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.