Margaret Sanger, "Birth Control--Ten Eventful Years," 30 July 1946.

Source: "Margaret Sanger Papers, Sophia Smith Collection Margaret Sanger Microfilm, Smith College Collections S72:501."

No published version found; for another version, see Margaret Sanger Microfilm, Smith College Collections S72:517.


Birth Control--Ten Eventful Years

Ten years ago, a colorful chapter in the saga of birth control had reached its climax and another was beginning. In 1936, in a far-reaching decision, the Federal courts lifted a Victorian ban which for sixty-three years had prevented physicians from freely exchanging information and materials for the control of human fertility. The decade following this decision was to mark attainment of maturity for the birth control movement, following its early history of perennial court battles, office raids and public controversy.

In the professions and among the public, fertility control won majority acceptance as a normal part of health education and preventive medicine. The term "planned parenthood" came into being as the description of a program which includes not only birth control but also includes aid to childless couples and education for marriage. The use of birth control for healthful spacing of births won inclusion in maternal care programs of seven states. And at the close of the decade control of human fertility was receiving approbation and support as a world need in the manner which Margaret Sanger, founder of the birth control movement in the United States had first seen it a quarter of a century before in relation to ill health, mortality, poverty, population pressures and cause of war.

Following clarification of the legal status of birth control in 1936, the inclusion of fertility control in public health programs throughout the country became a major objective of the birth control movement. For the better accomplishment of this purpose two organizations, the American Birth Control League and the Birth Control Clinical Research Bureau, were merged into one organization in 1938. One result of this merger was to eliminate duplication of effort and to permit presentation to the public of a comprehensive and practical program of education and action under the leadership of one strong national organization--the Birth Control Federation of America. A few years after the merger, in order to emphasize the positive character of the organization, the name of the national organization was changed to the Planned Parenthood Federation of America, Inc.

The Planned Parenthood Federation today is the national agency and clearing house for thirty-five state leagues and more than three hundred local committees affiliated with the national organization. The local committees carry the burden of operating privately supported clinics for parents unable to afford the services of private physicians. Since 1938, the time of the merger, the number of planned parenthood centers (including private, public health and hospital clinics) has grown from 489 to nearly 600.

The number of clinical services, however, do not indicate the phenomenal growth of public acceptance and use of birth control. For while the clinics perform a necessary and still expanding service, many millions of parents now find it possible to obtain advice and help in planning their families through the services of physicians in private practice or through commercially distributed contraceptives. Increasingly, too, other professional workers serving the family--nurses, clergymen, social workers, educators--have demonstrated acceptance by advising and counseling parents in the non-medical aspects of planned parenthood as an integral part of their services. Largely through this means the ignorance and prejudice once surrounding control of human reproduction have been vastly dissipated within the last decade.

PUBLIC OPINION.

There are still an estimated 6,000,000 married couples in the nation unreached by even the most elementary knowledge of fertility control. At the same time, public opinion polls during the last decade have repeatedly demonstrated the development in public acceptance of birth control as a health and social measure. These polls have been weather vanes indicating the prevailing winds of thought in relation to the control of human fertility.

In 1938 the Ladies Home Journal, reaching homes in every state, found in a survey that seventy-nine per cent of American women favored birth control. A Fortune Magazine poll in 1938 estimated that sales of contraceptives then totaled close to $250,000,000--a figure which undoubtedly increased appreciably in subsequent years. A nation-wide Gallup poll in 1940 among both men and women revealed that seventy-seven percent of those questioned favored furnishing birth control information through government health centers. In 1943, 84.9 per cent of women, answering a second Fortune poll, declared themselves in favor of making knowledge of birth control available to all married women.

Even in Massachusetts and Connecticut, the only two states still forbidding physicians from giving birth control information for any cause whatever opinion polls show the views of the public in sharp contradiction to the repressive legal barriers in those states.

MEDICAL and PUBLIC HEALTH ACCEPTANCE.

Striking evidence of the progress of the planned parenthood movement is found in the sanction it has received from the medical profession in the last decade. From the few doughty and far-seeing physicians who thirty years ago were willing to support contraception control as a necessary health and social measure, the picture has been almost completely revised so that only a small majority of physicians still refuse to make it part of their practice.

The most significant milestone in medical progress was passed in 1937. The American Medical Association adopted a report of its "Committee to Study Contraceptive Practices and Allied Problems", thus accepting birth control as an integral part of medical practice. From then on, advance along the road to medical recognition came quickly. The following year, 332 physicians of the National Medical Council, including the president, presented a signed document at a conference held by the Children's Bureau in Washington, asking that contraceptive information be included in all obstetrical, maternal and post-natal clinics as a means of reducing infant and maternal mortality.

Shortly thereafter, the Journal of the American Medical Association for the first time published a series of articles giving approved standards of contraceptive techniques and a list of reliable products. This medical triumph was immediately succeeded by another when the first scientific treatment of the subject of conception and birth control appeared in the Cyclopedia of Medicine and Surgery. Over a decade discussion of various phases of conception control have appeared in medical journals with increasing frequency. Most recently a study made by the Medical Committee of the Planned Parenthood Federation showed that of the 3,381 physicians, obstetricians and gynecologists answering a questionnaire, 96 per cent declared their approval of conception control when medically indicated; that 88 per cent approved of it for spacing births; and 77 percent believed it should be furnished to any married woman on request.

Perhaps the most straight forward recognition of birth control by the medical profession was given at a dinner during the Federation's Annual Meeting in 1943 when a committee of forty-five outstanding New York doctors, headed by Dr. William W. Herrick, President of the New York Academy of Medicine, sponsored by a Physicians Dinner to discuss the subject, "Responsibility for the Health of Tomorrow's Family." Nationally known leaders in the fields of obstetrics, gynecology, psychology, psychiatry and public health took part in the discussion.

With the rapid growth of medical acceptance of birth control as a health measure, and the growing interest of the public in family planning, effective steps have been taken to provide educational facilities for Doctors in the techniques of conception control. To medical meetings have gone exhibits, films and technical manuals. Textbooks and pamphlets have had nation-wide circulation among physicians and medical students. Increasing interest by nurses, health officers and social workers in planned parenthood resulted in the circulation of voluminous amounts of technical literature. "The Technique of Conception Control", published in 1933, has gone through a half-dozen editions and has become a text book in senior medical classes. Requests for copies come from Navy, Army and Marine Hospitals and translations have been made into Spanish and Hebrew. In 1942, more than half of the Grade A medical schools were reported giving students some teaching in contraceptive technique.

Expert testimony as to the advantage of spacing children was the study of 7,000,000 births and stillbirths made by Dr. Jacob Yerushalmy. This study indicated that mothers could lower the chance of still birth in their babies were born neither too close nor too far apart. His findings supported the long-standing contention of medical authorities that child-spacing is a maternal health measure.

In the annual report of the New York Academy of Medicine for 1945, the Committee on Public Health restated an opinion it had first expressed in 1931: that "the public is entitled to expect counsel and information concerning contraception, given by competent physicians." Finding from a survey of 89 hospitals in Greater New York, that only five had special contraceptive service in their gynecologic departments, the Committee recommended strongly that "Child spacing should be recognized as a medical indication and that contraceptive advice should be given by well-trained physicians, both in their offices and in hospitals clinics."

LEGAL ACCEPTANCE.

Legal obstructions which for more than a half century hampered the democratization of birth control knowledge in the United States have all but been swept away in the past ten years. Epochal was the decision in the United States Circuit Court in 1936 (U.S. versus one Package) that contraceptives imported for legal purposes did not come within the restrictions of the Federal Statutes as these were articles employed by conscientious and competent physicians "for the purpose of saving life or promoting the well-being of their patients." Similar decisions were thereafter won in the Canadian courts, the judge ruling that birth control information was "for the public good." And in Puerto Rico, the United States District Judge ruled in favor of a defendant, declaring that "contraceptive articles may have a lawful use."

The United States Treasury, recognizing the humane character of the birth control movement, declared the American Birth Control League a philanthropy and therefore tax free; that gifts and bequests were deductible from tax returns. Furthermore, cooperation with the Federal Trade Commission resulted in halting advertisements of fraudulent and dangerous drugs.

Significant of the trend of modern legal opinion are recent decisions on the question of the right of birth control literature to the use of the mails. By a decision of the United States Court of Appeals, the Consumer's Union won the right to recommend approved contraceptives to married women. A similar decision was won after the pamphlet, "Preparing for Marriage" by Paul Popenoe, a recognized authority, had been barred from the mails. Neither case, said the court, came under the Comstock obscenity law as charged by the Post Office authorities.

Implicit in all the Federal decisions that have been won in these ten eventful years, is the recognition of birth control as a health service, having medical and social sanctions.

Two adverse decisions in state courts prove temporary setbacks. Temporary because they do not reflect public sentiment and because they are anachronisms in a democracy. In Massachusetts the Supreme Court ruled that the State's proscriptive law on birth control was constitutional and with no exceptions for physicians. Immediately a Committee for Defense of Medical Right was formed, among whom were leaders in medicine, public health, religion, education, business. In 1944, a referendum to repeal the law lost by a close vote, although public opinion polls a few weeks before the election had indicated a majority of voters in favor.

In Connecticut, the State Supreme Court of Errors likewise upheld an antiquated statute retained through religious and political pressure, making it illegal for physicians to prescribe contraceptives or for individuals to use them. This ruling was appealed to the United States Supreme Court which, on the basis of a technicality, declined to review the decision of the lower courts.

Efforts are continuing among citizens' groups to turn the clock forward in Massachusetts and Connecticut in line with the liberalization of legal restrictions on birth control everywhere else in the nation.

RELIGIOUS ATTITUDES.

Marked has been the increased interest and growing support of Planned Parenthood on the part of the Protestant and Jewish clergy. During the late 30's many of the leading Protestant and Jewish denominations took positive positions favorable to birth control. More recently, concerned with juvenile delinquency which begins with unwanted and rejected children, with an all-time high divorce rate, with the number of illegal abortions which are estimated as high as one to every three births, with the vast number of army rejections for mental or physical ill-health, clergymen of the country have come to recognize that planned parenthood fosters both responsible parenthood and the birth healthy, wanted children--a quality population. In increasing numbers clergymen have extended their ministry to include marriage counseling, providing instruction for modern young men and women as to the spiritual significance of marriage, of the importance of good sexual relationship and harmonious family life.

Responsive to this awakening, a National Clergymen's Advisory Council of more than one thousand leaders was organized in 1944, and planned parenthood leagues in fifteen states formed state advisory councils to cooperate with the National organization. The National Council was responsible for distributing thousands of copies of the manual, "Marriage Counsel in Relation to Planned Parenthood," among clergy and lay counselors of many denominations.

The most consistent opposition to the birth control methods prescribed by most doctors has come from the Roman Catholic Church. However, in 1937 that church gave its "ecclesiastical approbation" to "The Rhythm", a now widely distributed book by Dr. Leo J. Latz, offering a "natural" method of birth control. To many the difference between Catholic and non-Catholic opinion on birth control now appears to center on method rather than on principle.

Youth itself, during the past dynamic years when the salvation of the world from tyranny rested on young shoulders, demanded scientific information upon the facts of sex. Many High Schools and Universities, Y.M. and Y.W.C.A.s, Public Hygiene service in Army and Navy have responded to this challenge. The decade has witnessed the subject of sex, marriage and birth control emerge from whispers to serious, scientific, open discussion among America's future parents.

MINORITY GROUPS.

During this past decade the greatest need for birth control information has been most apparent among the less privileged minority groups. This has been particularly true of the negro population in as much as twice as many negro mothers die in childbirth as do white mothers; twice as many babies die at birth as do white babies. Parallel to other efforts to better the economic, health and social lot of the negro, in 1939 a duel program of birth control service and education was initiated; demonstration areas in the south were established and a National Negro Advisory Council organized. From that date on educational and clinical services have met increasing cooperation. Effort has been made to reach even the most limited in opportunity.

In 1944 a bi-racial committee on work with Negroes was appointed, a full-time Negro worker added to the National Planned Parenthood staff and later a full-time field consultant. Conferences, meetings, institutes have part of an extensive and successful educational program. Over a period of a few years strong support has come from the National Medical Association, the National Council of Negro Women, The Negro Newspaper Association, Jeannes teachers, public health educators, the Y.M. and Y.W.C.A. staffs, the National Urban League and the . In twenty-four Negro colleges and professional schools, interpretative programs have been given, clinics in congested Negro districts opened and Negro doctors added to the list of Planned Parenthood referral physicians.

The condition of the migrant labor, particularly in the years before World War II and during the depression, brought poignantly to the attention of the American people the plight of the migrant workers. With thousands of families uprooted, homeless, camping on roadsides, the future uncertain, insecure, the immediate need for birth control knowledge and service was obvious. Children were being born in wayside camps, mothers unattended. Death rates among both mothers and babies were phenomenally high. With the cooperation of official agencies and camp public nurses, birth control service was brought to many migrant camps and remote rural communities. In one year, 1938, more than 20,000 women had been reached through this special effort.

THE WAR YEARS.

Out of 22,000,000 young men in the Selective Service, 8,000,000 were found unfit to fight. Commenting thereon, the Medical Division of Selective Service said, "many of the defects which have resulted in the rejection stem from the fact that they are the children of parents who were unfit for reproduction." Leaders concerned with maternal health, aware of war marriages hastily contracted, of long separations, of the mass recruiting of women into industry, of congestion in industrial centers, stressed the importance of planned parenthood to the well-being of children born in this period.

With millions of new women workers taking jobs on factory production lines, old patterns were broken as women left their homes and migrated to industrial centers. Under abnormal war-time conditions illegal abortion became commonplace in factory centers. To meet this menace to the health of their workers, certain industrialists introduced maternal care programs which included planned parenthood information and service. In so doing they were supported by the Industrial Hygiene Division of the United States Health Service which recommended child spacing for married women in industry as part of maternal health program.

As the war came to a close, planned parenthood organizations launched efforts to provide marital guidance to the returning soldier, who was confronted with the problem of finding a home for himself and young wife, of procuring a job and of adjusting himself psychologically to peacetime living. The Planned Parenthood Federation brought out two pamphlets to guide young husbands and wives. "The Solider Takes a Wife" had a circulation of tens of thousands among service men and women and was translated into brailled by the Library of Congress for the use of the Navy blind. And "Planning to Have a Baby", a pamphlet addressed to young wives, had instant acceptance and is widely used in college marriage courses and in Y.W.C.A.s.

INFERTILITY PROGRAMS.

In the last few years planned parenthood organizations have accepted aid to childless couples as a basic element of their program. In as much as one married couple out of ten is involuntarily sterile, the demand for medical fertility specialists in this field has increased yearly. Scores of letters ask for the names of such specialists. More than 23,000 copies of the Planned Parenthood Federation's pamphlet, "To Those Denied a Child" were circulated in the first year following publication.

Unfortunately, extension of both infertility research and services was severely hampered during the war years. At the present time there are only forty-seven established clinics where childless couples can obtain treatment. The number of private specialists is also limited, although fresh emphasis on teaching in medical schools on this subject can be effective. Most of the existing infertility services are now located in medical schools and hospitals, and a few in regular planned parenthood centers. Indicative of planned parenthood interest, was a grant of $2500 by the Connecticut League in 1946 for infertility research at Yale University.

CLINIC SERVICES.

One ultimate goal of the planned parenthood movement was reached during the past decade in seven states. In 1937 North Carolina became the first State to make child-spacing an integral part of its program for maternal care. South Carolina followed in 1938. Five other states have since included planned parenthood in their state health programs: Alabama, Florida, Texas, Mississippi and Virginia. Meantime medical interpretation of birth control as a health measure has been vigorously carried on in a number of other states to encourage acceptance of child-spacing in their public health services.

In 1941, the transition from the private clinic to state or county Departments of Health was facilitated by the action of the United States Public Health Service when it declared that should a State Department of Health decide on its own initiative to undertake a child spacing program, the Federal Public Health Service would give the proposal the same consideration given to any other state health measure. Still another important ruling was issued by the Commissioner of Health of New York City in 1944 whereby "upon request directional information may be given to any person asking for the location of a child-spacing service."

Throughout the decade which has included a great depression and a great war, 568 Planned Parenthood clinics have continued to serve thousands of patients, in hospitals, in public health centers and in their extra mural services. Hundreds of thousands of letters from parents have been answered, directing burdened mothers, hopeful brides or troubled fathers to physicians when no clinic was near.

The war interfered severely with clinical service, owing to shortages of professional personnel and the difficulty in getting medical equipment, yet the clinics, country over, carried on as the need for their services became ever greater.

The referral service of the Planned Parenthood Federation lists approximately 3,000 physicians to whom inquiries can be directed. In addition to these inquires are other thousands of inquiries from physicians, social workers, nurses, educators, ministers, professional workers desiring technical or specialized information.

An enormous amount of Planned Parenthood literature has been necessitated to meet the constantly growing demand for information on the planning of families. An ever broadening stream of technical material has poured steadily to State and Local groups, furnishing the tools for furthering local programs and procedures. In the later years of the decade, the literature has been directed mainly toward specialized groups rather than to the public on the profession at large. General acceptance of planned parenthood has called for constant interpretation, for more and more medical literature, for special studies of delinquency, of the emotional aspects of parenthood, of venereal disease as these social disorders relate to the need for birth control and early sex instruction.

PUBLIC INFORMATION.

By 1937, the taboo had already been lifted from the subject of birth control in a number of popular magazines. Each year their number has increased, reflecting the demand of the part of their readers for frank discussion of sex and health problems. From various angles magazines, their combined circulations reaching tens of millions, have discussed planned parenthood. From 1937 when Current History published "Birth Control's Big Year" until 1945 when Mrs. Franklin D. Roosevelt twice in the Ladies' Home Journal advocated the spacing of children in the interest of family well-being, magazines have given evidence of the ever growing interest in this subject.

Use of radio has also increased as a medium for public education. In 1942 the National Association of Broadcasters informed radio stations that there was nothing in its code which would bar a discussion of birth control from the air. The announcement was followed by a larger number of radio broadcasts of National conferences, forums and programs initiated by local groups.

INTERNATIONAL ASPECTS OF BIRTH CONTROL.

The problem of the control of fertility is not confined to our country alone but is a subject of global proportions; its solution of profound consequence to the human race. Moreover, demographers see in uncontrolled reproduction of human life as it exists in many countries a constant threat to the well-being and peace of the world.

To study this larger aspect of the birth control movement, Margaret Sanger, in 1922, made a trip around the world, noting that wherever there were over crowded populations, there was also abject poverty, vast hunger, disease, and high maternal and infant death rates. The discontent and hopelessness among teeming populations has frequently exploded into wars for the conquest of neighboring land or ampler resources when exploited by unscrupulous leadership.

This direct relationship of population pressures to war has been strikingly apparent in the immediate history of Germany, Italy and Japan whose leaders, in planning for world conquest, suppressed all birth control information and encouraged unlimited reproduction.

In our "one world", the problem of feeding famine stricken areas confronts the world. In countries like India, China, and nearer home, Puerto Rico hunger is constant and well-nigh universal. With resources utterly inadequate to feed vast and multiplying populations, the people live at or below subsistence level. Death rates for mothers and babies are high, the span of life is short. India presents a classic and appalling example of uncontrolled fertility. Where over a quarter of her children do not reach their second birthday and although 3,000,000 died in 1943 of starvation, her relentless birth-rate more than offset this repeating catastrophe.

With these situations in mind, birth control and its relation of world health and security became a subject for thoughtful consideration by the United Nations.

At the International Health Conference of the United Nations, presided over by Dr. Thomas Parran of the United States Public Health Service, the subject was introduced by Dr. Djamil Pasha Tutunji, health director of Transjordania. Dr. Tutunja declared that birth control is as important as control of the atom bomb. He warned the conference that the population at the present rate of growth will be too large within 100 years unless something is done about it. He urged the conference to support birth control as the first means of stopping wars.

And thus the subject of birth control, thirty years ago but a whisper, is beginning to be heard, like the world democracy, around the world.


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Copyright, Margaret Sanger Project


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