The Birth Control Movement and American Society The Birth Control Movement and American Society From Private Vice to Public Virtue With a New Preface on the Relationship between Historical Scholarship and Feminist Issues JAMES HEED Princeton University Press / Princeton, N.J. Published by Princeton University Press, 41 William Street, Princeton, New Jersey 08540 In the United Kingdom: Princeton University Press, Guildford, Surrey Copyright © 1978 by James W. Reed Preface to the Princeton Edition, Copyright © 1983 by James W. Reed ALL RIGHTS RESERVED First Basic Books edition, 1978 First Princeton Paperback printing, 1984 LCC 83-60459 ISBN 0-691-09404-7 / ISBN 0-691-02830-3 (pbk.) The author wishes to thank the following for permission to quote from the sources listed: Houghton Library, American Birth Control League Papers; Richard Gamble and Countway Library, Clarence J. Gamble Papers; Dorothy Dickinson Barbour and Countway Library, Robert L. Dickinson Papers; Sophia Smith Collection, Margaret Sanger Papers and Dorothy Brush Papers; Countway Library, Norman Himes Papers; the Schlesinger Library, Transcript of Interviews with Emily H. Mudd; Alfred A. Knopf, Inc., Emma Goldman, Living My Life © 1934; Harcourt Brace Jovanovich, Inc., Mary McCarthy, The Group © 1954; T. S. Eliot, "Difficulties of a Statesman" in Collected Poems, 1909-1962, © 1936 by Harcourt Brace Jovanovich, Inc.; © 1963, 1964 by T. S. Eliot. Reprinted with permission of the publishers. Qothbound editions of Princeton University Press books are printed on acid-free paper, and binding materials are chosen for strength and durability. Paperbacks, while satisfactory for personal collections, are not usually suitable for library rebinding. Printed in the United States of America by Princeton University Press, Princeton, New Jersey TEXT DESIGNED BY VINCENT TORRE Original title: From Private Vice to Public Virtue: The Birth Control Movement and American Society Since 1830 Contents Preface ix Preface to the Princeton Edition xv Acknowledgments xxiv PART I BIRTH CONTROL BEFORE MARGARET SANGER ι Contraceptive Technology in the Nineteenth Century 3 2 The Rise of the Companionate Family 19 3 The Suppression of Contraceptive Information 34 4 The Anarchists 46 5 Permissiveness with Affection: A Sexual Standard for an Affluent Society 54 PART II THE WOMAN REBEL: MARGARET SANGER AND THE STRUGGLE FOR CLINICS 6 The Burden of Domesticity 67 7 European Models 89 8 Competition for Leadership 97 9 Providing Clinics 106 10 Woman and the New Race 129 PART III ROBERT L. DICKINSON AND THE COMMITTEE ON MATERNAL HEALTH 11 The Medical Man as Sex Researcher 143 12 Clinical Studies 167 13 Publisher and Clearing House 181 ν PART IV THE PROSPECT OF DEPOPULATION 14 Birth Control in American Social Science: 1870-1940 197 15 Birth Control Stalled 211 16 The Parents' Information Bureau 218 PART V BIRTH CONTROL ENTREPRENEUR: THE PHILANTHROPIC PATHFINDING OF CLARENCE J. GAMBLE 17 A Recruit for Birth Control 225 18 Policing the Marketplace 239 19 Experiments in Population Control: Logan County, West Virginia, and the North Carolina Public Health Department 247 20 Conflict and Isolation 257 PART VI PROPAGANDISTS TURNED TO PROPHETS: BIRTH CONTROL IN A CROWDED WORLD 21 The Population Explosion 281 22 Margaret Sanger from Exile: The Founding of the International Planned Parenthood Federation 289 23 The Failure of Simple Methods: The IUD Justified 294 PART VII THE PILL 24 The Prospects for Hormonal Sterilization 311 25 A Life in Experimental Biology 317 26 The Lady Bountiful 334 27 The Product Champion 346 PART VIII THE TROUBLE WITH FAMILY PLANNING Abbreviations Used in the Notes 3^3 Notes 385 Bibliographical Essay 439 Index 448 Preface I set out to write a history of the birth control movement in the United States but had to make hard choices about what should be included. From Private Vice to Public Virtue describes the ef­ forts of a small group of Americans to spread the practice of contraception, first in the United States, then in the rest of the world. Given the complexity of the problem of changing human reproductive behavior, birth controllers inevitably dis­ agreed over strategy. This study focuses on those individuals who at any given time represented innovation or change in the birth control movement. I have neglected the internal history of the Planned Parenthood Federation of America and of state and local birth control leagues in order to concentrate on the role of key individuals and their relationship to American soci­ ety. They worked through a variety of institutions, ranging from the anarchist journal Mother Earth to the relatively con­ servative Population Council. They ranged in political values from socialists to capitalists, but for all of them the separation of sex from procreation had revolutionary implications. Birth control was a metaphor for individual responsibility, an essen­ tial first step in the effort to achieve self-direction. The desire to control fertility, as old as human society, has found expression in a startling variety of means. The Egyptian recipe for a contraceptive suppository of crocodile dung (1850 B.C.), described by Norman Himes in Medical History of Con­ traception (1936), was but one of many such devices which could be culled from the literature of ancient cultures. Anthro­ pologists studying human reproduction in premodern cultures have found that the desire for children is not an innate human drive but an acquired motive which must be reinforced by social rewards and punishments sufficient to overcome the wish to avoid the pain of childbirth and the burdens of parent­ hood. There have never been any happy savages reproducing with ease. Rather, conflict between the social need to preserve Preface the species and the individual desire to escape the burdens of childbearing is a universal part of the human experience. So­ cieties that survive necessarily develop pronatal values that support the process of reproduction. The Europeans who founded American society in the seven­ teenth century came from an expanding culture that had devel­ oped a powerful rationale for parenthood. Woman's main so­ cial role was to bear many children in order to guarantee the growth and eventual worldwide triumph of the Christian faith. Social needs or goals are often at odds, however, with the as­ pirations of individuals. Eighteenth century Americans in­ herited and built upon a manipulative attitude toward nature. Some men and women perceived an advantage in having fewer children and began seeking ways to control family size, despite values inherited from the past that imposed a burden of guilt for failure to accept society's version of what was natu­ ral. By the turn of the nineteenth century, the fertility of Amer­ ican women had begun a long secular trend downward. Infant mortality remained murderously high. Yet generation after generation of American women had fewer children than their mothers, despite the wails of social leaders that they were shirking their patriotic duty, committing "race suicide," sin­ ning against Nature. Part I of this study analyzes how and why socially ambitious Americans began to limit their families and examines the changes in values, in attitudes toward women, children, and sex, that made possible the demographic transi­ tion to small families in a nation dedicated to peopling a conti­ nent with good Christian republicans, a nation where Malthus was irrelevant. The desire of socially ambitious Americans to control their fertility provided a market for numerous "little books" that de­ scribed birth control methods. These nineteenth century mar­ riage manuals testify to the fact that Americans possessed the technology and knowledge of the process of conception neces­ sary to develop effective and safe contraceptives, but, begin­ ning in the 1870s, birth control information was suppressed by federal and state legislation. The majority of American men feared both the dissatisfaction of middle-class women with χ Preface traditional roles and the high fertility of the foreign born in comparison with those from genteel background. For social leaders, male and female, the desire to have fewer children was associated with hedonism and the decline of the Protes­ tant values of self-sacrifice and hard work. Thus, contraception remained a furtive private practice until the twentieth century. There were three motives for wanting to make birth control available to everyone. Parts II, III, and V are devoted to analy­ sis of the efforts of Margaret Sanger, Robert Dickinson, and Clarence Gamble to justify and to spread contraceptive prac­ tice. These three "birth controllers" articulated the concerns of large numbers of Americans, but each came to the cause of birth control from a different background and each found in it a means of expressing a personal animus. Sanger gave expres­ sion to a feminist impulse, the desire to give women control over their bodies. Dickinson believed that the main threat to stable family life sprang from poor sexual adjustment and championed birth control as a means of strengthening the fam­ ily. Gamble was concerned over the fact that the poor had more children than their social betters and feared that this dif­ ferential fertility between classes would lead to the welfare state or worse. These three motives, autonomy for women, better marital sex adjustment, and concern over differential fertility, provided the impetus for the emergence of the birth control movement in the 1920s and 1930s. I have provided separate treatment