Margaret Sanger, "At Long Last," 6 Jul 1937.

Source: " New Masses, July 6, 1937, pp. 19-20 Margaret Sanger Microfilm, Smith College Collections S71:948."

A subtitle added by the editor reads: " A veteran crusader for birth control reflects on the campaign in terms of the medical association's action .

At Long Last

By Margaret Sanger

The action of the American Medical Association in adopting the report of its committee to study contraceptive practices opens the door to a new epoch in preventive medicine. It marks the close of a twenty-year struggle for medical recognition of birth control as a legitimate practice.

On the one hand I am filled with joy and gratitude that the policy underlying a program which I saw so clearly after my return from Holland in 1916 has been justified. Birth control, or "neo-malthusianism" as it was cumbersomely called, was more a philosophical concept, a theoretical idea, than a practical matter. It was primarily an issue of free speech and free press. I saw, however, soon after I became convinced of the fundamental importance of the movement, that it must be considered as a medical and technical problem if it was to serve as an instrument for woman's freedom. This conviction was due in large part to my education as a trained nurse, in part to what I learned in the clinics of Holland, and from such men as Havelock Ellis.

From the day I opened America's first birth control clinic in Brownsville (New York City) in 1916 to the present time I have stood for medically directed clinics, for the principle of birth control as a necessary part of medical practice, and for recognition of this by the medical profession as a whole.

The student of public opinion will find much to intrigue him in a study of the gradual build-up which led this year to the court decision firmly establishing the legality of birth control, and in its medical recognition by the American Medical Association.

Fears and taboos, inertia and bigotry, ignorance and dogma blocked the path. One by one these barriers have been cleared away. Support from individual physicians with vision and courage came first. Support from leading religious denominations soon followed. Even the Catholic Church, previously the outstanding enemy of birth control, was forced to recognize the need for family limitation when it sponsored the rhythm, or so-called safe period, method. Dr. Leo Latz's book, The Rhythm, which carries on its fly-leaf the phrase "Published With Ecclesiastical Approbation," gives reasons for family limitation which agree point for point with those advocated in birth-control literature. The Catholic Church has wriggled out of its absurd and inconsistent position by conceding the truth of the principles of birth control, but it differs on methods.

Gradually more and more medical schools included instruction on contraceptives in their curricula, and articles on the subject both in medical and lay magazines increased in number and improved in quality year by year. The demonstration clinic in Brownsville was closed as a "public nuisance," but the gesture served its purpose; in the test case arising from that step the courts ruled that physicians were permitted to give birth-control instructions "for the cure and prevention of disease."

Thus a group of judges admitted twenty years ago that birth control was a medical problem, which affected health and was part of preventive medicine. A broad interpretation of the word "disease" opened the way for giving birth-control instruction for economic as well as health reasons.

The history of birth control clinical service, which stemmed from this decision, is another story. But all progress and activity in this field has had a bearing on the victories of today. On the strength of the interpretation of the New York state law rendered by the courts, I founded the Birth Control Clinical Research Bureau in 1923. It has been serving the women of New York and vicinity ever since. It has, to date, advised more than 58,000 patients. From this one clinic the movement has grown to 350 clinics scattered all over the country, all medically directed, all keeping scientific records, and functioning under medical advisory boards composed of leading physicians in their respective communities.

Meanwhile evidence as to the medical necessity for birth control was piling up. Studies carried out by the U.S. Children's Bureau proved the necessity of planning and spacing families. The inquiry into the causes of infant and maternal mortality stressed the inescapable relationship between infant deaths and children born too close together. It showed the correlation between the age of the mother and maternal deaths, and the effect of financial ability to provide proper maternal and infant care upon the chance of survival for both mother and child.

Medical evidence as to conditions when pregnancies should be avoided or postponed was finding its way into medical journals. The obvious truth that birth control--the prevention of conception--is far preferable to abortion--that is, termination of pregnancy after conception has taken place--was increasingly emphasized.

This demand of medical recognition grew. Outstanding among physicians who courageously advocated birth control as a medical necessity was Dr. Robert L. Dickinson of the National Committee on Maternal Health. Ever a fearless crusader, he fought against the taboos and inhibitions which made the medical profession ignore the whole field of sex. Dr. Prentiss Willson of Washington, D.C., was moved to action by the testimony presented at our Congressional hearings on a birth control bill to amend the obsolete Comstock statutes. Feeling that physicians were letting the lay public fight the battles they themselves should wage, he organized the National Medical Committee on State and Federal Birth Control Legislation. The support of individual doctors developed into support, formally taken through resolutions, or organized groups, of local, county, and state medical societies, and of national medical organizations.

The wonder, in retrospect, is that the American Medical Association's action was so long delayed. For while the doctors were delaying, while questions of expediency and politics delayed their action, women and babies were dying needlessly. One-fourth of all maternal deaths in this country are caused by abortions. And abortions occur, for the most part, among married women with several children, who take this tragic and desperate means of preventing the birth of another child they cannot provide for. Birth control would have saved their lives. It would also have saved the lives of countless infants who died because their mothers were too depleted in health to give them a fair start in life.

In 1924 Dr. William Allen Pusey advocated birth control in his presidential address before the annual convention of the American Medical Association. The following year the section on obstetrics, gynecology, and abdominal surgery of the Association passed a resolution favoring "the alteration of existing laws, wherever necessary, so that physicians may legally give contraceptive information to their patients in the regular course of practice." But there, as far as the Association was concerned, the matter rested for eight years.

It took three years, from 1932 to 1935, for the Association to appoint a committee to study the subject. Its first report a year ago was marked by timidity, confusion of thought, and an unwillingness to consider the problem in the only way physicians should consider it, as a medical issue.

Its second report, adopted in Atlantic City on June 8, 1937, brings the story, finally, to a "happy ending." Birth control was recognized, at long last, by the medical profession as a whole. The report recommends: (1) that the American Medical Association take such action as may be necessary to make clear to physicians their legal rights in relation to the use of contraceptives; (2) that the Association undertake the investigation of materials, devices and methods; (3) that through instruction with respect to the various factors pertaining to fertility and sterility, be promoted in medical schools.

Thus the Association has sanctioned the legality of birth control, medical control of methods and materials, and medical education.

The full report and further findings on the subject are to be printed in the Journal of the Association, thus making them accessible to all physicians, and, indeed, to any interested member of the general public.

"Information concerning contraception," says the report, "is admittedly available to persons in favorable economic circumstances." This has been my contention for years. Women who have the fee to pay private physicians can and do secure contraceptive advice. But the thousands upon thousands of women whose only contact with physicians is through free clinics have been denied it. The 350 clinics of which I spoke are doing yeoman's service, but they cannot begin to take care of all who should have their help.

But the future is bright. Nothing now prevents public-health organizations from giving birth-control advice to those who need it. Poor parents, as well as rich, can now secure instruction on how to plan their families and space their children. They need no longer be forced through ignorance to have children they cannot afford to rear adequately. And women need no longer be at the mercy of blind chance, helpless victims forced to undertake motherhood when they are physically unfit.

I place all these much to be desired conditions in the present, but my enthusiasm outruns the facts, I fear. This rosy picture still lies in the future. But it can and should exist, and we, the public, can make it come to pass. For birth control is today a part of human knowledge, which must not be denied to all who want it and need it.

The NEW MASSES--and the "old"--can proudly celebrate the 1937 birth-control victories, for through the long years they have given fearless support to the movement. In 1914, when I launched the first birth-control magazine in America, The Woman Rebel, the Masses said: "We must thank Margaret Sanger for speaking out clearly and quietly for popular education in the means of preventing conception. And if she goes to court in this fight,"--and I did go to court--"we must go too and stand behind her and make her martyrdom, if martyrdom it must be, the means of that very publicity she is fighting to win. There is no more important stand, and no stand that requires more bravery and purity of heart, than this one she is making."

The old Masses and the NEW MASSES have always seen clearly that legal obstruction and medical obscurantism is class injustice, that it denies to the poor what is the privilege of the rich.

The way is open today for justice in this field. For all parents knowledge which is their right and due, so that they may bring into the world only wanted children, with the heritage of sound bodies and sound minds.

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