diaphragm use. Other methods were therefore needed, and medical debate centered on what kinds of contraception these should be: "simple" or "scientific." Many physician advocates of birth control, like Dickinson, believed that "major progress would have to wait for breakthroughs in basic science that would provide methods requiring less motivation or skill from the user" (Reed 1983:190, 212–14).

At the core of these objections lay the culture of scientific medicine revealed in physicians' dislike of available simple methods of contraception. A medical journal editor spoke for a good part of the general public as well as his profession when he declared in 1943: "Caustic self-analysis leads to only one honest conclusion: candid physicians are ashamed of these messy makeshifts. ... [T]here is a sense of relative inadequacy ... nourished by the contemplation of these disreputable paraphernalia. The messy little gadgets, the pastes and creams and jellies [were simply] an embarrassment to the scientific mind" (Reed 1979:132). Yet other NCMH physicians, notably Robert Latou Dickinson and Clarence Gamble, argued for expanded research and application of such "simpler" methods. Reproductive scientist F. A. E. Crew agreed, noting that for a country like China, contraceptives should be based on materials available in coolies' pantries.^[17] Gamble, a physician and philanthropist, sought doctor-free contraception.

In 1934, Gamble's offer to fund a "Standards Program" for testing contraceptive product effectiveness through the NCMH was accepted. This became the NCMH's second spermicide research project, including the establishment of state and federal product regulations. Gamble established the R. L. Dickinson Research Fellowship in Chemistry at New York University in 1935, which was held by Leo Shedlovsky, Ph.D. Research focused on measuring the physical and chemical properties of the more than forty contraceptives then on the market (mostly spermicides). This was the first laboratory study of contraceptives in the United States, notable here because it was done in a chemistry department rather than a biology or medicine department. Reprints of Shedlovsky's work were sent to fifteen hundred teaching physicians throughout the United States as part of the NCMH effort to get the AMA Council on Pharmacy and Chemistry to issue reports on contraceptives as it already did on other drugs; the effort succeeded, and a major report was published in 1943 (Reed 1983:245–46).

As birth control became more legitimate and "scientific," both suited to medical science and increasingly under its professional control, hostility within the medical profession ebbed. Moreover, medical efforts to take over the birth control movement could certainly be said to have succeeded by 1950.

Social/Academic Movements: Eugenics and Neo-Malthusianism

Other social worlds concerned with birth control were eugenics and neo-Malthusian movements. Within and beyond the academy, across multiple disciplines and professions but probably most deeply based within biology, these two social movements were confronting birth control issues. Eugenics was a social and intellectual movement, begun in Great Britain in the nineteenth century, that sought to apply hereditarian principles of improved agricultural breeding to humans. Eugenicists hoped to breed "better" people through positive eugenic activities (increasing the reproduction of persons deemed "fit," or aristogenic) and negative eugenic activities (decreasing the reproduction of persons deemed "unfit," or cacogenic). Eugenic conceptions of fitness were deeply class- and race-based, focusing on increased reproduction among the Anglo-Saxon upper classes and decreased reproduction among the lower classes, both white (especially in England) and of color (especially in the United States and in British colonial regimes).^[18]

Most eugenicists initially opposed birth control for popular use during the early decades of this century, fearing that upper-class women would use it more effectively than would people of other classes, thereby reducing the numbers of the "fit" while the "unfit" multiplied unchecked. They viewed birth control solely as a technique for negative eugenics.^[19] Eugenicists' con-

traceptive advocacy had focused on negative eugenics since the turn of the century. Eugenicists advocated involuntary surgical sterilization of the "unfit" with institutionalized criminal, insane, and "feebleminded" people as targets of special legislation. But by the mid-1930s, such laws met with considerable opposition, especially after the Nazis copied and used them. Many eugenicists had also regarded such sterilizations as an ineffective strategy.^[20]

Demonstrating the diversities within these movements, several eugenicist strategists were also early birth control advocates. E. M. East, a Harvard biologist and member of the Advisory Board of Sanger's Clinical Research Bureau, was one. In 1925, he persuaded Sanger not to publish an attack on eugenicists in the Birth Control Review for failing to support contraception, arguing that she needed their support and that they, in time, would need her. East warned: "No matter what you say, birth control is only part of a eugenical program. It is a secondary aspect of a larger whole, but it is the key. The mere fact that so many eugenicists have not been able to think straight does not make the abstract subject itself any less valued" (Reed 1983:135). During the 1920s, other eugenicists sought evaluation of the eugenic value of contraception, including Simon Flexner, C. C. Little, and Adolph Meyer of the Committee on Eugenic Birth Control.^[21]

During the Great Depression era 1930s, more eugenicists and other social conservatives began to find contraception attractive, especially as birth control advocates exploited the issue of skyrocketing welfare costs. They talked much less of women controlling their bodies and much more of the need to "democratize" contraceptive practice—to spread it "down" from the upper and middle classes to the lower classes.^[22] Since the middle classes clearly would not stop practicing contraception, eugenicists concerned about differential fertility between classes believed that their best hope for altering "dysgenic" population trends was promoting birth control for the poor. How much this was also racialized varied among individuals and regionally (e.g., McCann 1994; Larson 1995).

Some eugenicists were swayed by Raymond Pearl's studies at Johns Hopkins of populations and reproduction by economic sector or class. In studies supported by the Milbank Fund and drawing on sophisticated Pearsonian statistics, Pearl demonstrated that the differences in fertility by class and race correlated with differences in access to and use of contraceptive information and technologies. Pearl's conclusions ran counter to current biological explanations and other social/cultural explanations (including Pearl's own beliefs) of the incapacity of the lower classes to practice contraception. The studies were therefore significant in convincing eugenicists of the need for broad-based access to contraceptives (Allen 1991; Notestein 1982). In Pearl's words, "Hitherto, everybody excepting the scientist had a chance at directing the course of human evolution. In the eugenics move-

ment an earnest attempt is being made to show that science is the only safe guide in respect to the most fundamental social problems." Pearl then sought changes in policy among the "agencies under social control that may improve or impair the racial qualities of future generations" toward providing contraceptive information (Allen 1991:235; Cooke 1997).

Under the influence of Fredrick Osborn, men who placed less stress on heredity and more on environment replaced the old leadership of the American Eugenics Society in the 1930s. Osborn said in 1937: "The question I want light on is how the spread of contraception can be carried on in such a way that it will give opportunities for contraceptive practice to those families who shouldn't have children without indoctrinating too much those families who should have more children?" Ideally, eugenicists would decide who should and who should not practice contraception. Osborn was anxious to cooperate with birth control advocates in spreading contraception among the poor, but he insisted that greater emphasis be placed on "positive" eugenics: "birth control" should be replaced by "family planning" and encouragement of large families for those who could afford them (Reed 1983:213, 136). Policing yet another boundary, Osborn also convinced Margaret Sanger to withdraw as a candidate for vice president of the Population Association of America, arguing that it should be a "scientific" organization (Notestein 1982:660).

In accepting voluntary birth control as a eugenic strategy, eugenicists themselves then ceded ground on both negative and positive eugenics. At that time sterilization was the only method by which to address directly the inheritance of dysgenic qualities. Moreover, eugenicists had to acknowledge the failure of "positive" eugenics. In short, eugenicists accepted birth control and population control because they had no other activist choices.^[23] Voluntarism rather than state compulsion seemed more likely to succeed in reducing the numbers of the "unfit." There was even talk of combining the ABC League and the American Eugenics Society (McCann 1994:181).

Neo-Malthusianism was the name used early in the twentieth century for the social and academic movement of those concerned with overpopulation, both numerically and proportionally by social class, who also supported birth control. As noted earlier, the term Malthusian was also used synonymously with what we now call birth control (as in Foucault's Malthusian couple). By 1940, neo-Malthusians had moved successfully into the scientific study of population phenomena as a means of promoting social policy, developing an elaborate institutional infrastructure for their new discipline of demography. The list on page 57 contains some of the key organizations and events in the movement's development. Its rhetoric shifted from neo-Malthusianism to population research to population control and demography.^[24]

At the organizing meeting for the Population Association for the United

States in 1930, Dr. Henry Pratt Fairchild summed up its mission: "We are all convinced of the importance of having an association to consolidate the population interests of this country. ... [W]e are in a position to take up the phenomenon of population as one of the great factors of human welfare to be rationally manipulated, just as we manipulate the other factors in human relations."^[25] However, neo-Malthusian population scientists were not in accord on contraceptive advocacy. They debated effectiveness, costs, and accessibility. Many population scientists asserted a direct correlation between socioeconomic status and the ability to nurture children in ways that remain too familiar. Many advocates of population control through contraception were also deeply racist, targeting lower-class and poor people and racial/ethnic groups of color both in the United States and abroad.^[26]

The period from 1920 to 1940 constituted the "emergence" era of the population enterprise, which coalesced between about 1940 and 1965.^[27] The British movement, which was larger and stronger than the American during the 1920s, focused primarily on colonial populations. British-ruled India had the first government-sponsored birth control clinic in the world, opened in 1930 (Hartmann 1987/1995). In the United States, organizing efforts focused on the academy and the philanthropic foundations. United States possessions were also the focus of birth control/population control programs; in the 1930s, a major program was established in Puerto Rico focusing on diaphragms, spermicides, and surgical sterilization (Ramirez de Arellano and Seipp 1983). This network was later enrolled to serve as the home base for testing the birth control pill prior to its approval for U.S. distribution (Oudshoorn 1994:122–37).

A number of reproductive and related scientists actively participated in the population establishment. For example, participants in the World Population Conference of 1927 included Leon Cole, C. C. Little, Adolph Meyer, Raymond Pearl, and J. Whitridge Williams (Hopkins gynecologist). Fellows and members of the Population Association of America included Little, Pearl, Dickinson (NCMH), L. B. Dunham (BSH), E. B. Wilson, Clark Wissler, and Robert Yerkes.^[28] Population concerns were raised in various media by these and a host of related organizations and demographers, generating wide cultural interest in population, and hence in reproductive issues more broadly.^[29] One of the key organizations in the present story is the Population Council, through which modern scientific IUDs (along with implantable hormonal contraceptives) were developed (Segal 1987), discussed next as a Rockefeller organization.

Rockefeller Philanthropy and Contraception

In addition to social movement groups committed to birth control and enhanced control over family size and composition, one of the major phil-

anthropic families of the twentieth century also manifested sustained commitments and a wide range of efforts in such directions. In some ways, Rockefeller involvement has been so powerful that it can easily be seen as on a par with social movement organizations as an actor in the arena. The Rockefeller-sponsored Bureau of Social Hygiene initiated such Rockefeller involvement in the birth control and population causes. In the 1920s, its commitment to birth control and population studies was thus not a wholly new direction. Like many other eugenics groups, Rockefeller interests shifted from contraception to population control (Allen 1981:253). The Laura Spellman Rockefeller Memorial Fund was supporting population research at the Scripps Institute in the 1920s (Notestein 1982:654). And as early as 1924, Raymond B. Fosdick, president of the Rockefeller Foundation, had written to J. D. Rockefeller Jr.: "I believe that the problem of population constitutes one of the great perils of the future. ... Scientists are pointing hopefully to such methods as Mrs. Sanger and her associates are advocating" (Borell 1987a:66). Fosdick himself had served briefly as the general counsel of Sanger's ABC League (Harr and Johnson 1988:191). Such philanthropists' commitments were significant for reproductive scientists because these same funding sources were often simultaneously sponsoring their basic research. Some sponsors attempted to recruit reproductive scientists for research on specific contraceptive projects, while other sponsors provided liaisons between birth control advocates and reproductive scientists. Reproductive scientists were obliged by their reliance on such sponsors to respond, often awkwardly.

The Bureau of Social Hygiene (BSH), funder of both the NRC/CRPS and the NCMH, was active in both liaison efforts and direct funding of contraceptive research. During her tenure as director of the BSH, Katherine Davis made numerous attempts to further such research.^[30] When she retired and L. B. Dunham took over as director in 1928, he was unsure about continued Rockefeller commitment to the birth control cause: "It seems to me that the project on spermatocides ... would lead to an extremely controversial field and one that is surcharged with theological politics. It seems to me that, necessary as that work is, it ought to be carried out as part and parcel of a larger research project by some medical center. Another course, it seems to me, might expose the Bureau to a lot of publicity of a nature that would lessen its general effectiveness."^[31] Dunham was quickly put in his new and "proper" place as a Rockefeller-funded birth control advocate by Raymond Fosdick of the Rockefeller Foundation, who vividly reasserted the Rockefeller commitment to contraception: "I do not share your feeling of [not] getting the Bureau into the controversial field of birth control. I think the Bureau ought to get into this field, and as a matter of fact it is in, and so is Mr. Rockefeller. Surveys of the type proposed by Dr. Dickinson

[on spermatocides] are enormously important and the Bureau exists for just that purpose ."^[32] Dunham then became a promoter of contraceptive research among reproductive scientists. For example, he set up a Conference on Birth Control in 1931. Guests included reproductive scientists Walter Cannon (Harvard Medical School and member of the NRC/CRPS) and Charles Stockard (Cornell Medical School researcher supported by the NRC/CRPS), as well as Henry Pratt Fairchild (demographer and president of the American Eugenics Society).^[33]

The BSH also sought to expand its funding of contraceptive research to include fresh efforts by reproductive scientists. Ruth Topping of the BSH talked about this goal at length on several occasions with Carl Hartman, who made numerous arguments for basic reproductive research as leading ultimately to contraceptive research (discussed in detail later in the chapter). Topping wrote to Dunham in 1931: "Might it not be possible to stimulate ... observation and experimentation [leading to contraception] among workers who are studying the reproductive cycle under grants from the [NRC/CRPS]? If some of these scientists became especially interested in the search for a contraceptive, the Bureau might later make supplemental grants."^[34] As we shall see, the NRC/CRPS refused such overtures. But the importance of such efforts by the BSH and the Rockefeller Foundation is that they added the voices of a major philanthropy and a major reproductive sciences funding source to the chorus of advocates attempting to engage American reproductive scientists in contraceptive research during the 1920s, 1930s, and 1940s.

In the 1950s, Rockefeller changed the form of its support for birth control. A key Rockefeller organization is the Population Council, through which modern scientific IUDs were developed. This organization was founded in 1952, and was funded through the direct commitments of John D. Rockefeller III, who despite being a board member, could not convince the Rockefeller Foundation of the importance of population control. At the time, the foundation was deeply involved in international agricultural reform and improvement, which, it was hoped, might eliminate the problem of "overpopulation" through production of adequate food. Moreover, the foundation per se had avoided directly supporting contraception and population projects for many years by funneling them through the BSH. After the BSH was terminated in 1933, the foundation had carefully avoided such responsibilities and had explicitly eschewed them during the McCarthy era, when it was under considerable scrutiny as a "liberal" organization. Instead, Rockefeller Foundation executives were pleased that other groups were shouldering this burden.^[35] The Population Council became, in fact, one of the sites of the implemented merger among birth control, eugenic, and population control groups.

A Synthesized Movement: Family Planning and Population Control

Family planning/population control became the banner or umbrella framework for an amalgam of birth control, eugenics, neo-Malthusian, and population/demographic movements and interests by about 1940, and by about 1950 it formed a fully articulated ideology (Gordon 1976:391). This banner provided excellent symbolic rhetoric for all of these groups. First, like the reproductive sciences, population control had developed a considerable scholarly scientific reputation, along with a well-organized institutional infrastructure (Allen 1991). Second, the terms family planning and population control omitted the words sex and birth control , sounded objective and scientific, and allowed racism to be expressed apparently neutrally concerning whole populations.^[36]

Population control organizers had considered the merger since the early 1930s. As Henry Pratt Fairchild said at the founding of the Population Association: "When this idea [for a Population Association] first came into my mind I was thinking about a possible merger of the Eugenics and Birth Control interests in the country, but now it is seen as a much bigger thing. ... It is feared by some that anything approaching consolidation may lose us support. There are some people who believe in eugenics, but not in birth control, and vice versa. We might lose some support on both sides, but would get it back from the united front we would present."^[37] And they did.

By 1934, greater coordination of effort among the constituent segments was already apparent: "There is clear evidence [of] greater coordination in the work of the [ABC] League, a sharper definition of program, and greater cooperation with such organizations as the National Committee on Maternal Health, the eugenics-focused Human Betterment Foundation in California, the National Committee on Federal Legislation [for Birth Control], the Population Association of America, and the American Eugenics Society."^[38] Further evidence of coordination and integration lies in the interlocking memberships and directorates of the multiple population, birth control, neo-Malthusian, and eugenics organizations, and in the new mission statements issued by these organizations. For example, the first Board of Directors of the Planned Parenthood Federation of America included former presidents of both the American Eugenics Society and the Race Betterment Conference.^[39] By 1953, American foundations had contributed over $3 million to the field of population study (Osborn 1967:368), and this was before the era of extensive government and foundation involvement and sponsorship (Greep, Koblinsky, and Jaffe 1976). The scale of private funding for population control was immeasurably greater in the 1930s, and especially after World War II, than it had been for orthodox eugenics (Allen 1991:254).

Fairchild made another statement about the merger to the annual meeting of the Birth Control Federation (successor to the ABC League) in 1940: "One of the outstanding features of the present conference is the practically universal acceptance of the fact that these two great movements have now come to such a thorough understanding and have drawn so close together as to be almost indistinguishable" (Gordon 1975:273). Within the birth control movement, those segments most supportive of eugenics and population control then became active around the International Planned Parenthood Federation, housed in the Eugenics Society building in London. Those in the middle of the road were active in the Planned Parenthood Federation of America, focused on the incorporation of reproductive control into state programs as a form of social planning and ultimately population control (Gordon 1976:342–47). Feminists and other progressives seem to have left the birth control/population control movement entirely at this time, or to have worked very locally in clinics providing direct access to birth control for women.

By the late 1930s, the birth control, eugenics, and neo-Malthusian movements had synthesized into a new "family planning and population control" movement. Sanger herself (1937:3–4) best captured the contraceptive advocacy of the newly synthesized movement in the quote that began this book. Sanger further argued: "We should place the scientists not only at the helm but on the bridge [of the movement] as captains to guide humanity." As we shall see, scientists were, by the end of World War II, almost ready to comply. Putting scientists at the helm transformed the nature of modern contraception.

Reproductive Scientists and Contraceptive Technologies

Responding to the loud and determined chorus of voices urging reproductive scientists into contraceptive research between 1925 and 1945, the scientists used three key strategies. They distinguished reproductive from contraceptive research; they argued with birth control advocates for basic research on reproduction from which applications such as contraception would flow; and they redirected contraceptive research from simple to scientific methods. It was eugenic arguments that first captured reproductive scientists' interest in birth control as a scientific problem (Borell 1987a), as many of them had both intellectual and organizational commitments to that movement. However, all of the initial voices seeking research on simple contraceptives were from the lay and medical birth control movements. The initial strategic response of reproductive scientists to these demanding yet illegitimate audiences was to turn a deaf ear.

First Strategy: Distinguishing Reproductive from Contraceptive Research

Reproductive scientists initially focused on distancing their enterprise from that of birth control advocates and establishing a clear set of distinctions between them. This strategy reflected both the general illegitimacy of the birth control movement (with its tattered but still present feminist garb in the 1920s) and reproductive scientists' own designation of contraceptive research as unattractive applied work. In 1920, reproductive scientists had strong hopes that their research area would become as prestigious as any other area of basic biology, a hope gradually abandoned over the next decades, especially after World War II.

Reproductive scientists worked hard to demarcate the boundaries of their work to exclude explicitly contraceptive research. Robert Latou Dickinson of the NCMH approached the NRC/CRPS on several occasions with a request to undertake contraceptive research. In 1924, he recounted one response he received:

A year ago we [the NCMH] tried to get some of our borderline sex problems, like sterility and information bearing on sex life in our histories, taken up by [the NRC/CRPS] and received a written answer that their Committee was only interested in animal research. Several months later when sex life of human beings was included in their studies we again tried to delimit our respective fields and suggested the whole subject be a matter of [joint] conference and allotment. Their meeting considered the matter and decided they need not coordinate the work as the Committee on Maternal Health had only to do with birth control.^[40]

At this point reproductive scientists in the NRC/CRPS rebuffed birth control research and any other research that the NCMH might have sought. While there was, in fact, considerable overlap in investigations sponsored by the two organizations, association with a birth control organization, even a medical one, was clearly not on their agenda.

Both the NRC/CRPS and the NCMH received support from Rockefeller philanthropies. A dozen years later, in 1936, the NCMH sought Rockefeller funding for sterilization and other research, including projects on both simple and scientific means of contraception, which the NRC/CRPS had refused to address.^[41] Warren Weaver, recently of the Rockefeller Foundation, then wrote to Robert Yerkes, chairman of NRC/CRPS since its inception in 1921. Weaver felt these projects "would appear to fall within the scope of the NRC/CRPS ... [yet] ... It is not clear to me whether such topics would be [so] viewed by your committee." Weaver even implied that if the NRC/CRPS would address the topics, its budget might be expanded accordingly.^[42] Here Yerkes's response to Weaver was the third rebuff of the

NCMH and such "human side" problems. Yerkes strongly reasserted the NRC/CRPS's clearly bounded research policy to Weaver:

Reference to [the NRC/CRPS] ... is not clearly indicated. The committee in question [the NCMH] is, like my own, composed of reputable specialists whose judgments are trustworthy. In my opinion, neither committee should be asked to advise concerning or endorse the program of the other. Inasmuch as the Committee on Maternal Health is concerned primarily with applied aspects of research on sex and reproduction, whereas the N.R.C. Committee has dealt almost exclusively with so-called fundamental problems in the biology of these subjects, I doubt that the N.R.C. Committee would favor support of such studies as are listed in your letter.^[43]

Finally, in 1939, the Rockefeller Foundation gave the NCMH funds for research that the NRC/CRPS refused to undertake, including studies of sperm morphology, spermatoxins, reproductive endocrinology, and sex cells (Reed 1983:269; see chapter 7).

The second element of the strategy of distinguishing reproductive from contraceptive research was refusing to participate in research on simple means of contraception such as spermicides and condemning any reproductive scientists who did so. The first two major studies of spermicides were undertaken in Great Britain because of the refusal of American scientists to undertake the work, combined with the restrictions of the Comstock Act. British scientists were also generally unenthusiastic about applied research on simple contraceptives (Soloway 1995). The outcomes of both studies demonstrate my point.

Cecil Voge conducted one study under the direction of F. A. E. Crew of the Animal Breeding Research Department of the University of Edinburgh. Voge's work focused on tests of extant spermicides to determine if there was a safe, highly effective one that would also work as a prophylactic against venereal diseases (a search that continues to this day; see Clarke 1997). Voge's project was sponsored by the NCMH and funded by the Rockefeller-supported BSH. Crew's department at Edinburgh was transformed between 1927 and 1930 into the Institute of Animal Genetics by a matching grant from the Rockefeller International Education Board that provided an endowed chair, buildings, and equipment (Hogben 1974:139). Apparently, Crew's approval of Voge's contraceptive research project was grudging, and his approval may well have been "induced" by his other Rockefeller grant. The NCMH's contraceptive advocacy here was for an "easily available chemical in a form that should keep in good condition over a long period of time and in all climates, and be so easy to use that the most ignorant woman in the Orient, the tropics, the rural outposts or the city slums might be protected."^[44] The Voge study, published in 1933, did

not produce such a "magic bullet" or miracle contraceptive, but sponsors considered it a great success in terms of establishing standards of safety and effectiveness.^[45]

Crew, however, had a very different reaction, calling Voge "a traitor to science."^[46] Despite having a doctorate in immunology, Voge (1933:11) had somehow crossed the invisible and shifting border into "applied" research. Crew then recommended that the NCMH cease to support Voge's work because his future as a research chemist was being jeopardized. Voge ultimately "fulfilled the worst fears of his colleagues" when he went into business as a consulting industrial chemist (Reed 1983:243). There was also some controversy about Voge's use of Baker's early research (Soloway 1995), discussed next.

The second spermicides study in Britain was sponsored by the Birth Control Investigation Committee, part of the British activist clinic movement, along with the British Eugenics Society and the American BSH and NCMH. Initially, reproductive scientist F. H. A. Marshall, then president of the Cambridge birth control clinic, tried to place the project in a lab at Cambridge University, but he was unsuccessful (Soloway 1995). Instead, in the late 1920s, John R. Baker, an ardent eugenicist of the Department of Zoology at Oxford, began examining the spermicidal value of pure chemicals, as well as testing extant means and vehicles used to deliver them vaginally (Baker 1930a,b, 1931a,b). According to one source, Baker assembled at Oxford a "team" of scientists in zoology, chemistry, physiology, and bacteriology and related both clinical and laboratory findings.^[47] Baker specified that the ideal contraceptive should be inexpensive and small; require no special appliance for insertion into the vagina; be unaffected by the ordinary range of climates; leave no trace on skin nor stain fabrics; contain no volatile or odorous substance; be nonirritating to the vagina, cervix, and penis; be without pharmaceutical effect if absorbed into the bloodstream; contain a substance reducing surface tension to ensure that the smallest crevices of the folds of the vagina are reached; be able to kill sperm at five-eights or lower concentration in the alkaline and acid test to avoid harm to mucous membranes; and be able to diffuse rapidly into the semen (Robertson 1989:84–85). These remain the key requirements for this common and simple contraceptive.

During the late 1930s, this work led to the development of a popular and highly effective spermicide called Volpar for vol untary par enthood (Borell 1987a). Baker, however, was forced to leave the Department of Zoology at Oxford when the director discovered the purpose of his experiments. (He was allowed to relocate to the Department of Pathology.) In Baker's own assessment, his contraceptive research was "rather prejudicial to his career" (Porter and Hall 1995:176). It was "permanently symbolized in his recollection of assembling his apparatus and reagents on a handcart

and trundling this from department to department," although he did remain in academic chemistry. Clarence Gamble then funded a research fellowship in chemistry at New York University to "complete the work done by Voge and Baker," focusing on spermicides available in the United States (Reed 1983:243–45).

In the United States, the NCMH made at least one attempt to "piggyback" applied spermicide research to ride on the back of "basic" sperm survival research. In 1938, the NCMH offered a grant to the Carnegie Department of Embryology to study the transport and viability of spermatozoa in the genital tracts of female dogs and monkeys.^[48] The department agreed, "provided work is designed specifically for study of the reproductive cycle and not for collateral problems of a social type."^[49] But in a personal letter to Carl Hartman of the Department of Embryology, Raymond Squier, then executive secretary of the NCMH, tried to remind Hartman that another reproductive scientist member of the NCMH (Earl Engle of Columbia) had discussed this matter privately with Hartman. The NCMH thought they had come to an understanding that spermicidal testing would be incorporated into the research. Squier said he was sure that Hartman understood that the NCMH could not afford to spend "$3000 simply on further study of the estrous cycle of dogs or other work on monkeys having no relation at all to possible practical applications for the control of human reproduction."^[50]

Despite his own long-term commitments to the birth control movement, Hartman's response fell fully within the strategy of reproductive scientists regarding their birth control audiences: he refused to incorporate the contraceptive research. He wrote to the head of the Carnegie Department of Embryology: "I assured Squier that we could work on any phase of pure science that we wished, leaving propaganda and 'applications or social implications' for organizations like his. As to effect of chemical or physical agents on sperms—we don't propose to touch that subject unless we get a new 'lead' that justifies [it]. ... What we shall do is study sperm survival under normal conditions—there will be little time for anything else."^[51] Even Hartman, a former chairman for research of the NCMH (from 1934 to 1937), would not bend the rules or cross the boundaries of the Carnegie Department of Embryology specifically or of the basic reproductive research enterprise generally.^[52]

Reproductive scientists' overall strategy of distinguishing reproductive research from contraceptive research was successful for them, especially in highlighting distinctions between applied and basic research and in clarifying their basic research identity. The career trajectories of reproductive scientists who did undertake research on simple contraceptives vividly demonstrated that there was an applied/basic boundary that could not be crossed without negative consequences. Not only was birth control research

socially illegitimate; it was also scientifically marginal or illegitimate—especially when it focused on simple methods.

Second Strategy: Arguing for Basic Reproductive Research

A corollary second strategy reproductive scientists used in response to birth control advocates was arguing for basic research as both the prerequisite for and the ultimate source of improved means of contraception. Here reproductive scientists turned the tables and attempted to recruit birth control advocates into providing financial and other support for basic reproductive research. Again, they were successful in the long run.

Carl Hartman at Hopkins, a major reproductive scientist active in birth control worlds, articulated this strategy very clearly when queried by Ruth Topping, a staff member of the Bureau of Social Hygiene:

When I asked Dr. Hartman in what directions research for a better contraceptive might most profitably be conducted, he recommended an indirect rather than a direct approach to the problem. After pointing out the vast amount of research being done in this country in the physiology of reproduction, particularly in relation to glandular activity, he expressed the opinion that if some of the outstanding workers in this field could be persuaded to keep contraceptive possibilities in mind in connection with their observation of the reproductive process, some of them might discover ways and means of interrupting the process at given points or under given conditions. These observations might narrow the lines along which specific research might then be carried on.

Here Hartman was speculating on the possibility of hormonal contraception emerging from reproductive endocrinological investigations. He further suggested that such work might well be carried on at or in connection with agricultural experiment stations, attempting to place it in supposedly intrinsically "applied" settings rather than "basic" reproductive biology labs.^[53]

Similar arguments were made by Lillie of Chicago and Crew of Edinburgh.^[54] In case Topping and other birth control advocates did not understand the distinction between basic and applied research, Crew clarified it: "It is impossible, in Dr. Crew's opinion, to make definite programs in scientific research. 'The real scientist is not an employee,' he said. 'He starts out to find something but may discover something on the way that changes the whole course of his investigations. He can't have someone pulling strings and keeping him to a course.'"^[55] This is a classic argument for both basic research and the autonomy of the scientific enterprise.^[56] Medical reproductive scientists made similar arguments for basic research, including Earl Engle, who bluntly exclaimed, "We don't give a damn about contracep-

tion. We want a study of basic factors in human reproduction," and Howard Taylor, who complained that "birth control was a banal topic for the first-class clinician." Even a physician birth control advocate such as Dickinson believed that "major progress would have to wait for breakthroughs in basic science" (Reed 1983:243, 129, 214).

An integral part of reproductive scientists' strategy here was to provide birth control advocates with token offerings from basic research. Many reproductive scientists in the United States undertook basic research that had clear potential for contraceptive development, while eschewing the simple-method spermicide studies of their British brethren. The classic basic investigations focused on the timing of fertility in women, which allowed more precise determination of "the safe period" during which unprotected intercourse would not result in pregnancy, generally known as the rhythm method. This research involved a wide range of basic problems intriguing to reproductive scientists, including the timing and occurrence of ovulation in relation to menstruation, egg transport through the fallopian tube, fertilization, implantation, and sperm vitality and motility.

In 1922, participants in the International Neo-Malthusian and Birth Control Conference lamented the lack of clarity about the timing of fertility (Pierpoint 1922:270), and the next decade saw numerous efforts in this direction. The leading researcher on this problem in the United States was Carl Hartman,^[57] who conducted numerous nonhuman primate studies (e.g., 1939) and also worked with Raymond Pearl (1932) on human studies. The major difficulties encountered by scientists pursuing this topic was the range of variation in women's cycles, both among women as a group and within individual women over time (Hartman 1962:vii). As Hartman put it, "There are almost no regularly menstruating women, any more than there are regularly menstruating monkeys" (Sanger 1934:53). Hartman published "Catholic Advice on the 'Safe Period'" (1933) in a birth control journal. His summary work was Time of Ovulation in Women: A Study on the Fertile Period in the Menstrual Cycle (1936), part of the Medical Aspects of Fertility Series sponsored by the NCMH.^[58]

George Papanicolaou of the Cornell Medical Center was also engaged in work sponsored by the NCMH on the "safe period," attempting to discover a means of determining the day of ovulation in women through vaginal smears (Papanicolaou 1933), excellent indicators in laboratory animals (Stockard and Papanicolaou 1917). Edgar Allen and his colleagues (Allen et al. 1928) also engaged in studies focused on the timing of ovulation and surgically recovered live human ova from the fallopian tubes, charting their place in the cycle. These researches offered some immediate contraceptive payoffs but were far from direct responses to birth control advocates' explicit requests for investigations of simple contraceptive technologies.

Third Strategy: Redirecting Contraceptive Research

The third strategy of reproductive scientists regarding birth control advocates was to continue with their own basic research agendas and claim that new means of contraception would eventually flow from this work. Here reproductive scientists essentially redirected contraceptive research along new basic "scientific" research lines and away from the "simple" means initially sought by birth control advocates. They did so by promoting four major research directions for modern "scientific" contraception: endocrinological, immunological, intrauterine, and radiation—most only in women. Each of these was attractive to a different subset of reproductive scientists, as we shall see.

Promoting Endocrinological Intervention.   Promoting endocrinological intervention in the female cycle can be analyzed as precursor research to the Pill, which operates through this mechanism. Such possibilities were attractive to both funding sources and some scientists by the 1920s. The basic principle was suggested by Haberlandt in 1921 (National Science Foundation 1973:10–12), though it seems to have been ignored. By the mid-1930s, however, Max Mason of the Rockefeller Foundation thought that "the ultimate solution of the problem [of birth control] may well lie in the studies of endocrinology, particularly antihormones" (which would counter routine cycling).^[59] The overall strategy was to use hormones to intervene in the monthly cycle of women to prevent conception, or, as Hartman put it, "to interrupt the process at given points or under given conditions" (Borell 1987a:fn76). Crew suggested experimental work with hormone injections for the object of developing a chemical combination that would prevent the ovum from entering the uterus.^[60]

Wary discussion of the possibilities of hormonal contraception began in the birth control literature in about 1928.^[61] The fundamental requirements for such methods were a clear understanding of the reproductive endocrinological cycle (e.g., Aberle 1934; Allen 1932) and chemical isolation and production of pure hormones (Djerassi 1981). These were precisely the tasks that many reproductive scientists had set for themselves during the "heroic age of reproductive endocrinology" between 1925 and 1940 (Parkes 1966a). Moreover, American reproductive scientists had sustained fiscal support in these endeavors through the NRC/CRPS, and by about 1940 hormones were widely used for medical treatment (Bell 1986, 1994b), though not for contraception.

In 1937, a summary of these endocrinological strategies was published by Ralph Kurzrok, a Columbia University endocrinologist, as "The Prospects for Hormonal Sterilization." He discussed six alternative interventions in the female hormonal cycle that would likely prevent conception,

including estrogen injections to inhibit ovulation (the subsequent basis of the Pill). He concluded, "The potentialities of hormonal sterilization are tremendous. The problem is important enough to warrant extensive work on the human." All of Kurzrok's fourteen citations were to basic reproductive scientists, most of whom were working with rats and rabbits at the time. But reproductive scientists did not answer his call to work on humans for many years, nor did he pursue such efforts himself. Serious work on the Pill itself did not begin until about 1951.

Movement toward scientific contraception was not always smooth, and there were debates about particular lines of research. In 1938, for example, Nicholas Eastman, a gynecologist at Johns Hopkins, was studying spermatoxins with NCMH sponsorship. He wanted to change "the direction of his work ... to hormonal means for avoiding pregnancy." However, Earl Engle, research director for the NCMH, decided that "the hormonal field is not very promising" and refused to sanction the change because the drug company that provided Eastman's funds through the NCMH was interested in spermatoxins and might withdraw its support. By 1945, Fuller Albright of Harvard was arguing in support of Kurzrok's hormonal method for women (Reed 1983:270, 315).

But talk about developing hormonal means of contraception was cheap. Reproductive scientists did not have to engage in applied research to make claims of future contraceptive payoffs from their work. As one historian has noted (Johnson 1977:77fn 10), Sanger knew what she wanted from the scientists, knew what their scientific research on contraception would likely produce, and was still unable to induce any scientist who could make a contribution to engage in such work until the 1950s. In fact, scientists did not undertake this work in explicit basic research settings until as late as the 1960s.

Ultimately, development of the Pill was initiated and fiscally supported by Sanger, her ally Katherine McCormick, and the lay birth control movement. It was developed through the efforts of several scientists, all of whom, at the time, were operating from institutional sites on the fringes of academia or in industry. Specifically, Gregory Pincus and M. C. Chang were at the private Worcester Institute of Experimental Biology, which in 1950 was fiscally dependent on contract pharmaceutical industry research. Pincus had a strong background in the agricultural end of the reproductive sciences from his personal experiences, his undergraduate studies in biology from Cornell, and a year spent at Cambridge University in one of the major British centers of agricultural reproductive science with John Hammond, F. H. A. Marshall's primary student then working on artificial insemination (Pauly 1987:187). Like Walter Heape and Jacques Loeb, Pincus had worked on artificial parthenogenesis and other reproductive problems in the 1930s and 1940s (Biggers 1991). When he began explicit work on the Pill, Pincus

was already "a refugee from academic biology" (Reed 1983:316), after being denied tenure at Harvard during the era when "proper" biology departments were getting out of the reproductive science business and expressing anti-Semitism.^[62]

Pincus had received $14,500 from the PPFA in 1948 and 1949 for work on the mammalian egg. In 1951, he conferred with Sanger regarding hormonal contraception and then reapplied to the PPFA for support of this line of research, receiving $3,100 in 1951 and $3,400 in 1952. Pincus then sent in a most promising report of this work, which was ignored by William Vogt (then directing Planned Parenthood), who wanted organizational expansion to be focused on his administrative functions rather than animal testing of the Pill. Sanger, in one of the preemptory moves for which she was famous, simply bypassed him. In 1953, she convinced Katherine McCormick, heir to the International Harvester fortune and longtime suffragist and birth control advocate, to accompany her on the now-famous visit to Pincus at the WFEB. At the end of their conversation, McCormick promised Pincus $10,000 per year on the spot; this increased to $150,000 per year and more during her life (totaling about $2 million), and she left the Worcester Foundation $1 million in her will (Reed 1983:340; Chesler 1992:432).

The strategy of endocrinological contraception was also appealing to biochemists, and developments in steroid chemistry were key to the Pill. Russell Marker's and Carl Djerassi's chemical efforts were based at different times in Syntex, the industrial pharmaceutical company Marker had helped to form in Mexico. When Marker analyzed plant steroids for the first time he realized that hormones could be produced synthetically using a Mexican yam. Frustrated by his inability to locate support, he left academia and went to Mexico to pursue this line of research. Djerassi joined Syntex after Marker's departure, and with colleagues produced an orally active estrogen, which he then sent to Pincus and others for testing. Both Searle (with whom Pincus was already working) and Syntex eventually produced birth control pills.^[63]

Not all reproductive scientists were thrilled with the Pill, and the clinical trials proved problematic.^[64] Carl Hartman, then chairman of the medical committee of Planned Parenthood, expressed reservations about the Pill's systemic properties and predicted a fifteen- to twenty-year period before its safety could be assessed (about the same amount of time women's health activists also estimated as necessary). But Sanger and McCormick were "so confident ... of the Pill's revolutionary consequences that they seemed positively immune to any objections to it whatsoever, and interpreted reasonable concerns about the liabilities of experimenting with so potent a drug as just one more round in the arsenal of opposition that birth control advocates had confronted for years" (Chesler 1992:434, 445). This pas-

sage also reminds us that women and feminists have held multiple positions about the Pill.

Pincus, Chang, Marker, and Djerassi all left academia under different conditions to pursue their work on their own terms in industrial or semi-industrial venues. They may have laughed at scholars' rejection all the way to the bank, but academic reproductive scientists were still refusing to do explicitly contraceptive research. These four in fact, had gone beyond the scholarly pale of their era—more or less commercial.^[65] It was not until well into the 1960s that "population" funding from foundations and the federal government filtered into academia on a scale massive enough to involve basic reproductive scientists in research related, both directly and indirectly, to endocrinological contraception (Greep, Koblinsky, and Jaffe 1976). By then, such research was undertaken almost exclusively in medical settings. By 1970, there were 9 million American women using the Pill. Currently about 60 million women around the world do so.^[66] Women Pill users are configured as active participants in contraception because the Pill must be taken daily.

Promoting Intrauterine Intervention.   Intrauterine devices (IUDs) are made of various substances (silk coils, rubber, metal, and after about 1958, plastic) and are placed into the uterus through the cervix. It is surmised that they prevent conception by creating a hostile uterine environment (one too irritated to allow implantation). Traditionally, the devices have been inserted by physicians (Langley 1973:336–37). IUDs are obviously directed at women actors—women as implicated users.

By the nineteenth century, IUDs had been patented and were in use for contraceptive purposes; Robert Latou Dickinson began promoting such devices in the United States in 1916 (Southam 1965:3). IUDs were also discussed at the Fifth International Conference on Birth Control in 1922 (Pierpoint 1922:275–77). The first modern developer was Ernest Grafenberg, a German gynecologist, who began experimenting with various types of devices in 1909 and began publishing on IUDs in 1928 (Langley 1973:336).^[67] Grafenberg reported great success with the method in 1930 at the Seventh International Birth Control Congress, and considerable experimentation followed with what were then called "Grafenberg rings" (Reed 1983:275). But IUDs also generated considerable debate within the medical community in the 1930s and later, with many physicians vehemently opposed to their use, largely on grounds of risk of infection.^[68] Physician opposition to it was strongest in the United States, where it was difficult even to publish on this method.^[69] "No physician who himself had used IUCDs published a report in any medical journal of the Western countries between 1934 and 1959" (Tietze 1965b:1148).

The increased availability of antibiotics after World War II helped to over-

come both the fears and the infections (Bullough 1994:186). Drawing on work done in Israel and Japan (Tietze 1965b), Lazar Margulies of the Department of Obstetrics of Mt. Sinai Hospital in New York and Jack Lippes of the University of Buffalo resurrected IUDs in the United States. Between 1958 and 1960, they pioneered a plastic product as a new, modern means of "scientific" contraception. The Population Council provided grants covering about 95 percent of development costs (Notestein 1982:678). Christopher Tietze of the Population Council candidly stated: "It was a very exciting period. ... [W]e were working with something that had been absolutely rejected by the profession. ... There was such a feeling of urgency among professional people, not among the masses, but something had to be done. And this was something that you could do to the people rather than something people could do for themselves. So it made it very attractive to the doers" (Reed 1983:307). It is this controlling approach—seeking something "you could do to the people"—that has guided much subsequent research within the population control framework.

As predicted by physicians in the 1930s, problems did appear with all IUDs, especially infection and "traveling." But one device in particular, the Dalkon Shield, was a transnational disaster, associated with an estimated seventeen deaths and extensive morbidity, including permanent infertility.^[70] Such disasters have certainly sustained the controversial status of the reproductive sciences. Currently only a few IUDs are marketed in the United States because of steep product liability costs following the Dalkon Shield case (Mastroianni, Donaldson, and Kane 1990).

The configured users of the IUD are women who do not want to or cannot practice a method of contraception that requires active involvement, such as taking the Pill daily or using condoms. Those who developed techniques of contraception such as the IUD (and later injectables and implantables) to be "done to the people," in Tietze's terms, have taken an array of approaches that draw on different professional skills and knowledges within different and often competitive organizations.^[71] But not all such efforts were as successful as the Pill and the IUD, as we shall see next.

Technological Intervention: Radiation for Sterilization. Voluntary (instead of involuntary, state-ordered) sterilization began to be seen as a viable means of contraception by birth control advocates in the 1920s (e.g., Dickinson and Gamble 1950; Sanger 1934:71). Although the usual means of sterilization were surgical (Langley 1973:272–336), a "simpler" and less invasive method of achieving permanent sterility was seen as desirable, and research was undertaken on sterilization by irradiation of the ovaries and testes. Radiation technology was the current "magic bullet" for new approaches to old problems. Whether the sterilizing potential of

x-rays was discovered inadvertently is not clear. An early text on fertility and sterility notes, "A few years ago before the nature of the Roentgen rays [was] understood, practically all x-ray workers were sterile" (Reynolds and Macomber 1924:128). This method was therefore directed at both women and men as implicated actors/users. Both would be configured as passive users once radiation had been done.

In 1922, Donald Hooker of Hopkins reported on his preliminary investigations of sterilization by x-rays in the rat (Pierpoint 1922:236–39).^[72] Hooker's research then generated further funding from the NRC/CRPS for the years 1922 to 1925; the committee also briefly funded clinical research on the effects of x-rays on sterility and fertility from 1924 to 1927 (Aberle and Corner 1953:93, 120). In 1925, Robert Latou Dickinson wrote to Katherine Davis of the BSH that in order to get away from mechanical appliances and "to suspend temporarily or to arrest ovulation permanently, irradiation of the ovaries must be studied in animals, especially in monkeys."^[73] The BSH then offered Dickinson and the NCMH a matching grant for such research.^[74] After consulting with Hooker at Hopkins, Corner at Rochester, and Stockard at Cornell Medical School, the NCMH granted aid to Halsey J. Bagg and Harold Bailey for a project using monkeys, to be cosponsored by the Carnegie Institution of Washington.^[75] Dickinson's project was challenged by C. C. Little, president of the University of Michigan, and member of the board of Sanger's Clinical Research Bureau, who wrote to Sanger in 1925 that physicians were reckless in attempting x-ray-induced infertility (McCann 1994:85). Again, multiple positions were held within the scientific community.

By about 1930, investigations of radiation as a means of contraceptive sterilization began to disappear from the literature. One German physician opposed x-ray sterilization because she regarded the maintenance of the endocrine organs (ovaries) as essential for prevention of premature menopause (Sanger and Stone 1931:118).^[76] In Germany, one physician attempting to avoid the use of genocide as "the final solution" of "the Jewish problem" proposed covertly radiating all Jews and thereby sterilizing them (Proctor 1995). When the AMA's Council on Pharmacy and Chemistry began reporting on contraceptives in the late 1930s, it found that the use of x-rays for contraception was "of no value" (Reed 1983:245)—and highly carcinogenic and unreliable to boot.

Radiation sterilization initially offered a promising line of investigation to predominantly medical reproductive scientists, suitable both on scientific research grounds and as fundable work. Medical scientists thus found scientific contraception appropriate, regardless of the ultimate demise of this method. Investigating the consequences of radiation was also not viewed as, or at least was not transparent as, contraceptive research.

Promoting Immunologic Intervention: Spermatoxins.   In the search for scientific biological contraception, as opposed to simple and local chemical or mechanical means, reproductive scientists viewed immunology as a logical and exciting research path and sought means of immunizing women against pregnancy. The means of effecting immunity at that time was subcutaneous injection of the female with a serum or spermatoxin derived from fresh sperm of the same or different species. Mention was made of the possibilities of contraceptive autoimmunity in the male, but as in the lay and medical birth control movements, the focus was on female means of contraception (Sanger and Stone 1931:112–13). Biologists also found sperm research problems of classic physiological and morphological interest. Animal agricultural scientists were also interested in sperm studies, especially in relation to artificial insemination (Brackett, Seidel, and Seidel 1981). Both basic and clinical medical scientists found spermatoxin research problems attractive especially in relation to "classic" problems in immunology.

Initial work done in Germany at the turn of the century was continued in Germany (e.g., Ardelt 1931), and in the United States new work was begun by W. F. Guyer of the Department of Zoology at Wisconsin, who worked with rabbits and guinea pigs (Cooper 1928:115). The NCMH funded Guyer's endeavor,^[77] and he was soon joined by others such as J. L. McCartney (Cooper 1928:268) and M. J. Baskin (1934), who performed clinical trials calling the method "temporary sterilization." Biologist investigators were quickly followed into this line of work by medical scientists.^[78]

Because animal sperm were more available and hence more desirable for serum preparation, international debate focused on whether same-species sperm were requisite.^[79] Guyer, for example, worked with whale testes and sperm, plentiful if properly preserved. In 1929, Stewart Mudd, a microbiologist of the Phipps Institute at the University of Pennsylvania and an active birth control advocate, in research with Emily Mudd, a sociologist on the medical school faculty, found both species and tissue specificity in mammals. There was also debate about how and where in the reproductive system spermatoxins operated and concern about possible "side-effects."^[80]

As with some other methods of contraception, Soviet scientists were pioneers because of the legitimacy of birth control and hence of contraceptive research there: "To them it is a problem of scientific interest, worthy of the same amount of study as any other problem of scientific research, such as control of tuberculosis or cancer" (Daniels in Sanger and Stone 1931:109). By the mid-1920s, research on humans had begun: "The Russians feel that the use of spermatoxins has come out of the stage of pure theoretical research and has entered into the field of practical experimentation" (Stone in Sanger 1934:105–8). The Russians were certainly faster in moving from pure to applied contraceptive research, and American birth control advo-

cates were most interested. Marie Kopp, an American clinical and epidemiological birth control researcher, went to the Soviet Union in 1932 to gather information on birth control methods and report back to American colleagues (Kopp 1933).^[81]

Two aspects of spermatoxin contraception became especially attractive during the Great Depression: its simplicity and its low cost. "Think of how wonderful it would be if one could immunize a patient by simple hypodermic injection once every six months, just as we today immunize children against diphtheria. It will indeed be a new and wonderful era in the practice of preventive gynecology" (Daniels in Sanger and Stone 1931:111, emphasis added). The appeal of injectable hormonal means is clear here as well. Dr. McCartney commented: "Devices are all very nice for those who can afford them. The poor people with whom we are really concerned in this [Depression] recovery program cannot afford them. ... [I]t is quite necessary to be concerned with something that can be applied very much more cheaply. Spermatoxins ... are one of the methods" (Sanger 1934:111). Whether they actually would have been cheaper is debatable; they certainly would have been more easily controlled by physicians. Women here were configured as semiactive users because they would need to receive injections at regular intervals.

In the late 1930s, the NCMH again supported spermatoxin research through grants from Squibb and Sons. The scientists' conclusions were the (temporary) death knell of spermatoxin research: "When one compares ... the fertility of the injected animals with the controls, it appears that paraenteral injection of live sperm reduces slightly the fertility of the recipients, but the reduction is neither of significant degree nor of practical importance" (Eastman, Guttmacher, and Stewart 1939:151). While contraceptive application seemed futile, spermatoxin research had instigated considerable sperm research in humans. One product at the time was a much greater understanding of male infertility and sterility, issues of concern to the NCMH and other birth control organizations as they shifted from woman-controlled birth control to "family planning" approaches and included infertility research and treatment in their array of services (e.g., Reynolds and Macomber 1924; Weisman 1941).

Further, spermatoxin research had proved to be of considerable interest to biomedical scientists regardless of its association with birth control. Again, the appeal of research on scientific means of contraception to reproductive scientists was clearly demonstrated to birth control advocates during the 1930s. Since about 1967, there has been a renaissance of interest in what is now called "immunoreproduction," with considerable focus on finding a male means of spermatoxic contraception. This research initiative was led by Bulgarian scientists, echoing the Russian initiatives of half a century earlier.^[82] But it has also been sustained in the United States and else-

where (Mastroianni, Donaldson, and Kane 1990:33). However, national and transnational women's health groups have raised serious questions about the safety and efficacy of immunocontraception (e.g., Richter 1993). Their concerns center on the consequences of contraceptive-caused immunosuppression or immune system compromise, both because of the AIDS epidemic and for many women who are already malnourished. Other lines of current immunological contraceptive research continue to seek what, during the 1930s, Max Mason of the Rockefeller Foundation called "anti-hormones": vaccines to block hormones needed for very early pregnancy and a vaccine to block the hormone needed for the surface of the egg to function properly (Mastroianni, Donaldson, and Kane 1990:33; Alexander 1995).

Each of the four methods of contraception examined here involved different key actors and reproductive sciences worlds. Each addressed birth control advocates' goals in some way. Most were directed exclusively at women users, who were not included in the design stage but instead were positioned as implicated actors. None of these methods met the original desires of the early feminist lay birth control movement for safe and effective, simple means of contraception that would enhance women's autonomy. All met the goals of reproductive scientists to make contraception scientific.

The Quid Pro Quo

Through ongoing negotiations, heterogeneous birth control advocates and reproductive scientists arrived, between 1925 and 1945, at a congruence of interests that adequately met the changed needs of the major participants in the birth control arena. The quid pro quo achieved was based on changes, compromises, and trade-offs both within and among participating social worlds. Reproductive scientists had demonstrated that they would do "basic" research on problems related to "scientific" means of contraception and publishable in their "basic science" journals. In some such instances, they would even accept fiscal support from the birth control/population control movements, as some already did from pharmaceutical companies. In turn, birth control advocates had learned to cease demanding reproductive scientists' involvement in research on simple chemical and mechanical means of contraception (such as spermicides and diaphragms) and found other avenues through which such research could be pursued (such as academic chemistry and the pharmaceutical industry). This quid pro quo has been the fundamental basis for all subsequent relations over half a century.

But this accommodation and quid pro quo could only have been

achieved given the shifts within the lay, medical, and academic birth control movements between 1925 and 1945. The most pronounced shifts were from commitments to birth control as a means of enhancing reproductive and sexual autonomy for women to contraception within an economic ethic of childbearing—economic planning, eugenics, and population control, often with racialized agendas (e.g., McCann 1994). These shifts led many birth control advocates to seek modern "scientific" means of contraception that are "done to the people," relying for effectiveness more on biological and medical research and expert control than on the users' own motivation.

Reproductive scientists also underwent transformatory experiences during this period. In the development of this quid pro quo, reproductive scientists' struggles for professional legitimacy, autonomy, and cultural authority for their enterprise were central. That is, the driving force behind the development of "scientific" means of contraception was and remains reproductive scientists' desires for professional autonomy as "basic" scientists. As Borell put it, reproductive scientists continued to do their "pure" or "basic" research, but they also provided a social product—the technology of scientific biomedical contraception—that gave them greater social authority.^[83] In so doing, they both drew upon and further contributed to the cultural authority of science. Final development of means of contraception using that technology was to be left to the pharmaceutical industry and clinical practitioners (e.g., Segal 1987; Mastroianni, Donaldson, and Kane 1990).

The contraceptive Pill, based on decades of reproductive endocrinological and physiological research, and developed in marginal academic and commercial institutions, is the strongest demonstration of this process. Academic reproductive scientists did the bulk of the "basic" work, leaving it to lapsed scholars in quasi-industrial settings to push and polish it into a final product, with support from only two pharmaceutical companies from the established industry and a couple of new companies founded by other renegade scholars. The fiscal support provided by the birth control and population control movements from the 1930s to the 1950s was still too low to stimulate deeper involvement of reproductive scientists (Greep, Koblinsky, and Jaffe 1976). Moreover, contraceptive research still bore the stigma of illegitimacy. The clinical trials of the Pill, done almost exclusively on women of color in the Third World/Southern Hemisphere countries, were also problematic.^[84]

The problem of the illegitimacy of birth control was alleviated by the coalescence of the various birth control movements into a legitimate, middle-class, professional, international family planning and population control establishment between about 1940 and 1965. This establishment

was deeply linked with the reproductive sciences, sharing quite porous boundaries. As late as 1959, the Ladies' Home Journal would not address modern birth control in its regular medical column (Meldrum 1996). But by the 1960s, the publicity achieved by the population establishment claiming a "population explosion" in the Third World was sufficient to trigger the federal government's involvement in both contraceptive development and distribution. As Reed (1983:373) observed, "Social order everywhere suddenly seemed threatened by human fertility."^[85] The National Academy of Sciences Committee on Science and Public Policy selected population problems as its focus in 1961 (National Academy of Sciences 1979:v). Most reproductive scientists agreed with these arguments (e.g., Pincus 1965; Djerassi 1981), including proposals for more integrated approaches such as Shelesnyak's (1963a,b) call for "biodynamics" as a new interdisciplinary frame for the study of reproductive phenomena and fertility control in all their complexity. During these years and after, reproductive scientists were drawn ever more deeply into public- and foundation-funded research that addressed "population problems"—basic research yielding clear and high contraceptive payoffs. But their involvement was very much on the terms of the quid pro quo negotiated with birth control advocates before World War II.^[86] The arguments for basic research made by reproductive scientists enhanced the legitimacy, autonomy, and social and scientific authority of the enterprise. The culture of science predominated, and women were by far the most commonly configured users.

Both federal policy and public opinion on contraception also changed dramatically between 1945 and 1970. In 1942, after over a quarter century of agitation by the lay birth control movements and their establishment of 803 birth control clinics throughout the country as their major form of activism, the U.S. Public Health Service ruled that federal funds allocated for local health services could be used for family planning in the states (Ray and Gosling 1984–85:404). By 1963, however, only fifteen state health departments offered such services (Reed 1983:268). In 1959, President Dwight Eisenhower responded to a question about foreign aid for contraception by stating: "I cannot imagine anything more emphatically a subject that is not a proper political or governmental activity or function or responsibility. ... This government will not, as long as I am here, have a positive political doctrine in its program that has to do with the problem of birth control. That's not our business." Four years later, during the administration of the first Catholic president, Democrat John F. Kennedy, Republican Eisenhower dramatically changed his mind. He then wrote in the Saturday Evening Post that population growth posed a threat to world peace and that birth control was a legitimate concern of government (Reed 1984–85:383).

After Kennedy's assassination, the Johnson administration provided an

array of family planning services nationally and transnationally through many legislative acts. The Fulbright amendment to the foreign aid bill, signed in December 1963, authorized programs in population research and technical assistance. Special recognition of American family planning needs began in 1967, and in 1969 the National Center for Family Planning Services was established in the Department of Health, Education, and Welfare. The Family Planning Act of 1970, under President Nixon, expanded services and federal funding, which totaled over $68 million in 1971 and $336 million in 1987 (Davis 1991:386–87, 398). Extensive research, transnational distribution, and technical support for family planning services has been provided by the U.S. Agency for International Development and other organizations. In short, the United States became the dominant transnational distributor of the means of control over reproduction. By the late 1960s, thirteen pharmaceutical companies were involved in contraceptive research and development (Djerassi 1992:119). The "Contraceptive Revolution" (Westoff and Ryder 1977) took place in the 1960s and 1970s as the direct result of the negotiation of the quid pro quo between birth control advocates and reproductive scientists. Its impacts have been and continue to be global.

Feminist voices, so strong at the beginning of the century in the formation of lay birth control movements, were co-opted and silenced in the shift from birth control to family planning and population control by the end of the Great Depression (McCann 1994:chapters 5–6). Ironically, they reappeared in new forms in the 1970s at the height of population control efforts. National and transnational women's health movements have formulated multiple, divergent critiques of the contraceptive revolution, and such groups are now participating in many of the venues where family planning and population concerns are translated into health care policy and foreign policy.^[87] Further, over eighty years since Margaret Sanger's first appeal, demands for more and better simple means of contraception are still heard, along with detailed explication of concerns with safety, such as the following, derived from the 1994 Cairo Conference Organizing Committee (Organizing Committee 1994:6):

Item 13. In the area of contraceptive technology, resources should be redirected from provider-controlled and potentially high-risk methods, like the vaccine, to barrier methods. A significant proportion of the participants also felt strongly that Norplant or other long-term hormonal contraceptives should be explicitly mentioned as high-risk methods from which resources should be redirected. Female controlled methods that provide both contraception and protection from sexually transmitted diseases, including HIV, as well as male methods, should receive highest priority in contraceptive research and development. Women's organizations are entitled to indepen-

dently monitor contraceptive trials and ensure women's free, informed consent to enter the trial. Trial results must be available for women's organizations at the different stages of such trials, including the very early stages.

Equally significant, in the United States and abroad, women have voted with their feet, resisting and rejecting means of contraception that do not meet their needs. Many feminists tacitly or explicitly draw on the "three contraceptive axioms" specified by Dr. Mary Calderone (1964:153) when she was medical director of Planned Parenthood—World Population:

Partly because of such feminist interventions, there has been a shift away from the modernist, standardized "one-size-fits-all" approach so deeply embedded in the search for scientific contraception described in this chapter. The shift is to a more postmodern, economic, and individualized nicheoriented "cafeteria approach" offering an array of means of contraception, ideally suited to the highly varied health care and living situations of prospective users—men as well as women—and accommodating changing reproductive needs and goals across the life course. However, the modernist "one-size-fits-all" pattern remains dominant in many Southern Hemisphere countries, while the postmodern "cafeteria" is available primarily in the Northern Hemisphere (Oudshoorn 1995, 1996a).

Conclusions

The arenas concerned with human reproduction changed between 1925 and 1945 in ways that ultimately allowed the quid pro quo to develop. One shift was from progressive reform to conservative control—from birth control as a means of individual self-determination, especially for women, to family planning and population control. There was also a shift from an individual choice to a social control agenda, and shifts of focus from concerns about qualities of individuals to quantities of populations, and from user control of simple means of contraception to professional control over scientific means of contraception, from means "people do for themselves" to means "done to the people." The rationalized family could be achieved via modernist control over reproduction, biologically based social engineering that allowed scientific management and planning to be applied in the supposedly private domain of reproduction—the bedroom.^[88]

This chapter illustrates the utility of a social worlds and arenas approach

in technoscience studies. Scientific enterprises such as the reproductive sciences are especially in need of individual case studies and comparative analyses that examine their embeddedness in specific market and resource networks. Multiple nonmonolithic social worlds were engaged in the birth control arena at the turn of the century, and others were reluctantly enrolled. That is, reproductive scientists who by and large did not want to do contraceptive research could not avoid participating directly or indirectly in the birth control arena. We can see them as reluctant actors, coerced or seduced by funding and their own dreams for the larger enterprise.

I examined the earliest moments in the making of two successful technologies of modern scientific contraception—the Pill and the IUD—analyzing the interests and commitments built into the actual design of these technologies by examining the engaged social worlds, their perspectives and commitments. Failed approaches, specifically immunotoxins and sterilization by radiation, were also discussed. Women were the targeted/implicated users (Clarke and Montini 1993) but were excluded from direct participation, then as now. Most users were configured (Woolgar 1991) as women, and they were reconfigured from Sanger's goal of women as autonomous sexual beings to people something should "be done to." Both the Pill and the IUD were intended as what Oudshoorn (1995, 1996a) has called universal, "one-size-fits-all" technologies. Latour's (1987, 1991) notions that technology is society made durable and that scientists should be seen as in the driver's seat are clearly upheld in the case of the reproductive sciences and contraceptive technologies.

Contraceptives are what Foucault termed "disciplinary technologies" (Rabinow 1984:17), part of the "socialization of reproductive behavior" that can discipline such behavior in multiple ways. But, simultaneously, contraceptives can be means of liberation, offering strategies of resistance against related disciplines of gender as well as race, class, and global position. Many contradictions are carried on the n-way webs of relations along which both simple and scientific means of contraception travel. As feminist women's health advocates have learned, especially but not only through the transnationalization of their movements, the heterogeneity of women's situations must be of paramount concern. This heterogeneity requires that women and men have access to a diversity of means of control over reproduction. Current feminist goals call for active user participation in design and in all subsequent stages. Further, the calculus of risks and benefits for each method must take diversities of women's health care, cultural, and economic situations into account. This would, of course, change the reproductive arena considerably.

Hard (1993) has argued for a more explicitly and vividly conflictful social constructionism as not only possible but also likely to be found in empirical research, along with issues of power, stratification, and hierarchy.

Drawing upon social worlds analysis, the story of the emergence of modern scientific contraception told here meets these criteria. The reproductive arena was conflictful when it emerged, it remains conflictful today, and closure is not in sight. It is a modernist technoscience story of hierarchies, gender, and power that has now segued into the postmodern era and is still unfolding. But the quid pro quo constructed between reproductive scientists and birth control advocates of multiple kinds remains the foundational moment that still must be addressed.