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Birth Control: An Historical Study (Part 1 of 2)
by Linda Gordon
Linda Gordon has been active in the socialist-feminist movement. She is an editor of Radical America and is presently teaching history at U Mass. Boston. In addition to her book on the history of the birth control movement, she is the author of America’s Working Women (1976).
This article is part one of a two-part article. Part two will appear in the next issue of Science for the People.
Birth control can have three major social purposes: to increase the individual freedom of women; to control overall population trends; and to improve and protect health. When the modern birth control movement began in the early 20th century, the first was its dominant motive. Organizations demanding the legalization of birth control were formed by feminists and other radical political activists concerned with women’s rights. The medical and population control motivations for supporting birth control came primarily from other sources which entered the birth control movement later but ended by dominating it.
Beginning in the 1920s birth control as a cause was taken over by male professionals, many of them physicians, in a “planned parenthood” campaign that made women’s equality and autonomy a secondary issue. In the 1970s a revived feminist movement reentered the birth control cause, mainly through campaigns for legal abortion. The existence once more of an approach to birth control primarily concerned with individual human rights has created an historical context in which it is appropriate to reexamine the historical legacies behind birth control.
In this article I argue that the influx of professionals into the cause changed the goals of the birth control movement, from a campaign to increase the area of self-determination for women and all working-class people to a campaign infused with elitist values and operated in an elitist manner. These professionals were mainly of two groups: doctors and eugenists. The latter group was not, of course, a professional occupation in itself, but was mainly composed of university professors and researchers. However, professional eugenics organizations brought them together and gave them a collective consciousness as strong as that among doctors. Despite important differences, the two groups had an ultimately similar influence on birth control.
The need to identify and analyze the influence of doctors and eugenists is not merely a question of setting the historical record straight. Their impact on birth control has left serious problems today for anyone concerned with that issue. The identification of the birth control movement with the demographic theories of the population controllers and the small-family ideal of white, prosperous Americans has created antagonism to birth control among many poor people, and especially the nonwhite poor, in the U.S.· and abroad. They often perceive population-control programs as coercive, imposing alien cultural values. That antagonism to birth control is sometimes associated with an antagonism to feminism, especially since feminism until recently has been primarily a movement of educated and prosperous women. I would argue, on the contrary, that birth control has failed to cross class lines because it has not been feminist enough. A feminist birth control movement would struggle to expand women’s options, to extend their right to choose, not to impose a certain economic or political theory upon them. In the first agitation for birth control, feminists argued for the legitimacy of having children, in or out of marriage, and for mothers’ and children’s rights to a decent standard of living, as well as for women’s rights not to have children.
The Birth Control Movement in the Early 20th Century
Nineteenth-century feminists had argued that involuntary child-bearing and child-rearing was an important cause of women’s subjugation. Their agitation for “voluntary motherhood,” beginning in the 1870s, was limited by the prudish sexual fears and moralities that pervaded capitalist society at that time. In the first decades of the 20th century a loosening in acceptable standards of sexual conduct, particularly in the cities, made public advocacy of mechanical contraceptive devices politically possible.
In 1915 the issue of birth control came out into public rather suddenly, as radicals like Emma Goldman and Margaret Sanger deliberately defied obscenity laws by distributing information on contraception. By late 1916 there was a nationwide campaign of agitation and direct action for birth control. By 1917 there were national and local organizations, run almost entirely by women, devoted to the legalization of contraception. Most of these groups considered themselves within the feminist tradition, concerned with women’s right to reproductive self-determination. In many instances these organizations were connected to the Socialist Party or to local socialist and anarchist groups.
Still, birth control did not immediately become respectable. Not only was it illegal, but its militant advocates were occasionally arrested on obscenity charges, though none were heavily sentenced. By the outbreak of the First World War Margaret Sanger had become the chief spokesperson for the cause. In her regular column in the New York Call, a Socialist Party paper, she began in 1911 to write about birth control, venereal disease, and other previously unmentionable topics. In 1914 she published seven issues of a revolutionary feminist paper, The Woman Rebel, which advocated birth control, printed the views of Emma Goldman, and attacked the suffrage movement for its irrelevance to working-class women. Sanger wrote that she saw birth control primarily as a means to alleviate the suffering of working-class and poor women from unwanted pregnancies, and in the long run she identified the demand for birth control as an important weapon in the class struggle.
Rejecting the path of lobbying and winning over influential people, Sanger chose direct action. In October 1916 she, her sister, and a few other women opened a birth control clinic in Brownsville, Brooklyn. She and her sister were arrested, and the publicity around their trial and imprisonment gave them a public platform from which to present their ideas. Largely through their influence, direct action became a part of the tactics of the large network of local birth control organizations that existed by 1917.
World War I, however, brought with it a sharp and effective attack on the American Left. One of the fatalities of the rightward political swing of this period was the feminist movement. Although the woman suffrage organizations went on to victory after the war, they lost their Left wing — those whose analysis of women’s oppression led them to demand social change more fundamental than extension of the franchise. In 1916 the birth control activists had been politically connected to the Left wing of the feminists and to pro-feminist groups of socialists and anarchists. When these political groupings were broken up, the birth control advocates — mostly educated women and some even upper-class — floundered politically. Losing confidence in the legitimacy of the rebellion of women of their own class, they fell back into an orientation as social workers. Their own class position often led them to isolate the birth control issue from other social and economic pressures working class people faced; this separation made their appeals unconvincing to the working-class women they hoped to win over. The continued existence of organized feminism might have reinforced their inclination to fight for themselves (as the abortion movement of the 1960s and 1970s has been powerful because it has been essentially a movement of women fighting in their own interests). Without it, the birth controllers remained social workers, with the tendency to think that they knew best what was good for their “clients.” Given this orientation, it was not unnatural that the birth controllers, despite their feminism, welcomed the aid of professional experts and, in many cases, sought them out.
Of those among the original birth controllers who resisted the rightward swing of the War and postwar era, many deserted the birth control movement. For most socialists, the War itself, and then the Russian Revolution and the defense of the American Left against repression, seemed the most pressing issues after 1918. They were able to change causes because most of them had seen birth control as a reform issue rather than a revolutionary demand, something requiring less than fundamental change in the society. Liberal reformers, however, did not share this view, and several groups of professionals perceived birth control as especially fundamental. Doctors saw it as a health measure, and increasingly a preventative health measure; and naturally doctors viewed human health as a fundamental, not a superficial, condition of social progress. Eugenists saw it as a race health measure; their hereditarian views led them to consider reproduction the fundamental condition of social progress.
The desire to make a contribution to civilization led many professionals to go beyond their places of employment to seek wider social influence. For many professionals, seeking political influence seemed a contribution, not an indulgence, because they believed society needed them. Especially in the early 20th century, many professionals believed that their superior intelligence and education entitled them to a larger share of political leadership than their numbers in the population would automatically create in a true democracy. Their view of democracy was meritocratic. Edward L. Thorndike, a eugenist educator, wrote in 1920: “The argument for democracy is not that it gives power to men without distinction, but that it gives greater freedom for ability and character to attain power!” Henry Goddard, who introduced the intelligence test in the United States, thought that democracy was “a method for arriving at a truly benevolent aristocracy.”
Professionals did not assume that their intellectual superiority came entirely from innate ability. On the contrary, they perceived that rigorous training in intellectual discipline, general knowledge and tested methodologies had given them skills unavailable to the masses. They did not see their monopolization of this expertise and knowledge as special privilege because they were committed to equal opportunity. They did not usually perceive the effective social and economic barriers that kept most people from these opportunities. But they never doubted that their expertise and knowledge were useful guides for social policy. They did not hesitate to build professional organizations, institutions, and programs of self-licensing which excluded others from their privileges and influence because they had confidence in the universality, objectivity, and social value of the expertise they possessed. Conscious, many of them, of having rejected aristocratic and plutocratic values, they did not think that their meritocratic values were antisocial or unjust. Their basic assumption was that greater intellectual ability, learned and innate, should be rewarded and entrusted with public power.
Despite their posture as reformers who sought changes for the benefit of the whole society, or for the less fortunate in it, in fact professional men brought to the birth control movement their own political beliefs and social needs. Molded by professional training and practice but also by class origin and individual experiences, these beliefs were by no means identical among professionals and even within one profession. But leading professionals shared a common set of values, with meritocracy at its root. The professionals of the 1920s believed that some individuals were more valuable to society than others. Whether environmentalists or hereditarians or both, they doubted that superior individuals were equally distributed within all classes and ethnic groups, and believed that scientific study could determine where talent was most likely to be born. Birth control appealed to them as a means of lowering birth rates selectively among those groups less likely to produce babies of great merit.
Most physicians remained opposed to contraception in the early 1920s. The predominant position among prestigious doctors was not merely disapproval, but revulsion so hysterical that it prevented them from accepting fact. George Kosmak, a prominent gynecologist, asked rhetorically: “Is this movement to be ascribed to an honest intent to better the world, is it another expression of the spread of feminist doctrines … or is it merely another instance of one of those hysterical waves with which our civilization is so frequently assailed?” The social values underlying Kosmak’s opposition were extremely conservative:
… fear of conception has been an important factor in the virtue of many unmarried girls, and … many boys are likewise kept straight by this means … the freedom with which this matter is now discussed … must have an unfortunate effect on the morals of our young people. It is particularly important… to keep such knowledge from our girls and boys, whose minds and bodies are not in a receptive frame for such information.
Running throughout Kosmak’s attack was an expression of strong elitism:
… those classes of our social system who are placed in a certain position by wealth or mental attainments, require for their upkeep and regeneration the influx of individuals from the strata which are ordinarily regarded as of a lower· plane … it is necessary for the general welfare and the maintenance of an economic balance that we have a class of the population that shall be characterized by “quantity” rather than by “quality.” In other words, we need the “hewers of wood and the drawers of water” and I can only repeat the question that I have already proposed to our good friends who believe in small families, that if the “quantity” factor in our population were diminished as the result of their efforts, would they be willing to perform certain laborious tasks themselves which they now relegate to their supposed inferiors? Might I ask whether the estimable lady who considered it an honor to be arrested as a martyr to the principles advocated by Mrs. Sanger, would be willing to dispose of her own garbage at the river front rather than have one of the “quantity” delegated to this task for her?
The sexual values that the anti-birth-control doctors cherished were not so different from 19th century conservative values: that the major function of women and sexual intercourse both was reproduction of the species; that the male sex drive is naturally greater than the female, an imbalance unfortunately but probably inevitably absorbed by prostitution; that female chastity is necessary to protect the family and its descent; and that female chastity must be enforced with severe social and legal sanctions, among which fear of pregnancy functioned effectively and naturally.
Toward Medical Birth Control
A significant minority of physicians, however, did not share these conservative values. Arguments for a higher valuation of human sexuality as an activity in itself, separate from reproduction, were expressed not only by radicals such as Dr. William Josephus Robinson but by liberal physicians as well in the early 1920s. A leading spokesman of this point of view among prestigious physicians was gynecologist Robert Latou Dickinson. He had applied his medical expertise to social problems for several decades already. He believed that mutual sexual satisfaction was essential to happy marriage. He shared the view of Kosmack and the anti-birth-controllers that doctors ought to assert moral leadership, but chose a more flexible approach. Dickinson encouraged his Ob-Gyn colleagues to take greater initiatives as marriage and sex counsellors. In his 1920 address as President of the American Gynecological Society he recommended that the group take an interest in sociological problems. He too disliked the radical and unscientific associations of the birth control movement. But unlike Kosmak he preferred to respond not by ignoring the movement but by taking it over, and he urged his colleagues to that strategy as early as 1916.
Sensitive to the difficulties of pulling his recalcitrant colleagues into a more liberal view of contraception, Dickinson began his campaign with a typical professional gambit. In 1923 he organized a medical group to study contraception, with the aim of producing the first scientific and objective evaluation of its effectiveness and safety. He consciously used anti-radicalism to win support for the plan. “May I ask you, … whether you will lend a hand toward removing the Birth Control Clinic from the propaganda influence of the American Birth Control League … , ” he wrote to a potential supporter in 1925. So firm was Dickinson’s insistence that the group would merely study, without preformed opinion, that he was able to get Kosmak himself to serve on the committee. He got financial support from wealthy Gertrude Minturn Pinchot and a qualified endorsement from the New York Obstetrical Society.
Dickinson did not merely use antiradicalism: it was in part his genuine purpose. His Committee on Maternal Health (CMH}, as his “study” project was called, was a reaction to Margaret Sanger’s efforts to open and maintain a birth control clinic. Sanger had insisted on considering social and economic problems as sufficient indications for prescribing contraception. Thus because of Sanger’s alternative, many doctors, while remaining suspicious of birth control, supported Dickinson’s endeavor as a lesser evil.
At first Dickinson’s group was hostile to the Sanger clinic. But several factors intervened to lessen this hostility and even bridge the gap between Sanger and the Committee on Maternal Health. One was the fact that the CMH clinic found it difficult to get enough patients while Sanger’s clinic was booming.
Another factor leading toward unity between the two clinics was Sanger’s conciliatory, even humble, attitude toward Dickinson and other influential doctors. The American Birth Control League (ABCL), which united some of the local birth control leagues into a national propaganda and lobbying staff organization, primarily under Sanger’s control throughout the 1920s, had been courting medical endorsement since its establishment in 1921. Sanger’s standard procedure in response to letters asking for information on contraceptives was to send the writer the names of nearby sympathetic doctors. In response to criticism of her clinic from the Dickinson group in 1925 Sanger, avoiding any defensive reaction, asked the Committee on Maternal Health to take over and run the clinic, hoping in return to be able to get licensing from the New York State Board of Charities. Dickinson demanded in return the removal of all propagandistic literature and posters, to which Sanger agreed. The scheme failed anyway, because Sanger’s radical reputation and opposition from the Catholic Church led the State Board to refuse a license. Dickinson, on the other hand, made his professional influence clear and useful to Sanger by procuring for her a $10,000 grant from the Rockefeller-backed Bureau of Social Hygiene.
Undoubtedly the largest single factor drawing doctors into the birth control movement, however, was Sanger’s support for a “doctors only” type of birth control legislation, legislation that would simply strike out all restrictions on doctors’ rights to prescribe contraception, giving them unlimited discretion. A corollary to Sanger’s support for federal and state “doctors only” bills was her work on birth control conferences at which nonmedical personnel were excluded from the sessions which discussed the technique of contraception. At birth control conferences in 1921 and 1925 organized by the ABCL, sessions on contraception were for physicians only and by invitation only.
Meanwhile, other birth control groups, such as the Voluntary Parenthood League, continued to campaign for open bills, exempting discussion of contraception from all restrictions for anyone. These groups had substantial objections to the “doctors only” bill. They felt it excluded large numbers of women who lacked access to clinics, and that birth control methods were simple enough to be used without a physician’s constant supervision. Furthermore, the “doctors only” bills left “the whole subject … still in the category of crime and indecency.” Not only did they accept the definition of sexuality without reproduction as obscene, but they also removed the technique of birth control from a woman’s own control. If women could not have direct access to birth control information, they would have to get their information from doctors accompanied by censorship at worst and moral guidance at best.
Tactically, the “doctors only” bill had serious repercussions. As Dr. Antoinette Konikow wrote, the very advantage that its supporters liked — that it would make birth control seem safely controlled — was its worst feature “because it emasculates enthusiasm. To the uninformed the exemption seems hardly worth fighting for ….. ” The very substance of the politics doctors brought to the birth control movement tended to squash widespread participation in the movement.
A Local Birth Control League: The Massachusetts Case
The effect of concentration on a “doctors only” bill can be seen by examining the work of a local birth control league. While there were of course many differences in the histories of the local leagues, we are emphasizing here certain developments that were common to most of them while illustrating them with specifics from the Massachusetts case. A birth control group had emerged in Boston in 1916 with the arrest of a young male agitator, a Fabian socialist, for giving a police agent a pamphlet entitled “Why and How the Poor Should Not Have Many Children.” Supporters of the accused, Van Kleeck Allison, organized a defense committee which later became the Birth Control League of Massachusetts (BCLM). The League members were from the beginning a coalition of radicals (Allison’s fellow Fabians and members of local Socialist Party groups) and liberals (social workers and eugenics reformers in particular). As elsewhere, no doctors — with the exception of the revolutionary socialist Dr. Antoinette Konikow — were conspicuous in the movement in its first years.
The BCLM members agreed in 1916 and 1917 on tactics designed to make birth control a public issue and a popular cause. They tried and often succeeded in getting publicity in the popular press, they held mass meetings and public debates, and they contacted 900 women’s clubs around the state in efforts to recruit supporters. They accepted support from all quarters, and featured speakers identified as radicals. From the beginning, however, some of the socialists in the BCLM encountered a tension between offering a genuinely radical social alternative and using the support of conservative but powerful people to win immediate gains. Cerise Carman Jack, a Harvard faculty wife of radical leanings, was typical of many women of similar views when she decided in 1918 that the most important and strategic direction for her political efforts should be defense work against political repression. Birth control could wait; it would come anyway after the revolution, would “come so spontaneously wherever the radicals get control of the government, just as the war has brought suffrage … now is the time to work for the fundamentals and not for reform measures”.
In Massachusetts, as in many places, the immediate effect of the defection of radicals and the entrance of professionals into the birth control league was a period of inactivity. In 1918, birth control supporters among high professionals were still the minority. Most doctors, lawyers, ministers, and professors found birth control too radical and improper a subject for public discussion. Besides, they feared “race suicide” among their own class. But throughout the 1920s quiet but steady concentration on a “doctors only” bill by remaining birth control activists transformed medical opinion.
The principle of doctors’ rights even led the by now exclusively liberal and conservative Massachusetts Birth Control League to defend radical Dr. Antoinette Knoikow. She regularly lectured on sex hygiene to women, demonstrating contraceptives as she discussed birth control, and was arrested for this on February 9, 1928. She appealed to the now defunct League and her defense in fact rehabilitated the organization. Konikow was a difficult test case for the League to accept: a Bolshevik, and a regular contributor to revolutionary socialist periodicals, she lacked a refined personal style and was rumored to be an abortionist. Nevertheless, the principle at stake was too important for the doctors to ignore: the prosecution of any physician under the obscenity statutes would have set a dangerous precedent for all physicians. The Emergency Defense Committee formed for Knoikow worked out an extremely narrow line of defense: that she was not exhibiting contraceptive devices within the meaning of the law but was using them to illustrate a scientific lecture and warn against possible injuries to health. This line worked and Konikow was acquitted.
The verdict stimulated renewed birth control activity and a new BCLM nucleus drew together with the goal of persuading doctors to support birth control and passing a “doctors only” bill in Massachusetts. A new board for the BCLM was chosen, and 10 of the 16 new members were physicians. The lobbying activities took all the League’s time, and there was virtually no public visibility in this period. Konikow herself was extremely critical of this policy. She saw that commitment to it required maintaining a low profile and specifically meant giving up the project of a clinic. She argued, in fact, that opening a clinic would in the long run do more to bring the medical profession around than a long, slow legislative lobbying campaign.
As Konikow had predicted, one of the consequences of the change in character of the organization was failure. While the BCLM had become narrow and elitist, the opposition from the Catholic Church was based on mass support. The Birth Control League, meanwhile, had become less an organization than a professionals’ lobbying group. Furthermore, no matter how decorous and conservative the League’s arguments for birth control, they could not escape red-baiting and other forms of scurrilous attack. Cardinal O’Connell said that the bill was a “direct threat . . . towards increasing impurity and unchastity not only in our married life but … among our unmarried people …. ” The chief of obstetrics at a Catholic hospital said that the bill was “the essence and odor that comes from that putrid and diseased river that has its headquarters in Russia.” Another opponent made the direct charge that this was a campaign supported by Moscow gold. A broad opposition defeated the doctors’ bill.
While the Catholic Church played a particularly large role in Massachusetts, “doctors only” bills were defeated in every state in which they were proposed, even in states without large Catholic populations. Indeed, the whole pattern of development of the BCLM was echoed in many local birth control leagues. The impact of professionals — particularly doctors — on birth control as a social movement was to depress it, to take it out of the mass consciousness as a social issue, even as information on contraceptives continued to be disseminated. Furthermore, the doctors did not prove successful in the 1920s even in winning the legislative and legal gains they had defined as their goals. While some birth control organizers, such as Cerise Jack of the BCLM, felt that they were torn between radical demands and effectiveness, in fact there is reason to question whether the surrender of radical demands produced any greater effectiveness at all.