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.